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“Randomized comparative Clinical Study of Palash Twak Kashaya and Vrikshamla Twak

Kashaya in the Management of Kashtartava w.s.r. to Primary Dysmenorrhoea.”

Dissertation submitted for

M.S. (STREEROG-PRASUTITANTRA)

58 MAHARASHTRA UNIVERSITY OF HEALTH SCIENCES NASHIK

2020-2023

INDEX

Sr. No

Title

Page no

1.

Introduction

3-6

2.

Aims and Objectives

3.

Review of Literature

8-70

5.

Material and Methods

71-79

6.

Observation and Results

80

A. Observation

80
B. Statistical Analysis

84

7.

Discussion

107

8.

Summary

118

9.

Conclusion

121

10.

References

122

11.

Bibliography

134

12.

Annexure

136

a) Abbreviation

b) Abbreviation for Master Chart

c) Consent Form

d) Case Record Form

e) Certificates

f) Master Chart
137

138

139-140

141-142

143-144

145-146

The condition of dysmenorrhoea is explained in Ayurvedic literature in terms of

‘Kashtartava 35 / Kukshi Shoola, Vatala Yoni, Udavartini Yonivyapad (Ayurvedic names of

disease under Striroga-Gynecology)1. The causative factors, pathogenesis, symptoms and

treatment are also described in Ayurveda and based on that, the increased ‘Vata’ type of

humors in the body is responsible for disease creation.2

वेगोदावर्तनाद्योनिमुदावर्तयतेऽनिलः|

सारुगार्तारजःकृच्छ्रेणोदावृत्तंविमुञ्चति||

आर्तवेसाविमुक्तेतुतत्क्षणंलभतेसुखम्|

रजसोगमनादूर्ध्वंज्ञेयोदावर्तिनीबुधैः|| च.चि. ३०/२५-२६

Kashtartava i.e. dysmenorrhea is most common gynaecological problem bringing the

women to clinician. Various studies in India revealed that prevalence of dysmenorrhoeal

varies from 33% to 79.67% 3. However, the true incidence and prevalence of

dysmenorrhea are not clearly established in India. One study shows overall prevalence of

dysmenorrhea was 65.02% with 68.4% in urban and 61.2% in rural areas.4 The difference

in the prevalence of the urban and rural adolescent girls is not significant then also former

is on higher side. 3 Morbidity due to dysmenorrhea represents a substantial public health

burden.

It is one of the leading causes of absenteeism from school and work and is responsible for

significant loss of earnings and diminished quality of life. Despite its high prevalence and

associated negative effects, many women do not seek medical care for this condition.5

This common problem results in number of physical and emotional symptoms and it also

affects their quality of life. In many conditions, these girls suffer a lot 50 and use OTC

medications to manage the discomforts without medical supervision. It ultimately leads to

mismanagement of Kashtartava. These types of self-medication and continuous

medication affect the health. One of the studies says that dysmenorrhea can be better

managed by mental preparation and by appropriate changes in lifestyle like regular

physical exercise. The etiology of uterine pain in primary dysmenorrhea is still not

established. But several risk factors have been identified, such as young age, early

menarche, positive family history, nulliparity, stress/depression, and smoking.6

The evaluation of Lakshana and pathogenesis of Kashtartava reveals similarity with

Primary Dysmenorrhea in modern. Kashtartava is the Tridoshaja Vatapradhana Vyadhi, in

which vitiation of mainly Apana Vayu and Vyana Vayu takes place. Many researches have

been done in regards with Kashtartava but less many works has been done in relation to

its Specific treatment.

In Ayurveda different Kalpas are given management of Kashtartava mostly Tridosh

Shamak Ahar specially Vata Shamak, Madhur,Amla,Lavan Rasa prominent Ahar.

Ushna,Laghu and Snigdha Ahar. Snehan, Swedan, Kumbhi Sweda is indicated by

Acharyas. In Sahatrayogam Palash Twak Kashaya and Vrikshamla Twak Kashaya is

indicated in Kashtartava Chikitsa.7 Hence study has been planned entitled ‘Randomized

comparative Clinical study of Palash Twak Kashaya and Vrikshamla Twak Kashaya in the

management of Kashtartava w.s.r.to Primary Dysmenorrhoea.’

Need of study :

The lifestyle of today’s women is getting changed due to modernization and sedentary life
style. Her adaptation in this competitive world is getting her on different path. This has

resulted in increase in number of diseases alarmingly like infertility, abortions,

miscarriages, early menopause, breast cancers, cervical and ovarian cancers and many

more gynecological disorders. Such kind of unhealthy lifestyle, food habits, and

psychological factors has affected the offspring also. Kashtartava i.e. dysmenorrhea is

most common gynecological problem bringing the women to clinician. Various studies in

India revealed that prevalence of dysmenorrheal varies from 33% to 79.67%.8 So, there is

need to evaluate the etiological factors responsible for the Kashtartava. Also finding out

some formulations which are easily available and more effective treatment in practice.

Palash Twak Kashaya and Vrikshamla Twak Kashaya is used in Practice but still no

research has been done comparatively. Palash Bark ( Butea monosperma (Lamk.)Taub. It

is also useful in abdominal tumours,colic, bleeding piles, haemorrhage, amenorrhoea and

dysmenorrhoea.9 also Vrikshamla is used in dysentery, diarrhoea, abdominal pain,

infected wounds, chronic ulcers, rheumatism, skin infections, bowel complaints, oedema,

and delayed menstruation.10

AIM:

To study comparative effect of Palash Twak Kashaya and Vrikshamla Twak Kashaya in the

Management of Kashtartava w.s.r. to Primary Dysmenorrhoea.

OBJECTIVES:

Primary Objective:

To study the clinical effect of Palash Twak Kashaya in the management of Kashtartava

w.s.r.to Primary Dysmenorrhoea.

Secondary Objective:

To explore the data related to Kashtartava in Ayurvedic and Modern texts in detail.
HYPOTHESIS

 Null Hypothesis (H0):

There is no significant difference Palash Twak Kashaya and Vrikshamla Twak Kashaya in

the management of Kashtartava w.s.r. to Primary Dysmenorrhoea.

 Alternate Hypothesis (HA):

There is significant difference between Palash Twak Kashaya and Vrikshamla Twak

Kashaya in the management of Kashtartava w.s.r. to Primary Dysmenorrhea.

DISEASE REVIEW (AYURVEDA)

INTRODUCTION:

In present study to understand pathophysiology of Udavartini Yonivyapada we have

to know the entire physiology of menstruation according to Ayurveda classics.

ARTAVA NIRUKTI:

ऋतौ भवंआर्तवम्॥

(A.H./sha./01/01 -Arunadatta commentary) 11

The word Ritu means particular or specific time and Bhavam means occurrence or

product. The whole term denotes a substance of the body which flows out at a specific time

or period is called as Artava.

PARYAYA: 12
 Artava,Shonita,Asrk, Raja,Rakta,Lohita,Beeja,Puspa etc

Words are use in 34 classics to denote menstrual blood or ovum at different places,

while Rudhira and Puspa denotes only menstrual blood and Bija is used for ovum. 40

Though commentator Arunadatta has specifically indicated to consider menstrual blood

with word Artava, yet, in A.H. word Artava is used to donate ovum also.13

ARTAVA NIRMAN:

From rasa (dhatu), the Rakata named raja is formed. Rakta reaches 36 uterus and

coming out for three days in every month is called artava. The raja is formed from essence

part of rasa.

There are several theories are available in different texts to describe artava utapatti.

According to Acharya Charaka rasa is responsible for formation of Artava. According

to Acharya Sushruta from rasa dhatu ,rakta named raja is formed. Rakta which nourished

the uterus, coming out from vagina in every month for three days is known as raja.14

A) According to Charaka, Susruta, Ashtanga Hridaya - formation from rasa dhatu.

B) According to Ashtanga Samgraha – formation of raja is from rakta dhatu.

By analysing the above theories, conclusion is that both descriptions have same point

of view. Because by the action of rasagni over rasa, rakta is produce either dhaturupa or

artavarupa.

Acharya Charaka and Sushruta explain the first stage of raja formation while Ashtanga

Samgraha has narrated on second stage.15

According to Chakrapani, during the process of formation, the artava is saumya due to

51 influence of rasa, while at the time 41 of its excretion due to specific changes it

assumes agneya character. Blood collected by both dhamanis assuming slight black colour

and specific odour is brought downwards to yonimukh by vayu for excretion.

C) According to Acharya Arunadatta artava is devloped from ahararasa not from

rasadhatu.16

D) Acharya Sharangadhar and Bhavaprakasha says that raja is by product

(Upadhatu) of Rakta.
ARTAVA SWAROOPA:

29 Artava is agneya, has characteristics of rakta, forms garbha and is also essential

for life.

ARTAVA PARIMAN:17

It is four anjali (approximately four ounces).

ARTAVA UTPATTI HETU:

Kala, karma, dhatuparipoornata, swabhava and vayu .

Kala:

According to kashyapa as fruit is situated in minute form of flowers and fire in the

wood. Similarly menstrual blood flow needs particular time and specific efforts.18

Dhatuparipoornata:

Acharya Bhela said that artava is occurred because of dhatuparipoornata. It means

that kala has its own importance in reproduction of artava.

Acharya kashyapa says that yoni of bala is not well developed and blood supply to

yoni is also deficient. The blood is used for development of whole-body organs. When

maturity occurs then blood is visible in the form of menstruation.

Swabhava :

Jatottara kalaja bhava swabhava is included. Everything on earth get

manifested naturally. According to bhavaprakasha, swabhava does have effect on monthly

blood flow.

Vayu:

Apan vayu help in all excretory activities such as mala,mutra,shukra, artava and

garbha nishkrama. Production of artava is under vyan vayu and explusion of artava is

under apan vayu. All anuloman kriyas are function of apan vayu.Both vyan and apan vayu

work together for proper function of menstrual cycle.

PRESENCE OF RAJA OR SHONITA SINCE CHILDHOOD:

As the flower contain fruit that is not visible due to very small structure similarly shukra
in male seen after sixteen, after seventy shukra is not visible in male. In female 59 raja

(menstrual blood) and stanya (milk) is visible after twelve, after fifty years raja is not visible.

PRATHAMA RAJODARSHAN AND RAJONIVRUTTI:

Twelve and fifty years is the age of menarche and menopause respectively.

Acharya Kashyapa mentioned age of menarche is sixteen years same as shukra

pravartan. He explains that, ahara (dietetics) and arogya (health) has a great effect on

menarche.19

Acharya Arunadatta explain that, these are the approximate data of age, these are

varied person to person menarche may come earlier at the age of eleven years same as

menopause may be delayed.

According to all Samhitas artava nivritti kala is 50 years. The reason behind the rajo

darshana and rajo nivritti is that, the raja is the updhatu of rasa. Rasadhatu functions vary

according to age. rasa dhatu better in tarunavastha and decreases during praudhavastha.

SHUDDHA ARTAVA LAKSHAN:

Serial

Author

Colours

Symptoms

no.
1

Charak 20

Gunjaphala

Without pain,

slimy

Rakta Kamal

burning sensation
•

Alaktaka

Not very

scanty not

Indragopa

very excessive
2.

Sushrut21

Sashasrika

Does

not

stain

the

cloth

Laksha

rasa
•

Ishat Krishna

3.

Astang

Sashrudhira

Stain

washed

away

Sangrah22

Laksharasopamam

from cloth
4.

Astang

Laksha rasa

Does

not

stain

the

Hridaya 23

Shashastrabham

cloth
RITUCHAKRA (MENSTRUAL CYCLE):

Entire period of one month (chandramasa= 28 days) is divided into 3 parts:

1. Rajahsrava (menstruation) – 3 to 5 days

2. Ritukala (proliferative phase including ovulation) – 12 or 16 days

3. Ritu 37 vyatitakala (post ovulatory phase or secretory phase) - 9 or 13 days.

THEORIES OF RITU CHAKRA:

Collection of blood is done by 47 the dhamanis (uterine vessels and their

endometrial capillaries) for whole month. According to acharya sushrut slight black colour

and specific odour blood is brought downwards by vayu for excretion from genital tract.24
 As Acharya Vishwamitra has explain that uterus is filled by hairy thin vessels

(sukshma kesh pratikasha) for whole month to receive beeja (both stri and pumbija or

zygote).

Acharya Kashyapa explain that, during her reproductive period, every month blood

goes in to garbhashaya (uterus) and by the rajovaha siras which are present in the uterus.

Artava excreted through vaginal orifice in every month. Artava is formed by Rakta by the

action of artavagni the and fills the uterus in one month.25

Above description clearly indicates that menstruation is cyclical changes of

endometrium for whole month.

RAJAHSRAVA KALA (MENSTRUAL BLEEDING)-

Here are so many different views regarding duration of menstrual bleeding describe

in ancient texts. 3 days (Vagbhata and Bhavamishra), 5 days (Charaka), and 7 days

(Harita and Bhela).

According to above references artava srava kala: 3-7 day so as average is 5 days.

If flow of menstrual bleeding is more than 7 days and less than 3 days it may be due

to some abnormality. Secretion of artava is under control of apana vayu hence this phase

is controlled by vata dosha.

RITUKALA (PROLIFERATIVE PHASE INCLUDING OVULATION)-

In ritukala kaphadosha is dominant. Ritukala is the fertile period. During which

maximum chances of conception. According to acharya indu the beeja (sperm) deposited

during this time period are likely to develop fruit. Hence it is known as Ritukala.

Sushruta - 12 days

Aastang sangraha - 12 night, 16 days, 1 month

Arundatta - 6 days

Aastang hridaya - 12 night

According to others author it may be 16 nights. If garbhashaya, raja and yoni are

healthy it may be whole month. According to Acharya Dalhana first 3 days and last one day

is not counted among 16 days. Sometime Ritukala may come without menstruation.
RITUKALA ON THE BASIS OF CASTE:

Caste

Bhavprakash

Kashyap

Brahmanis

12

12

Kshatriya

10

11

Vaishya

08

10

Shudra

06

09
 Ritukala is the stage of formation hence kaphadosh pradhanya. In this stage purana

raja flow out and new one set in.

RITU VYATITAKALA (POST OVULATORY PHASE OR SECRETORY PHASE):

As lotus flower constricted after sunset same as in rituvyatit kala i.e. after ritukala yoni

of female constricted and does not allow entry of shukra in to garbhashaya.

Duration of ritu vyatit kala is not clearly defined in any Samhita. In this stage closure of

yoni occur. After ovulation artava becomes more agneya due to ushna guna of pitta hence

this stage is pitta dosha dominant.

YONIVYAPADA: 26

In Ayurvedic classic majority of 6 gynaecological disorders have been described

under the heading of yonivyapada.

Yonivyapada is made up of two words Yoni +Vyapada.

DERIVATION OF YONIVYAPADA:

The word yoni 44 is derived from the root ‘YU’ with the suffix ‘NI’ to form the word

yoni , meaning ‘youti’ or ‘samyojayati’ i.e. ‘to unite’ as per shabda Kalpadruma.

The word ‘vyapada’ refers to ailments (a pathological condition).

According to acharya sushrut, females have 3 extra external orifices, one in each

breast and one downwards to excrete artava, which is situated below clitoris.

SHAPE OF YONI-

शङ्खनाभ्याकृतिर्योनिस्त्र्यावर्ता सा प्रकीर्तिता ।

तस्यास्तृतीये त्वावर्ते गर्भशय्या प्रतिष्ठिता ॥

(Su. /Sh./5 / 55)

Yoni resembles sankhanabhi (hollow portion of conch shell) in shape and has 3 avartas

(circles). Garbhashaya is attached in third avarta .27

NADIS OF YONI AND THEIR SPECIFICATIONS:

In manobhavagara- mukha of females there are three nadis are present.28

1. Samirana- present in clitoris if shukra falling over it becomes futile.

2. Chandramukhi- present in mid vaginal canal, easily satisfied with coitus and delivers

female children.

3. Gauri- present in depth of vaginal canal, is attained with difficulty and delivers usually

male children.

GARBHASHAYA:

Women possess one extra ashaya as garbhashaya , 38 which is situated in third

avarta of yoni, behind the urinary bladder. 24 In between pittasaya and pakwasaya or in

between uipula kundala of srotas (multiple coils of intestine) covered with jarayu

(peritoneum). It resembles mouth of rohita fish.29

ARTAVAVAHA SROTAS:

According to Acharya Sushrut artavaha srotas mentioned as bahirmukha srotas.

Garbhashaya (uterus) and artavavahi dhamanies are roots of artavavaha srotasa.

These are two in number. If any injury occurs in to these it causes vandhyatva,

maithunaasahishnutwa and artavanasha. Acharya Ghanekar explains that blood vessels

and capillaries are included in artavavaha srotasa. Artava utapatti is a natural process in a

female.30

NUMBER AND CLASSIFICATION OF YONIVYAPAD:

All the classics have given the number of yonivyapada is twenty.

Charak samhita - Chikitsasthana adhyay 30. 31

 Sushrut samhita - Uttartantra adhyay 38.32

Ashtang Hriday - Uttartantra adhyay 33.33

Madhav Nidan Adhyaya 62.34

Sharangdhar samhita - Purvakhanda adhyay 7.35

Kashyap samhita - Sutrasthan 27. 36

Bhavprakash - Chikitsasthana 70.37

Yogratnakara – Yonirogadhikara 38

Table no.3.5. Showing Classification of Yoni Vyapada (20) by different Texts (Based on

Dosha)

Dosha

Charaka

Sushruta

Vagbhata

Sharangd

Bhavprakash

Yogaratnakar

hara
Vata

Vatiki

Vata

Vata

Acharan

Atichara

Suchimuk

Na

hi
Atichara

Udavarta

Prakchar

Khandita

Udavarta

Udavarta

na

Vandhya

An

Nanda

Vandhya

Vandhya

Prakcha

Vipluta

Udavarta

Aticharan

Vipluta

Vipluta

rana

Paripluta

Antramu

Paripluta
Paripluta

Udavarti

Vatala

Khi

Prakchar

Vatala

Vatala

ni

(5)

Suchimu

ana

(5)

(5)

Putragh

Khi

Jataghni

ni

Suska

Antarmuk
Antram

Vamini

hi

ukhi

Sandi

Shushka

Suchim

Maha

Vamini

ukhi

Yoni

Maha
Suska

(11)

yoni

Sandha

(11)

yoni

Maha
yoni

(11)

Pitta

Paitiki

Rudhiraks

Paitiki

Pitta

Rudhiraks
Lohitksya

Rakta

Hara

Rakta

(1)

hara

Vamini

yoni

Vamini

Yoni

Vamini

Sransini

Arajska

Sransini

(2)

Sransini

Putraghni

(3)

Putraghni

Putraghni
Pittala

Pittala (5)

Pittala (5)

(5)
Kapha

Slaismu

Atyanada

Slaismki

Kapha

Atyanada

Atyanada

khi (1)

Karnini

(1)

(1)

Karnini

Karnini

Acharana

Anandcha

Anandcha

Aticharan

rana
rana

Aticharan

Aticharan

Sleshmal

Sleshmal

Sleshmal

(5)

A
a

(5)

(5)

Tridos

Sannipa

Sanda

Sannipat

Sannipati

Sanda

Sanda

aja

tiki (1)

Phalini

iki (1)

ki(1)

Phalini
Phalini

Mahati

Mahati

Mahati

Suchivakt

Suchivakt

Suchivakt

Saravaja

Saravaja
Saravaja

(5)

(5)

(5)

Vata-

Pariplut

Lohitaks

Lohitaksh

Pitta

Haya

aya
Vamini

Paripluta

Paripluta

(2)

(2)

(2)

Vata-

Upaplut

Upapluta

Upapluta

-
-

kapha

Karnini

Karnini

Karnini

(2)

(2)

(2)
Krimi

Vipluta

Vipluta

(1)

(1)

Rakta

Rakta (1)

-
-

ja

विंशतिर्योनिव्यापद् इति । Ch./Su. / 19/3 39

विंशतिर्व्यापदो योनेर्निर्दिष्टा रोगसंग्रहे ॥ Ch./ Chi. / 30/7 40

Twenty types of Yonivyapada are described by all Samhita.Classification of all these

yonivyapada based on specific doshas. According to Acharya Charaka eleven

yonivyapada is due to vata, three yonivyapad is due to pitta, one yonivayapada due to

kapha and one due to sannipataj dosha and remaining four are dvi doshaj.

GENERAL ETIOLOGY OF YONIVYAPAD OR GYNAECOLOGICAL DISORDERS-

मिथ्याचारेण ताः स्त्रीणां प्रदुष्टेनार्तवेन च।

जायन्ते बीजदोषाच्च दैवाच्च श्रृणु ताः पृथक्॥

(Ch./Chi./ 30/ 8)
 Abnormal dietetics and mode of life, abnormalities of artava and bija (ovum or

sperms) and curses of God (in absence of another cause) are causative factors of all these

20 disorders of yoni, is the opinion of charaka .41

Acharya Sushruta including above views has added that when a woman having ruksha

(dry) body or else a weak 60 or very young women does excessive maithun with a man

having pravruddhalinga, then her vayu gets aggravated. This vayu withholding pitta and

shleshma already to their specific causes, goes to 7 the region of yoni and produces

various vitiated due to their specific causes, reaches the region of yoni and produces

various disorders.42

Both Vagbhatas accepting abnormalities of artava and beeja as well as and

daivajata, abnormal diet, having coitus in abnormal posture, excessive coitus and use of

iron made object etc. for sexual pleasure are also causes of the yonivyapad. 43

Acharya kashyapa says that when a woman takes Nasya just after menstrual period is

over, she suffers from yonishosha.44

Acharya madhav, bhavmishra and yogratnakar views are same like acharya charaka.

Acharya Bhela included disease of sacral region, yoni and garbhashya (uterus) due to

vata in yonivyapada.

Table no.3.4 various causative factors of yonivyapad

Causative factors

Charak

Sushrut

Samhita

Samhita /Bhavpraksh/ Madhav

nidan/ Astang sangraha

Mithya Ahara

Mithya Vihar

Artava

Dushti

Shukra

Dushti
Beeja Dosha

Daiva

Considering description of all the ancient text following etiological factor are emerge out-

1. MITHYACHARA-

Mithyachara includes-

Mithya Ahara (abnormal diet)

16 Mithya vihara (abnormal mode of life)

Various environmental factors operating either during embryonic life of the girl

(congenital anomalies) or at later life also come under this heading.

a) Abnormal diet- Abnormal diet includes excessive inadequate unhygienic and

incompatible food. Over eating may cause various gynaecological disorders due to

overweight, diabetes, PCOS and menstrual irregularity etc while weakness and lohitkshaya

are caused due to nutritional deficiency. Dosa and dushyas of body influence by ahara,
main causes of all the disorders.

b) Abnormal mode of life- when a woman does 23 excessive coitus with a man having big

size penis in abnormal position and use artificial organ for sexual pleasure then local

ulceration hyperaemia and infection occur. It causes various gynaecological disorder of

yoni and reflect the abnormal psychology of individual these psychosomatic abnormalities

are causes of gynaecological disorders.

2. PRADUSTA ARTAVA-

23 The word artava refers to ovarian hormones, ovum and menstrual blood. Every

month regularly endometrial shedding occurs due to hormonal changes this shedding is

known as menstrual blood. It reflects the status of reproductive system as well as

hormones, it is never a cause of diseases, thus here artava refers to hormones. Disturbed

hormones function are most common cause of gynaecological disorders.

3. BIJA DOSHA OR ABNORMALITIES OF SPERM OR OVUM-

Various chromosomal or genetic abnormalities included under this group.

4. DAIVA OR GOD-

Unknown cause comes under this category.

UDAVARTINI YONIVYAPADA:

Udavartini yonivyapada is one of the gynaecological disorders in among 9 20

yonivyapada, which is caused by vitiation of vata dosha. Acharya Charaka, Sushruta,

Vagbhatas, Madhava Nidana, Bhava Prakasha and Yogaratnakar explained about

udavartini yonivyapada.

SYNONYMS :

Udavartini, udavarta, udavritta.

DERIVATION OF WORD UDAVARTINI :

Meaning of udavartini yonivyapad is related to obstruction (avrodha) like in

malamutra rodhaka- 9 vyadhis and also to a painful menstruation.

The word derivation also refers to obstruction as in disease of gudagamrbha,

malamutra rodhaka-vyadhis and also to a painful menstruation.

According to all classics Udavartini yonivyapda comes under vataja yonivyapda only.

DEFINITION :

वेगोदावार्तानादयोनिमुदावर्तयेऽनिलः|

सारुगार्तारज: कृच्छ्रेणोदवृत्तंविमुञ्चति||

आर्तवेसाविमुक्तेतुतत्क्षणंलभतेसुखम्|

रजसोगमनादुर्ध्वंज्ञेयोदवर्तिनीबुधै:||

(Ch./ chi.30/25)

According to Acharya Charaka the aggravated vayu (apana vayu) and natural urges

like flatus all are moving in reverse direction and 31 fills yoni (uterus). This yoni (uterus)

seized with pain, initially throws or pushes the artava (menstrual blood) upwards, and then

discharges it with pain. The women feel relief immediately following discharge of raja. 26

Since in this condition the raja moves upwards or in reverse direction, hence it is termed as

udavartini 45.

Acharya sushruta describe udavartini yonivyapad very shortly that besides painful,

frothy menstruation with symptom of vata (bodyache, general malaise etc). 46

Astangahridaya and Astangasangraha have followed Charaka.

Acharya Indu added the discharge of clotted blood.

Madhav nidan and Bhavaprakasa followed Sushrut Samhita.

Acharya Yogratnakara had added the discharge of frothy 52 menstrual blood

associated with kapha with difficulty.

Table no. 3.5 Lakshanas of Udavarta Yonivyapada according to different authors-

Lakshana
Charak

Sushrut

Aastang

Madhav

Yogratnakar

hridaya/

Nidan

astang

sangraha
1

Krichartava

Vimukhta

sukha
3

Phenilatwa

Ruk

+
+

Yoniprapeedana

Kaphanivam

-
+

Artava

SAMPRAPTI (PATHOGENESIS) 47

Vata because of its swaprakopa karanas like vegavidharana attains prakopa

avastha and moving in reverse direction fills yoni. Yoni in turn 15 seized with pain, initially

throws, or pushes the raja upward and then discharges.

Hetu Sevana (swaprakopa karana like vegvidharana and vishamasana)

Vata dusti

Apan vayu dwara yonipidan

Fills yoni

Yoni seized with pain

Rajas moves towards reverse direction

Discharges artava with great difficulty

Painful menstruation (udavartini yonivyapad)

SAMPRAPTI GHATAKA:

Dosha : Vata

Vata : Vyana Vayu, Apana Vayu

Dushya-dhatu : Rasa, Rudhir, Raja

Upadhatu : Raja

Agni : Jatharagni, Rasagni, Raktagni

Srotasa : Artavavaha Srotasa

Srotodushti : Vimargagamana And Sanga

Roga- marga : Abyantara

Sthana-samshraya : Garbhashaya

Vyakti-sthana : Garbhashaya

Udbhava -sthana : Pakvashaya

FEATURES OF PAIN IN UDAVARTINI YONIVYAPAD: 49

The nature of pain not only signifies the intensity but suggests pathology behind

its origin. In udavartini yonivyapad menstruation is associated with severe pain which is

due to vata-dushti are as fallows-

Varti - Anything wrapped around, a swelling, a swelling form by internal

rapture. Obstruction of passage causes vata prakopa, vata trying to push the contents

outside but gets obstructed and produces varti vedana.

Toda: This type of pain arises due to obstruction of vata due to vata prakopa. Here pain

arises because of striking, 10 hitting of vata against its boundaries. The severity depends

upon quantity. As soon as vata outlets the pain disappears.

Bheda: Bheda denotes pain which resembles pain of breaking up of tissues, or separation

of tissues. It is more severe than toda. Dhatukshaya is due to vataprakopa that increases

rukshata and kharata (dryness) in body. That is responsible for Bheda type of pain.

PURVARUPAM:

In udavartini yonivyapada vata dosha becomes vitiated and purvarupas of vata vyadhi

is said to be avyakta, so purvarupa of udavartini yonivyapada also avyakta.

RUPA:

वेगोदावार्तानादयोनिमुदावर्तयेऽनिलः|
 सारुगार्तारज: कृच्छ्रेणोदवृत्तंविमुञ्चति||

आर्तवेसाविमुक्तेतुतत्क्षणंलभतेसुखम्|

(Ch./chi. / 30/25-26)

Acharya Charaka says that due to due to movement of flatus etc. 9 Natural urges in

reverse direction the aggravated vayu moving in reverse direction fills yoni (uterus). This

yoni seized with pain initially throws the artava (menstrual blood) upwards direction and

then discharges with great difficulty and pain. The lady feels immediate relief after passing

the menstrual blood.50

सफ़ेनिलमुदावर्ता रजः कृच्छ्रेण मुञ्चति।

चतसृष्वपि चाद्यासु भवन्त्यनिलवेदनाः। (Su. /

ut. / 38/9-11)

According to Acharya Sushruta it is characterized by painful, frothy menstruation,

there are other pain of vata (bodyache, general malaise).51

सा पीडिता सत्युदावृत्तं बध्दं.....रजो रक्तं....। (A.S./ut. /38/36 - Indu)

Acharya Indu added discharge of clotted blood 52

या फ़ेनिलमुदावर्ता रजः कृच्छ्रेण मुञ्चति। सा तु योनिः कफ़ेनैवमार्तवं च विमुञ्चति|

(Y.R./Yoniroga.)

Acharya Yogaratnakara 45 has added the discharge of frothy menstrual blood associated

with Kapha with difficulty.53

VYAVACCHEDAKA NIDANA (DIFFERENTIAL DIAGNOSIS)

Clinical features of one disease may mimic the other. It is must to confirm the

diagnosis by another similar characteristic disease. Udavartini yonivyapada must be

differentiated from the following diseases:

1. Vataja yonivyapada

2. Sannipatika yonivyapada

3. Pariplutta yonovyapada

4. Suchimukhi yonivyapada

5. Mahayoni yonivyapada
6. Vataja artavadushti

7. Kshina artavadushti

8. Asrugdara

9. Pandu

SADHAYASADHYATA (PROGNOSIS) :

In disease udavartini yonivyapada specific sadhyasadhyata is not mentioned but it

may be considered as krichchhasadhya vyadhi.

COMPLICATIONS OF YONIVYAPADA:

9 According to Acharya Charaka, due to vata prakopa yoni of woman does not retain

shukra (sperm) and female have problem in conception.Besides all these women also

suffer gulma, piles (arsha) and pradara (menometrorrhagia) and other disorder of vata.

According to Astang Sangraha and Astang Hrudaya including all above symptom

stiffness and pain also occurs in yoni.

CHIKITASA (TREATMENT):

SAMANYACHIKITASA (GENERAL TREATMENT):

Vitiation of vata is responsible for all type of yonivyapada (gynaecological disorders).

So vata should be normalised first then do the treatment of other doshas.

Nidan parivarjan (eradication of cause) is most important treatment described in

Ayurveda. Use of appropriate ahara vihara we can avoid so many diseases.

In all yonivyapada after proper oleation (snehan) and sudation (svedan), emesis all five

purifying measures i.e. shodhan panchkarma should be used. 61 Only after proper

cleansing of doshas (sodhan) through upper and lower passages, other oral medicine

(abhyantar chikitasa) should be given. All these panchkarma is very effective in

gynaecological disorder.

The purifying measures used in proper sequences. After using proper oleation (swedan)

and shodhan other measures i.e. uttarbasti (uterine instillation), to be given on the basis of

vitiated dosha.

After proper oleation and cleansing, other measures i.e. uttarbasti, massage, irrigation,
anointments and tempons etc should be used.

18 The treatment prescribed for diseases of shukra, artava,wetnurse, breastmilk,

impotence and obstructed labour along with monthwise treatment of pregnant women with

history of repeated abortion and congenial diet prescribed for every month should also be

used. Use of purgative (virechak aushadhi) is also beneficial. Milk is beneficial in all

gynaecological disease.

INTERNAL MEDICINES FOR GENERAL MANAGEMENT OF GYECOLOGICAL

DISORDERS: 54

Churna - Pusyanuga churna

Ghrutas - Brahat shatavri ghruta

Phalaghruta

Laghu phalaghruta or triphaladi ghruta

Kwatha (decoctions) -

Nyagrodhadi kwatha

Maharasnadi kwatha

Modaka - jirakadi modaka

External medicines -

Pichu (tampons)- Mushaka tila yoni pichu

Basti (enema i.e. enema and uterine or vaginal instillation) - Palasha niruha basti,

Satawaryadi anuwasan or Guducyadi rasayana basti, Baladi yamak anuvasan basti,

Satawaryadi rasayana basti.

VISHISHTA CHIKITASA (SPECIFIC TREATMENT) :

Oleation (snehan) with traivrutta sneha (ghrita, oil and fat), sudation (swedan), mansa

rasa of gramya (wild), anupa (living in marshy land) and audaka (aquatic) animals. Basti of

milk medicated with dasamula and its oral (paan) is used, anuvasan basti and uttar basti

with traivrtasneha should be done.

All measures capable for supressing vata should be use. Utkarika (poultice) made with

yava, godhum, kinva, kustha, satapuspa, priyangu and bala should use locally.
PATHYA (CONGENITAL DIET): 55

a. Aharaja

Sura, Aasava and Arishta Sevana as per Dosha.

Lasuna as Rasayana Sevana

Ksheera, Mamsa Rasa

Madhura, Amla and Lavana Rasa prominent food Tridosha Shamaka food specially

Vata Shamaka

Ushna, Laghu and Snigdha food

Yava (Barley)

Avisya (meal made of ghee, Sali rice and milk)

Yawaka (meal made of barley and milk)

b. Viharaja:

Bath with Luke warm water

Kumbhi Sweda

Sneha, Sveda

APATHYA (NONCONGENITAL DIET):56

Aharaja

Manda (secum of boiled rice)

Vatala food – brinjal, ladies finger, potato etc.

Tikshna, Ushna, Katu, lavana and Ruksha foods.

Viharaja

Divaswapna

Excessive exercises

Sheeta Udaka Snana

Udavartana

Vata Prakopaka Vihara – Ratrijagarana, Atichankramana, Vegadharana

LIFESTYLE MODIFICATIONS:

In menstruation period female undergoes physical and psychological changes in

body. In premenstrual and menstrual period, she must take light and simple diet, avoid

spicy and deep-fried food item and junk foods, avoid excessive physical exercises and

heavy work can balance vata dosha which is responsible for severe spasmodic abdominal

pain (menstrual cramps). To avoid excessive bleeding and pain during menstruation

rajaswala paricharya during menses must be followed.

• Follow regular routine work and rest.

• Do not skip meals, take a nutritious food at mid-day and lighter food at morning and night.

• Do daily exercise and yoga in early morning that help to reduce pain during menses.

DISEASE REVIEW (MODERN)

INTRODUCTION: 57

25 Dysmenorrhoea literally means painful menstruation. But more realistic and practical

definition includes cases of painful menstruation of sufficient magnitude to incapacitate day

to day activities. Dysmenorrhoea is a pathological condition which is strictly related to the

menstruation. For diagnosis of pathological condition, the knowledge of normal anatomy

and physiological must be known.

UTERUS:

A hollow pyriform muscular organ situated in pelvis between the bladder in front & the

rectum behind.

Position – normally ante verted & ante flexed.

Size – nulliparous uterus 48 measures about 7.5 cm in length, 5 cm in breadth at the site

of cornua & 2.5 cm in thickness & weighs 40 – 50 gm.

Parts - Body or corpus, Isthmus & cervix 58

Body or corpus –

Again, divided into fundus & body proper.

The superolateral angles of the body of the uterus project outwards from the junction

of the fundus & body are called cornua to which uterine tubes, round ligaments & ovarian

ligaments are attached.

Isthmus -

• 13 A constricted part measuring about 0.5 cm situated between the body & cervix.

• Limited above by anatomical internal os & below by the histological internal os.

Cervix -

Lower most part of the uterus. Cylindrical in shape & measures about 2.5cm in length &

diameter.

Divided into

Supravaginal part - lying above the vagina.

Vaginal part- lies within the vagina.

In nulliparous - conical with circular external os.

In parous- cylindrical with external os having bilateral slits.

Cervical stenosis, pinhole os etc conditions will lead into dysmenorrhoea.

The uterine wall consists of 3 layers;

1. Parametrium-serous coat 13 covers the entire organ except on the lateral borders.

2. Myometrium-is formed by bundles of smooth muscle fibres separated by fibrous tissue,

through which the blood vessels, nerves & lymphatics run. The musculature is arranged in

3 layers-outer longitudinal, middle interlacing & inner circular layer.

 The longitudinal layer lies immediately beneath the peritoneum, the fibres pass from the
cervix anteriorly over the fundus to reach the posterior surface of the cervix. It has detrusor

action during the expulsion of fetus.

 The longitudinal muscle fibres are attached with circular muscle fibres of the lower

segment & upper part of the cervix in a bucket holding fashion. 30 There is some co-

ordination between fundal contraction & cervical dilatation called polarity of the uterus. The

cervix dilates in response to the forces of contraction of fundus.

 The middle interlacing layer is the thickest of the 3 & consists of bundles of muscle

separated by connective tissue & as the blood vessels which supply the uterus are

distributed in the connective tissues, the caliber of the vessels is in part controlled by the

contraction of the muscle cells & also has the expulsive role. Thus it is described as living

ligatures of the uterus.

 The inner circular layer is well marked around the internal os & the openings of the

fallopian tubes & can be regarded as sphincteric in action.

Any anatomical or functional defect in myometrium will lead into dysmenorrhoea.

Blood supply -

• Arterial- uterine & ovarian artery.

• Uterine veins-corresponding veins drain into uterine veins which empty into internal iliac

vein.

Nerve – supply from the sympathetic & the parasympathetic nervous system.

Fallopian tubes:
Paired structures, measuring about 10 cm. Situated in the medial 3/4th of upper free

margin of the broad ligaments.

Two openings—uterine & pelvic opening.

Have 4 parts—interstitial, isthmus, ampulla & infundibulum.

3 layers—serous, muscular & mucous membrane.

Functions—transport of gametes, to facilitate fertilization & survival of zygote through its

secretion.

Blood supply—uterine & ovarian artery.

Venous drainage through the pampiniform plexus into the ovarian veins.

Nerve supply—derived from uterine & ovarian nerves. The tube is very much sensitive to

handling.

Ovaries 59

Paired sex glands or gonads. Shape—oval.

Colour—pinkish grey. Measurements—3 x 2 x 1 cm in length, breadth & thickness

respectively.

Two ends—tubal & uterine end.

Two borders—mesovarium & free posterior.

Two surfaces—medial & lateral surfaces.

The ovary is covered by a single layer of cubical cell known as germinal epithelium.

It consists of outer cortex containing stromal cells. It is studded with

numerous follicular structures during reproductive period.

Inner medulla consists of loose connective tissues, few unstriped muscles, blood vessels &

nerves.

Functions—repository for primordial sex cells, the woman’s chromosomal endowment for

procreation. Organ for the production, ripening & monthly release of mature ova during

reproductive life.

Production of steroid sex hormones in proper amount for normal growth, development &
function of female.

Blood supply – ovarian artery, a branch of abdominal aorta.

Venous drainage pampiniform plexus ovarian veins Inferior vena cava on the right side

& left renal vein on the left side.

Nerves – sympathetic from T 10 segment. Ovaries are sensitive to manual squeezing.

HPO axis & ovulation

 Pulsatile secretion of GnRH from the hypothalamus initiates FSH & LH secretion from

the anterior pituitary gland.

 FSH stimulates the recruitment & growth of groups of primordial follicles.

 Follicle with highest antral estrogen concentration & lowest androgen ratio & maximum

FSH receptors becomes the dominant follicle & undergoes further maturation.49

 Along with FSH, LH causes maturation of follicle. FSH induces LH receptors on the

granulosa cells of the dominant follicle.

 Due to LH Surge, FSH surge, stretching factor & contraction of the micro muscles

ovulation occurs.

 Development of corpus luteum from the ruptured Graafian follicle depends upon LH. It

has a life span of about 12 – 14 days. In an infertile cycle it undergoes degeneration.50

Menstruation

The word menstruation has its origin from the Greek word “men”-meaning month. Its

literary meaning is the cyclic, physiologic discharge of blood & mucosal tissues through the

vagina from the nonpregnant uterus; it is under the hormonal control & normally recurs,

usually at approximately four-week intervals, in the absence of pregnancy during the

reproductive period (puberty through menopause) of the female.60

Thus, both the word Artava and menstruation convey same meaning i.e. belonging or

confirming to seasons or periods of time.

Characteristics of menstrual blood 61

1. Colour

In the modern text the menstrual flow is said to begin as pink after word’s it turns into dark

red.

2. Odour

The discharge has disagreeable smell due to the secretion of vulvar sebaceous glands &

decomposition of blood elements.

3. Quantity

Total loss of blood is difficult to estimate but normally amount of blood loss is

approximately 20 to 80 ml. with an average of 35ml.

4. Composition of Menstrual Blood

The modern texts describe that menstrual discharge consists of dark altered blood mixed

with mucous secretion from cervi, vaginal secretion and endometrial debris,

prostaglandins, enzymes, bacteria and leukocytes. The normal menstrual discharge does

not clot and deficient in prothrombin & fibrinogen but rich in calcium.

5. Duration and Interval of Menstrual Period

The menstrual cycle is of 28 days. The regularity is generally mentioned, but cycles of 3 to

5 weeks are within the normal range.

Menstruation may last for 3 to 7 days but the usual duration is 4 to 5 days.

The Menstrual Cycle/The Uterine Cycle/ Endometrial Cycle

While the change concerned with ovulation, and the formation of the corpus luteum, are

going on in the ovary, the uterine endometrium shows striking cyclical changes. These

constitute the uterine or menstrual cycle. The most prominent feature of this cycle is a

monthly flow of blood from the uterus called menstruation. A menstrual cycle is taken to

begin with the onset of menstrual bleeding and end just before the next menstruation.

The menstrual cycle is usually divided into the following phases on the basis of changes

taking place in the uterine endometrium. 57

1. Regenerative 53 phase

2. Proliferative phase

3. Secretary phase

4. Menstrual phase

1. Regenerative phase :

Regeneration of the endometrium is completed 2 – 3 days after the end of menstruation.

New blood vessels grow. The glands & the stromal cells regenerate from the remnants left

in the basal zone. Thickness averages 2 mm.

2. Proliferative phase :

This extends from 5th or 6th day to 14th day. It is due to oestrogens. The glands become

tubular; epithelium becomes columnar with the nuclei placed at the base. Stromal cells

become spindle shaped. Spiral vessels extend unbranched & form capillary network below

the epithelium. Thickness about 3 – 4 mm.

3. Secretary phase :

It begins on day 15 & ceases 5 – 6 days prior to menstruation. It is due to the action of

progesterone on the oestrogen primed endometrium. The surface epithelium becomes

more columnar & ciliated at places. The glands increase in size & become corkscrew

shaped. The blood vessels undergo marked spiralling. The stromal cells become swollen,

large & polyhedral. The thickness is about 6 – 8 mm.

4. Menstrual phase

Withdrawal of hormones causes intense spasm of the spiral arterioles at the basal part

Stasis anoxaemia damage of the arteriolar walls phase of relaxation leads to bleeding
along with the superficial functional layer shed in to uterine cavity menstruation.

DYSMENORRHOEA 62

Dysmenorrhoea refers to the chronic, cyclic pain or discomfort in the pelvic region during a

menstrual period, and is considered to be a leading menstrual disorder in adolescent

women.

ETYMOLOGY

The word “dysmenorrhoea” has a Greek origin.

Dys - men – or - rhea

Dys - prefix meaning difficult, bad, painful, and disordered.

Men - month

Rein - to flow,

Thus, Dysmenorrhoea means painful or difficult menstruation. (Dorland’s Medical

dictionary)

DEFINITION:

⇒ Dysmenorrhoea means painful menstruation. But a more realistic and practical definition

includes cases of painful menstruation of sufficient magnitude so as to incapacitate day-to-

day activity.

⇒ Dysmenorrhoea means the painful menstruation-incapacitating woman.

⇒ Dysmenorrhoea means painful spasmodic pain accompanying menstruation.

TYPES & CAUSES OF DYSMENORRHOEA:

Dysmenorrhoea has been classified into primary & secondary types.

A. Primary Dysmenorrhoea:

The cause of primary dysmenorrhoea can be divided into two:

Disorder of Structure

 Hypoplasia of uterus

 Unequal development of Mulleriun duct

 Septate uterus

 Bicornuate uterus

 Stenosis at the internal os

 Narrowing of the cervical canal

 Bicornuate, septate uterus etc are considered as causative factors of even secondary

dysmenorrhoea.149, 150

Disorder of Function

? Inappropriate law of polarity

? Imbalance in the autonomic nervous control of uterine muscle

? Psychosocial factor

? An hormonal imbalance

? Prostaglandins

? Vasopressin.

B. Secondary Dysmenorrhoea

The factors causing pain lies with primary lesions as follows:

? Chronic pelvic infection

? Pelvic endometriosis

? Adenomyosis

? Ovarian cysts and tumours

? Fibroids

? Uterine polyps

? Intrauterine adhesions

? I.U.C.D. in uteri

Membranous

dysmenorrhoea, a rare condition, is one variety of primary dysmenorrhoea. It is probably

due to the deficiency in the tryptic ferment normally secreted in the endometrium.153

Dysmenorrhoea can be classified into 3 clinical varieties—congestive, spasmodic &

membranous dysmenorrhoea.

E. Other Causes

Functional congestion in many cases may be seen due to over-anxiety, emotional

instability to cope with domestic responsibility, sedentary life style, and problem in marital

and sexual life.155

A functional distension of large bowel in which spasm of the pelvic colon may be observed

frequently which is caused by an unduly sensitive autonomic nervous system, often

present as a part of menstrual tension syndrome.

The nervous control of large bowel and that of pelvic organ are closely related and that

exacerbates the symptoms.

The injury or strains during puerperium may produce low backache during menstrual days.

Disc lesion and arthritic changes in spine may be responsible for premenstrual and

menstrual backache. 157

CLINICAL FEATURES OF DYSMENORRHOEA 63

A. Primary Dysmenorrhoea

Pain, which is of uterine origin and directly due to menstruation. This is true

dysmenorrhoea and is also described as Spasmodic, Intrinsic, essential, true, idiopathic

and functional.

1. The pain arises in the uterus and is related to muscular contractions.

2. The pain rarely lasts in severe form for longer than 12 hours and is experienced a few

hours before and after the onset of menses.

3. The pain is 28 with suprapubic cramping and may be accompanied by lumbosacral

backache, pain radiating down the anterior thigh.

4. On examination, the suprapubic region may be tender to palpation, bowel sounds are

normal however; severe pain with movement of cervix or palpation of the adnexal structure

is absent. Pelvic organs are normal in primary dysmenorrhoea.

5. Patient is unable to recognize the colicky type of periodic exacerbations and narrate it as

constant dull ache, which causes her to double-up.

6. Unlike abdominal pain due to chemical or infectious peritonitis it is improved with

abdominal massage, counter pressure, or movement of the body.

7. The patient may look drawn and pale with sweating, nausea, vomiting, and diarrhoea

and bladder tenesmus during a severe attack suggesting an upset in autonomic nervous

system.

8. True dysmenorrhoea reaches a maximum between ages of 18 and 24 years and

thereafter diminishes exceptionally. It may begin at 25 years and can persist beyond 30

years.

9. Almost in all cases it is cured by pregnancy and that too by labor at term rather than

early abortions.

B. Secondary Dysmenorrhoea
A pain which is associated with menstruation & is related to pelvic lesions, e.g.-

endometriosis, chronic pelvic inflammation etc. It is also called as congestive, extrinsic,

organic dysmenorrhoea.

1. Menstrual pain is associated with under lying pelvic pathology.

2. The onset and duration of pain depends on the pathology producing the pain but, usually

it begins 1, 2 weeks prior to menses and persists until 62 a few days after cessation of

bleeding.

3. The pain is dull, situated in the back and in front without any radiation.

4. There are symptoms of associated pelvic pathology.

5. Abdominal and vaginal examinations usually reveal the offending lesion.

Difference between Primary & Secondary Dysmenorrhoea

Features

Primary

Secondary

Age

After 6 to 12 months of onset of Menarche, with establishment of ovulatory cycle. Peak at

18- 24 years. Decreases with child birth and advancing age

Appears in late twenties and thirties, progressive.

Nature of pain

Cramp like pain

Usually dull, steady

Location of pain

Main site is hypogastrium radiating towards inner and front aspect of thighs

Lower abdomen sometimes unilateral

Relation of pain to flow

Usually begins a few hours prior to or just after the onset of flow and may last as long as

2-3 days

Begins 1-2 weeks before the onset of bleeding, may persist throughout flow and even
beyond

Parity

Usually encountered in nullipara often disappears with pregnancy

Encountered in both nullipara and multipara not relieved by pregnancy

General symptoms

Nausea, vomiting, diarrhoea and bladder tenesmus suggesting an upset in autonomic

nervous system

Usually absent unless condition is superimposed on nervous background

Pelvic findings

Uterus may be normal but hypoplasia, acute anteflexion and cervical stenosis not

uncommon

Adnexal enlargement, pelvic fixation and adnexal tenderness may be found

THEORIES OF POSSIBLE CAUSES OF PAIN IN

DYSMENORRHEA:

Any deviation from normal anatomy & physiology will lead into many gynaecological

disorders.

1. Abnormal Anatomical and Functional Aspects of Uterus:

a) Unequal development of mullerian ducts:

Septate or bicornuate uterus unequal muscular contractions pain.

b) Hypoplasia of uterus:

Hypoplastic uterus inadequate uterine muscles inadequate explusive force

vigorous contrations hypoxia, pain.

c) Obstructive theory:

Stenosis 13 at the level of internal os, acute ante version or retroversion, stricture of the

cervix produced due to any cause i.e. cervical infections, surgical procedures,
instrumentation, irradiation of the cervix etc obstruction difficult for the menstrual blood

to escape strong Uterine contractions pain.

d) Inappropriate law of polarity:

When the body of the uterus contracts, the cervix normally dilates, this mechanism is

normally found. The term polarity denotes this co-ordinate association between

contractions 54 of the body of the uterus and dilation of the cervix. When this polarity of the

uterus is disturbed painful or difficult menstrual discharge through the os occurs.

e) Imbalanced autonomic nervous control:

There is over activity of the sympathetic hyper tonicity of the circular fibers of the isthmus

and internal os general nervous instability pain.

Muscle ischaemic factor:

By the action of prostaglandin, vasopressin exaggerated

uterine contractions uterine muscle ischemia pain.

Constitutional factor:

Impaired health status, physical & mental stress make the woman prone to be pain

conscious.

Psychological & social factor:

Most women are less efficient physically & more unstable emotionally just before & during

menstruation. These factors lower the pain threshold. By overanxious parents & by

curtailment of normal activities, the pain expectation may be cherished during

menstruation.

Due to faulty sex education a dysmenorrhoeic mother usually has a dysmenorrhoeic

daughter. Unhappiness at home or work, unsatisfied sexual urge, fear or loss of

employment & anxiety etc factors may make dysmenorrhoea worse even if they do not

cause it.

Uterine condition:
 Interstitial or sub mucous fibroid dysrhythmic uterine contractions Spasmodic

uterine attempts to expel the foreign body pain.

In adenomyosis the collection of menstrual blood in the cystic spaces increased

tensions in uterine muscles, pain. Moreover, the cysts also act as foreign body to the

uterus. Intrauterine contraceptive device can cause dysmenorrhoea.

Pelvic inflammatory condition:

Pain which is essentially premenstrual results from premenstrual pelvic congestion.

Pelvic endometriosis

Rising tension in the ectopic endometrial spaces in the pelvic endometriosis pain.

Hormonal Theory:

a) Progesterone

Known fact is that the anovular menstrual cycle without the luteal phase is followed by

painless menstruation. Thus, in ovulatory cycles, under the action of progesterone,

prostaglandins are synthesized from the secretary endometrium.

Another observation is that progesterone induces high tone in the isthmus & upper cervix.

An exaggeration of this could therefore be the basis of the incoordinate action of the

uterus.

b) Prostaglandin

Evidence of the role of PGs in the pathophysiology of dysmenorrhoea can be summarized

as follows-

• The side effects of PGF2 alpha administration for termination of mid trimester pregnancy

& induction of term labor include nausea, diarrhoea, head ache, vomiting & uterine cramps,

which are similar to the symptoms of primary dysmenorrhoea.

• Several studies have showed significantly higher levels of endometrial & menstrual fluid

PGs in women who have dysmenorrhoea.

• Certain PG synthetase inhibitors such as the fenamates, the indole acetic acid derivatives

etc have been shown to be effective in treating dysmenorrhoea.

c) Vasopressin

In women with primary dysmenorrhoea there is increased vasopressin release during

menstruation. This explains the persistence of pain in cases even treated with PGSI

(prostaglandin synthetase inhibitor) drugs. The mechanism of action is yet to be explored.

Vasopressin increases prostaglandin synthesis & also increases myometrial activity

directly. It causes uterine hyperactivity, dysrhythmic contractions, hypoxia, Ischemia ad

pain.

Membranous dysmenorrhoea:

Membranous dysmenorrhoea rare with familial incidence, in which the endometrium

instead of being fragmented strips off in large pieces, or even as a whole cast of the

uterus; the passage of these is preceded & accompanied by severe colic.

Others:

Endothelins & leucotrines are vasoconstrictors & stimulate myometrial contractions.

Platelet activating factor (PAF) is also associated with the etiology of dysmenorrhoea as its

concentration is found high.

Investigations

• The diagnosis of primary dysmenorrhoea can usually be made on history & examination.

• Blood haemoglobin estimation is to be routinely done for anaemia.

• In women suffering from secondary dysmenorrhoea, tests to confirm the clinical diagnosis

& unravel the extent & type of underlying pathology should be carried out.

• Cervical culture to exclude sexually transmitted diseases.

• WBC count, Sedimentation rate to exclude infection.

• Pelvic sonography followed by CT scan or MRI scan if indicated.

• Diagnostic hysterosalpingogram / sono salpingography

• Endoscopy—Diagnostic hysteroscopy / laparoscopy.

Treatment

General

 Assurance

 Mild analgesics & antispasmodic drugs

 To empty the bowel

 Encourage normal activities

 Low fat vegetarian diet.

Drugs: 64

Prostaglandin synthetase inhibitors are cyclo-oxygenase inhibitors. Non-steroidal anti-

inflammatory drugs (NSAIDs) are effective in relieving the pain. . NSAIDs decrease

menstrual pain by decreasing intrauterine pressure and lowering PGF2alpha levels in

menstrual fluid. Diclofenac, 19 ibuprofen, ketoprofen, meclofenamate, mefenamic acid,

and naproxen are the NSAIDs specifically approved by the US Food and Drug

Administration (FDA) for treatment of dysmenorrhoea.

 Transdermal nitro-glycerine by relaxing smooth muscle relieves pain.

 Progestogen containing IUCD (Mirena, Progestasert) relieves pain in addition to

providing contraceptive measures & reducing bleeding.

 Oral contraceptive drugs administered cyclically suppress ovulation & are useful in

relieving dysmenorrhoea.
 Pelvic endometriosis may be treated with increasing doses of danazol / oral

contraceptives / GnRH antagonists.

 Vitamin E 200 mg b.i.d. starting 2 days before & 3 days during period claims to reduce

dysmenorrhoea.

Surgery

 Surgery is generally not indicated for patients with primary dysmenorrhea.

 In patients with secondary dysmenorrhea, treatment of the underlying pathology may

necessitate surgical intervention.

 Surgical interventions may be diagnostic to begin with followed by definitive treatment

based on severity of symptoms, patient’s age, desire for childbearing, menstrual functions

& the patient’s perception of her problem.

DRUG REVIEW:

WHO defines drug as, “Any 17 substance or product that is used or intended to be used to

modify or explore physiological system or pathological states for the benefit of the

recipient. Ayurveda also told properties of drug i.e. Aushadhi or Dravya as, it should be,

1) Bahukalpam/ Anekvidh Kalpana- We can make various formulation of drug.

2) Bahugunam/ Bahuta- Drug should possesses many useful properties and it should be

abundant that is it should be easily available.

3) Sampannam/ Sampat- It should be useful in all ways.

4) Yogyam- It should be able to cure the disease.

In this study two drugs i.e Palash Twak Kashaya and Vrikshamla Twak Kashaya

were taken for the management of Kashtartava w.s.r. Primary Dysmenorrhoea. Both the

drugs are mentioned by Sahastrayogam chapter 1st, verse number 32, for the
management of Dushta artava or Krichhra Artava.

The detailed properties of these two drugs are as follows:

Classical Reference of Palash Twak Kashaya and Vrikshamla Twak Kashaya 65–

दृष्ट कृच्छआर्तवे सेव्यः पलाशत्वककषायकः

किंशुकक्षार संमिश्र : क्वाथ : कृष्णोतिलोद्भव :||

किं वा क्वाथो हितस्त स्याद वृक्षांम्ल त्वागुद्भव : || सहस्रयोग 1/38

Contents of Drugs-

Sr. No.

Name of Drug

Contents

Latin Name

Family

1.

Palash Twak Kashaya

Palasha

Butea monosperma

Leguminosae

2.

Vrikshamla Twak Kashaya

Vrikshamla

Garcinia indica

Clusiaceae

Method of Preparation of Palash Twak Kashaya –

पानीयंषोडशगुणंक्षुण्णेद्रव्यपलेक्षिपेत्।

मृत्पात्रेक्वाथयेद्‌ग्राह्यमष्टमांशावशेषितम् ॥ १ ॥ शा.सं.म.खं. 2/ 1-2 66

1. The Palasha Twaka were procured from college botanical garden and authenticated

then cleaned with tap water and was crushed thoroughly in grinder coarse powder was

taken 1 part

2. added with 16 20 parts of water and subjected to mild heat with infrequent stirring

without covering its mouth.

3. Reduction was done until the quantity reduced to 1/8th of its original volume.

4. Contents were filtered through double-folded clean cotton cloth in to a stainless-steel

vessel and the residue was discarded.

Method of Preparation of Vrikshamla Twak Kashaya-

The similar procedure was followed for Vrikshamla Twak Kashaya.

Detailed Description of Contents of Palash Twak Kashaya and Vrikshamla Twak Kashaya

1] Palasha 66 (Butea monosperma (Lam.) Kuntze.)

'पलाशपादपः सिद्धस्त्रिदलः शिशिरे क्षयः ।

कृष्णवृन्तोज्ज्वलद्रक्तपुष्पश्च तिक्तबीजकः ।

एकबीजायता शिम्बी त्रिपर्णश्च समिद्धवान् ।

गुणैः सर्वे समा ज्ञेयाः सितो विज्ञानदः परः ।॥' (शि०)

'पलाशो दीपनो वृष्यः सरोष्णो व्रणगुल्मजित् ।

भग्नसंधानकृद्दोषग्रहण्यर्शः कृमीन् हरेत् ॥

कषायः कटुकस्तिक्तः स्निग्धो गुदजरोगजित् ।

तत्पुष्पं स्वादु पाके तु कटु तिक्तं कषायकम् ॥

वातलं कफपित्तास्त्रकृच्छ्रजित् ग्राहि शीतलम् ।

तृड्दाइशमनं वातरक्तकुष्ठहरं परम् ॥

फलं लघूष्णं मेदार्शःकृमिवातकफापहम् ।

विपाके कटुकं रूक्षं कुष्ठगुल्मोदरप्रणुत् ॥'

'क्षारश्रेष्ठः कृमिघ्नश्च संग्राही दीपनः परः ।

प्लीहगुल्मग्रहण्यर्शोवातश्लेष्मविनाशनः ।

किंशुकस्यापि कुसुमं सुगन्धि मधुरं च तत्।

बीजं तु कटुकं स्निग्धमुप्णं कृमिबलासजित् ॥' (ध. नि.)

'पलाशतैलानि मधुरकषायाणि कफपित्तप्रशमनानि ।' (सु. सू. ४५)

किंशुकं कफपित्तघ्नम् ।' (सु. सू. ४६)

'पलाशबीजानि विडंगयुक्तान्युन्मिश्रितान्यामलकीफलानाम् ।

रसेन मध्वाज्ययुतानि पीत्या वृद्धोऽपि मासात्तरुणत्वमेति ।।' (रा. मा.)

Figure- Palasha Plant

Description of Palasha-

 Kingdom : Plantae

 Sub-kingdom : Embryophyta

 Division : Tracheophyta

 Sub-division : Pteropsida

 Division : Angiospermae

 Class : Dicotyledoneae

 Sub-class : Polypetalae

 Series : Calyciflorae

 Family : Leguminosae

 Sub-family : Papilionaceae

 Genus : Butea

 Species : monosperma

 Regional names :

Bengali : Palas, Polasi

Bombay : Khakara, Khakaro, Palasa

Gujarati : Khakara, Khakda, Khakhado, Khakhar

Hindi : Chichra, Desukajhad, Dhak, Kakria, Palasha

Kumaon : Dhak, Palas

Marathi : Kakracha, Palas, Paras, Phalas, Phulas

 Sanskrit Synonyms:

Bijasneha, Bramhapadapa, Brahamvriksha, Brahampaneta, Kamalasana, Krimighna,

Ksharashreshtha, Lakshataru, Palasha, Parna, Putadru, Raktapushpaka, Samidvara,

Suparni, Tripatraka, Yajnika.

 Rasapanchaka-

Rasa- Katu, Tikta, Kashya

Vipaka- Katu

Virya- Ushna

Guna- Laghu, Ruksha

Karma- Kaphahara

 Ayurvedic properties:

Agnimand, Krimighna, Stambhana, Shukaravardhini, Grahi, Trishna Shamani, Bhedani,

Garbhadhana-nivaraniya.

Seeds: Bhedana, Krimighna,

Flowers: Trishnaa-shamani, Stambhana, Mutrala,

Fruits: Pramehaghna, Kushthaghanam Udararogiaghna Arshaghana, Krimihara.

Action/ uses - Alkali: - (Kshara) Bhedana, Anulomana.

49 Gum is astringent; seeds are laxative and anthelmintic, flowers are aphrodisiac, and

diuretic (Chopra et. al. 1956).

Pharmacology 67:

The alcoholic extract of the seeds of Butea monosperma, on oral administration, was found

to have anti-fertility activity in female mice and rats the aqueous and chloroform extracts

were found in effective. The alcoholic extract partially inhibited ovulation and significantly

suppressed the decidua cell reaction in rats. The L.D.50 in mice was found to be 7.5 g. /kg.

(Raazdan et. al. 1969, Khanna and Choudhary, 1968). Hot petroleum ether extract of the

seeds showed significant anti-fertility effect in female rats (Khanna et al, 1966).

A good deal of controversy exists regarding the anti ? oestrogenic effect of the alcoholic

extract of the flower petals of B. Frondosa Laumas and Uniyal (1966). Reported anti-

oestrogenic effect of the extract at a dose level of 1.6mg. /k g. body weight per day.

However, no activity could be demonstrated at a dose of level of 1.6 mg /kg. body weight

per day. Razdan. et.al. (1970) reported that the alcoholic extracts of flower petals and

seeds of B. Frondosa did not significantly alter the effect of oestrogen in the dose range of
10-100 mg. /kg. /day. (Petal extract given subcutaneously) and 100 ? 150 mg. / kg. /day

(seed extract given orally) in mice.

Palasonin, an active principle isolated from B. frondosa seeds and its piperazine salts

exhibited good anthelmintic activity in vitro ascariasis

lumbricoids and in vivo on toxicara Cannes, comparing favourably with piperazine and

santonin (Kaleyasa and kurup, 1968).

Chronic administration of B frondosa by oral route for 2 months

produced marked nephrotoxicity and anaemia in rats, dogs and rabbits.

Congestion in liver, lungs and spleen was also observed. Stomach showed gross dilation

and chronic inflamation (saachdev ET al, 1965).

Oil obtained from the seeds of B. superba, in a dose of 120 mg./kg.

showed a marked and prolonged fall in the blood pressure with no effect on respiration.

The fall in atropine sulphate or mepramine maleate (2mg. /kg.), nor it was modified in the

presence of hexamethonium bromide (1mg. /kg.) or nitrate bitartrate (20mg./kg).

The oil in a dose of 80-100 mg./k.g. Showed inhibition of the ventricular movement. The oil

also reduced the amplitude of contraction of isolated frog heart. And relaxed the rabbit

duodenum. Mice tolerated doses, up to 1.5 mg. /kg. intraperitoneally (Siddique and

Inamdar , 1963).

The hot alcoholic extract of the seeds showed significant anti-implantation and anti-

ovulatory activity in rats and rabbits. Respectively, it also showed partial abortive activity in

mice. The alcoholic extract of seeds also inhibits the growth of Escherichia coli and

micrococcus pyogenus var. aureus. A crude saline extracts (0.9 %) 0f seeds agglutinates

the erythrocytes of several animal species.

2] Vrikshamla 68 (Garcinia combogia)

वृक्षाम्लमम्लं कटुकं कषायं सोष्णं कफार्शीघ्नमुदीरयन्ति ।

तृष्णा समीरोदर हृद्रदादि गुल्मातीसार व्रणदोषनाशि ||१२४|| रा. नि.

अम्लोष्णं रोचनं रूक्ष दीपनं कफवातनुत् ।

तृष्णार्शी ग्रहणी गुल्म शूल हृद्रोगजन्तुजित् ||३६९||

वृक्षाम्लमाममम्लोष्णं वातघ्नं कफपित्तलम् |

गुरु पक्वं तु सङ्ग्राहि कटुकं तुवरं लघु || ३७०|| कै.नि.

तित्तिडीकं च वातघ्नं ग्राह्युष्णं रुचिकृल्लघुः ||१०२|| ध.नि.

वृक्षाम्लमाममम्लोष्णं वातघ्नं कफपित्तलम् |

पक्वन्तु गुरु संग्राहि कटुकं तुवरं लघु ||१२१||

अम्लोष्णं रोचनं रूक्ष दीपनं कफवातकृत् |

तृष्णार्थो ग्रहणी गुल्म शूल हृद्रोग जन्तुजित् ||१२२|| भा.प्र

Figure- Vrikshamla Plant

Description of Vrikshamla-

 Kingdom : Plantae

 Subkingdom :Tracheobionta

 Division : Magnoliophyta

 Class : Magnoliopsida

 Subclass : Dilleniidae

 Order : Malpighiales

 Family : Clusiaceae

 Genus : Garcinia

 Species : Garcinia cambogia

 Rasapanchaka

Rasa : Madhura, Amla, Katu (Amlarasa dominant)

Guna : Ruksha, Laghu

Virya : Ushna

Vipaka : Amla

Prabhava : Hridya,

Doshaghnata : Kapha-Vatahara and Pittavardhaka

Chemical Composition-

The fruits of Vriksamala contains 10% maleic acid and very little quantity of tartaric and

citric acid. Garcinia is a rich source of active compounds including garcinol, isogarcinol,

xanthochymol, isoxanthochymol and Hydroxycitric acid. These are flavonoids,

benzophenones, xanthones, lactones and phenolic acids. Xanthones are oxygenated

heterocyclic compounds present in higher plants. Xanthone nucleus is symmetric and is

known as xanthen-9H-ones or 9- xanthenone or dibenzo-γ-pyrone 69.

The biological activities of these compounds depend on the different substituent’s position

and nature. Flavonoids are polyphenolic compounds, which are remarkable group of plant

metabolites. The antioxidant and free radical scavenging activity of flavonoids depend on

the position of hydroxyl groups and other chemical features 70.

Benzophenones are organic group of 14 aromatic ketones having the parent compound

diarylketone, which have wide applications in pharmaceutical industry 71. As the plant has

a wide range of biologically active compounds showing broader activity range.

Pharmacology-

1. The effect of HCA in animals is maximum when administered 30-60 minutes prior to

feeding 72.

2. Experimental studies shows that HCA inhibits fat synthesis and reduces food intake. 4

Acute oral toxicity studies in animals demonstrate that CitriMax (50% HCA as calcium salt)

has a low acute oral toxicity. HCA-SX was not mutagenic in the presence or absence of

metabolic activation in Ames genotoxicity assays in strains TA98 and TA102. In several,

placebo-controlled, double-blind trials employing up to 2800 mg/day HCA, no treatment

related adverse effects were reported. The intake of HCA at levels up to 2800 mg/day is

safe for human consumption73.

3. Long-term Garcinia cambogia supplementation ameliorates adipogenesis in mice fed a

HFD by promoting fatty acid oxidation with a simultaneous decrease in fatty acid synthesis

in visceral WAT. 1 Furthermore, GC exhibited a protective role against glucose

intolerance induced by HFD. Moreover, this study provides the first evidence that long-term

GC supplementation significantly increased hepatic collagen accumulation, lipid

peroxidation and MCP-1 and TNF-α mRNA expression as well as plasma AST and ALT

levels, thereby contributing partly to the exacerbation of steatohepatitis in HFD-induced

obese mice at the doses given 74.

4. Hydoxycitrate reduces body weight, which is regain after substantial body weight loss in

male rats and the effects are presumably linked to its inhibiting effect on lipogenesis, but

the exact mechanism still has to be determined 75.

5. Consumption of the Garcinia cambogia extract effectively ameliorates 21 HFD-induced

obesity, probably by modulating multiple genes associated with adipogenesis, such as

aP2, SREBP1c, PPARgamma2, and C/EBPalpha in the visceral fat tissue of mice 76.

6. Ethylacetate extract of fruit rind 55 of Garcinia cambogia and leaves of Bauhinia

variegata an invirtro study reveals that Garcinia cambogia is less efficient in scavenging

NO, DPPH, SO and H2O2 whereas it is more efficient in scavenging hydroxyl radical and

has high reducing activity. Bauhinia variegata is less efficient in NO, SO, DPPH, OH radical

whereas it is more efficient in H2O2 and has high reducing activity 77.

7. 3.3% of Garcinia extract was examined on 10% sucrose on mice for a period of 4

weeks. The findings of this study confirmed that Garcinia cambogia efficiently improved

glucose metabolism in mice and displayed leptin like activity 78.

PALASH TWAK CHURNA

VRUKSHAMLA TWAK CHURNA

PROCEDURE FOR PREPARATION OF KWATH

PREPARED KASHAYA
PALASH TWAK KASHAYA
VRIKSHAMLA TWAK KASHAYA

STUDY DESIGN:

Prospective, Comparative, Clinical study Screening of Subject for Inclusion criteria

Exclusion of subjects

Enrollment of subjects

Informed consent taken as per IEC

Initial Assessment

Group allocation by Randomization by lottery Method

Trial Group A

Palash twak kashaya

Assessment on

0th ,4th,8th week

Control Group B
Vrikshamla Twak Kashaya

Assessment on

0th ,4th,8th week

Collection, Classification, and presentation of data

Statistical Analysis Conclusion.

METHODOLOGY:

Criteria for selection of patients:

Diagnostic Criteria

Patients will be diagnosed as Kashtartava on the basis of symptoms then will be selected

for study. Further patients will be equally divided into two group viz. Group A and B. g.

INCLUSION CRITERIA:

1. Unmarried female patients between 13 and 19 years of age.

2. Patients suffering from pain during menstruation for more than 2 consecutive menstrual

cycles.

EXCLUSION CRITERIA-

1. Female patients with any identifiable pelvic pathology and menstrual irregularities.

2. Patients with history of any other systemic illnesses like K/C/O TB, diabetes, cancer that

may interfere with the course of treatment.

WITHDRAWAL CRITERIA-

Following patients were withdrawn from the trial,

 Occurrence of serious adverse events and were reported and treated as per protocol if

any.

 protocol was violated or patient was uncooperative.

 Patients who were not willing to continue the trial or to follow the assessment schedule.

Sample size calculation:

Sample size is calculated by formula given by Danniel 1999.

N= 4pq

l2

Z = 1.96 (Statistical level of significance.)

P = 40 (Prevalence rate of disease.)

q= 100

(100 - P) = 100 –40 =60

d = 10

n = Sample Size.

N= 4pq

l2

=
n= 96

So, final sample size was 96 female patients of kashtartava were selected for the study

In each group 48 patients were taken.

Randomization/Allocation concealment

● Selected 96 patients were randomly distributed into two equal groups each comprising

48 patients.

● Groups will be named as Group A and Group B.

⮚ Group A – Palash twak kashay

Patients in number: 48

⮚ Group B – Vrikshamla twak kashay

Patients in number: 48

Table no.12: Drug Regimen: -

Subject

Group A

Group B

Number of patients

48

48

Age group

13-19 yrs
13-19 yrs

Drug name

Palash twak kashaya

Vrikshamla twak kashaya

Dose of drug

40 ml 2 times a day

40 ml 2 times a day

Bheshaja sevan kala

Pragbhakta

Pragbhakta

Route of administration

Orally

Orally

Duration

8 weeks

8 weeks

Follow up

4th, 8th week

4th, 8th week

METHODS OF CLINICAL STUDY AND CRITERIA OF ASSESSMENT OF RESULT-

1) First of all, a special proforma was prepared, in which detailed Examination of patient

was recorded. C.R.F. is given at the end of the dissertation.

2) For further study 96 cases of Kashtartav (Primary Dysmenorrhoea) were selected from

O.P.D. and I.P.D. of our hospital and grouped randomly.

3) On the first day, counseling was done and the history of these patients was recorded.

Then all the patients were carefully examined as per the parameters of Ayurveda as well

as modern medicine and they were selected for the study according to criteria for
assessment of result of therapeutic trial.

ASSESSMENT CRITERIA-

A) SUBJECTIVE CRITERIA

1. Severity of pain (Multidimensional scoring pattern) Table no. 14

Sr

Severity of pain (Multidimensional scoring pattern)

Grade

Menstruation is not painful and daily activity unaffected

Menstruation is painful and daily activity not affected. No analgesic required.

12 Menstruation is painful and daily activity affected. Analgesic drug will be needed.

Menstruation is painful, she cannot do even her normal routine work and has to absent

from class / office during menses. Had to take analgesic but poor effect.

2) Duration: Table no.15

Sr
 Duration

Grade

no pain in menstruation

pain persist less than 12 hours

pain continue for 12 -24 hours

pain continue more than 24 hours

3) Artava Pramana (by number of Pad): Table no.16.

Sr

Artava Pramana (by number of Pad)

Grade

6 – 7 pads/cycle

4 – 5 pads/cycle
1

2 – 3 pads/cycle

Spotting or 1 pad/cycle

4) Artavasrava Avadhi (Duration of mences) Table no.17

Sr

Artavasrava Avadhi (Duration of mences)

Grade

Duration of menses 4 – 7 days.

Duration of menses 3 days.

Duration of menses 2 days.

Duration of menses 1 day

3
5) Yatochitkala Adarshanam (interval) Table no. 14

Sr

Yatochitkala Adarshanam (interval)

Grade

25-35 days

36-45 days

46-55 days

56-65 days

6) Praseka (Nausea): Table no.15

Sr

Praseka (Nausea)

Grade

No Praseka

2 – 3 times/day
1

4 – 5 times/day

>5 times/day

7) Chhardi (Vomiting): Table no.16.

Sr

Chhardi (Vomiting)

Grade

No Chhardi

Occasionally

1 – 2 times/day

More than 2 times/day

8) Vibandha (Constipation)Table no.17

Sr

Vibandha (Constipation)

Grade

No Vibandha

Frequency 2 once in a day, but hard stool pass.

Frequency of stool alternate day and patient feels difficulty in defaecation.

frequency ones per 2-3 days, difficult in defication

9) Atisara (Dhiarrhoea) Table no. 14

Sr

Atisara (Dhiarrhoea)

Grade

No Atisara

2
Occasionally

2 – 3 times/day and Drava Mala Pravritti.

More than 3 times/day Drava Mala Pravritti.

10) Shrama (Fatigue): Table no.15

Sr

Shrama (Fatigue)

Grade

No Shrama

Fatigue by single extra work other than daily routine.

Fatigue by normal daily routine.

Severe fatigue even without work.

3
11) Shirashula (Headache): Table no.16.

Sr

Shirashula (Headache)

Grade

No headache

Headache, ones in menstruation persist for less than 6 hours.

Frequent headache -2-3 2 times per menstruation, daily activity not affected

Persistent headache through out the menstruation, daily activity affected.

12) Vankshana Shula (Tenesmus of the bladder), Kati and Janu Shula Table no.17

Sr

Vankshana Shula (Tenesmus of the bladder), Kati and Janu Shula

Grade

No pain

0
2

Presence of all 03 < 1 hour / 02 features < 6 hrs / 01 feature < 12 hrs.

Presence of all 03 1-2 hrs/ 02 features 6-12 hrs/ 01 feature > 12 hrs.

Presence of all 03 > 2 hrs / 02 features 12-24 hrs./ 01 feature > 24 hrs.

FOLLOW UPS: 0th, 4th, 8th week

OVERALL ASSESSMENT CRITERIA:

After the end of study by using subjective and objective parameter assessment was done.

Before and after treatment all ophthalmic examination will be done. Periodic follow up of

the patient at an interval of 7 days for three weeks will be done. Significance of

improvement was classified as follows:

Criteria for Assessment:

Table no.19. Overall assessment will be done by following:

Sr.no

Class

Percentage of Improvement

Excellent improvement

75-100%

Marked improvement
50-74.9%

Mild improvement

25-49.9%

Poor improvement

0-24.9%

Unchanged

0%

OBSERVATIONS:

The data obtained from the study was tabulated & analyzed statistically and statistical

analysis was done. Observations were noted and result was written on the basis of data.

STATISTICAL ANALYSIS:

1. 2 test applied for the demographic (qualitative data) at the baseline to test

homogeneity.

2. Wilcoxon signed rank test was applied in each group to assess the efficacy of the

treatment.

3. Mann Whitney’s U test was applied to compare results among the both groups.

4. 2 test was applied to compare overall effect of treatment in both groups.

Level of significance was kept P=0.05

OBSERVATIONS

The present study on entitled “Randomized comparative Clinical Study of Palash Twak

Kashaya and Vrikshamla Twak Kashaya in the Management of Kashtartava w.s.r. to

Primary Dysmenorrhoea” was carried out on 96 patients of Kashtartava.

Diagnosis was done on the basis of sign and symptoms complained by the patients.

All the 96 patients were divided into two groups randomly GROUP- A treated with Palash

twak kashaya. GROUP-B treated with Vrikshamla twak Kashaya. The assessment was

done on the basis of changes occurred clinically. Data thus collected during the study,

summarized and statistically analyzed as per following protocol.

The data collected from study was analyzed under two headings:

1) Demographic data

2) Clinical data

1) Demographic data:

Frequency analysis done for the following data element.

1. Age

2. Diet

3. Religion

4. Occupation

5. Residence

6. Prakriti.
2) Clinical data:

a) Assessment of subjective Criteria by Wilcoxon rank test.

b) Comparison between trial and control group by Mann-Whitney test.

c) Chi square test was applied to Overall Assessment between two groups.

DEMOGRAPHIC DATA-

Table.No.20. Age-wise distribution of 96 patient suffering from Kashtartava.

Group

Total Patients

Total %

Sr No

Age

Trial

Control

13-15

04

8.33

06

12.5

10

10.41

2
15-17

25

52.08

24

50

49

51.04

17-19

19

39.58

18

37.5

37

38.54

Total

48

48

96

100

Above table shows that, maximum numbers of patients were found in (15-17 Years) age

group having 52.08% in trial group and 50% in control group. Combined percentage of this
group was 51.04%.

It was found that, patients in 17-19 Years and 13-15 Years age group were 38.54% and

10.41% respectively.

Table.No.22. Diet Wise distribution of 96 patients suffering from Kashtartav.

Group

Total Patients

Total %

Sr No

Diet

Trial

Control

Veg

27

56.25

28

58.33

55

57.29

Mixed

21
43.75

20

41.66

41

42.70

Total

48

48

96

Above table shows that, out of 96 patients, 55 patients i.e. 57.29% were on veg diet and 41

patients i.e. 42.70% were on mixed diet.

Table.No.23. Religion-wise distribution of 96 patient suffering from Kashtartav.

Group

Total Patients

Total %

Sr No

Religion
Trial

Control

Hindu

45

93.75

44

91.66

89

92.70

Muslim

03

6.25

04

8.33

07

7.29

Total

48

48

96
Above table shown that, 89 Hindu patients and 7 Muslim patients were affected by

Kasthartava.

In trial group, 45 patients (93.75%) and 3 patients (6.25%) were included. In control group,

44 Hindu patients (91.66%) and 4 Muslim patients (8.33%) were included in study.

Table No. 25. Residency wise distribution of 96 patients suffering from Kashtartav:

Group

Total Patient

Total

Sr. No

Residence

Trial

Control
%

Rural

23

46.66

25

46.66

48

50

Urban

25

53.33

23

53.33

48

50

Total

48

48

96
Above table shows that, out of 96 patients, 48 patients i.e., 50% was residence of urban

area and same number of patients i.e., 50% were residence of rural area.

Table No. 26. Prakruti wise distribution of 96 patients suffering from Kashtartav:

Group

Total Patient

Total

Sr.No

Prakruti

Trial

Control

VP

27

56.25

21

43.75

48

50

PK

2
4.16

2.08

3.125

KV

6.25

4.16

5.208

KP

8.33

10

20.83

14

6.66

PV

18.75

11

22.91

20
14.58

VK

6.25

6.25

6.25

Total

48

48

96

Above table shown that, according to prakruti, 48 patients (50%) were having Vatapitta

prakruti, 20 patients (14.58%) were having pittavata prakruti, 14 patients (6.66%) were

having kaphapitta prakruti.

CLINICAL DATA: Table No.32. showing Effect of therapy on Assessment Criteria:

Sr. No
Parameters

Group

Symptom Score

BT (Day0)

Symptom Score

At (8th week)

Difference

Relief In Percentage (%)

2 Severity of pain (Multidimensional scoring pattern)

Trial

2.625

0.4166

2.2084

84.13

Control

2.5

0.4791

2.0209

80.84

Duration

Trial

2.565

0.3333
2.2317

87.01

Control

2.458

0.3541

2.1039

85.59

Artava Pramana (by number of Pad)

Trial

2.645

0.4375

2.2075

83.46

Control

2.520

0.5000

2.0200

80.16

Artavasrava Avadhi (Duration of menses)

Trial

2.583

0.3541

2.2289

86.29

Control

2.5
0.4375

2.0625

82.50

Yatochitkala Adarshanam (interval)

Trial

2.666

0.375

2.2910

85.93

Control

2.437

0.4583

1.9787

81.19

Praseka (Nausea)

Trial

2.541

0.3333

2.2077

86.88

Control

2.479

0.4583

2.0207

81.51

7
Chhardi (Vomiting)

Trial

2.541

0.3125

2.2285

87.70

Control

2.416

0.375

2.0410

84.48

Vibandha (Constipation)

Trial

2.583

0.375

2.2080

85.48

Control

2.458

0.4166

2.0414

83.05

Atisara (Dhiarrhoea)

Trial

2.687

0.3125
2.3745

88.37

Control

2.583

0.4166

2.1664

83.87

10

Shrama (Fatigue)

Trial

2.604

0.375

2.2290

85.60

Control

2.562

0.4375

2.1245

82.92

11

Shirashula (Headache)

Trial

2.604

0.3958

2.2082

84.80

Control

2.479
0.4791

1.9999

80.67

12

2 Vankshana Shula (Tenesmus of the bladder), Kati and Janu Shula

Trial

2.604

0.4166

2.1874

84.00

Control

2.437

0.4583

1.9787

81.19

Effect of therapy in Both Group on Assessment Criteria:

1. Severity of pain (Multidimensional scoring pattern): Individuals of Trial Group patients

got 84.13% similarly, Individuals of Control Group patients got 80.84 % relief.

2. Duration : Individuals of Trial Group patients got 87.01% similarly, Individuals of Control

Group patients got 85.59% relief.

3. Artava Pramana (by number of Pad): Individuals of Trial Group patients 83.46%

similarly, Individuals of Control Group patients got 80.16% relief.

4. Artavasrava Avadhi (Duration of menses): Individuals of Trial Group patients got 86.29%

similarly, Individuals of Control Group patients got 82.50% relief.

5. Yatochitkala Adarshanam (interval): Individuals of Trial Group patients got 85.93%

similarly, Individuals of Control Group patients got 81.19% relief.

6. Praseka (Nausea): Individuals of Trial Group patients got 86.88% similarly, Individuals

of Control Group patients got 81.51 % relief.

7. Chhardi (Vomiting): Individuals of Trial Group patients got 87.70% similarly, Individuals

of Control Group patients got 84.48% relief.

8. Vibandha (Constipation): Individuals of Trial Group patients 85.48% similarly,

Individuals of Control Group patients got 83.05% relief.

9. Atisara (Diarrhoea): Individuals of Trial Group patients got 88.37% similarly, Individuals

of Control Group patients got 83.87% relief.

10. Shrama (Fatigue): Individuals of Trial Group patients got 85.60% similarly, Individuals

of Control Group patients got 82.92 relief.

11. Shirashula (Headache): Individuals of Trial Group patients got 84.80% similarly,

Individuals of Control Group patients got 80.67% relief.

12. 2 Vankshana Shula (Tenesmus of the bladder), Kati and Janu Shula: Individuals of

Trial Group patients got 84.00% similarly, Individuals of Control Group patients got 81.19

relief.

Table No.33 Statistical Analysis for Group A (Trial Group) for subjective criteria

by Wilcoxon signed Rank test-

Sr.

No.

Variables

Number of Pairs (N)

Sum of all Ranks (W)

BT

Mean

SD

AT

Mean

SD

1.

2 Severity of pain (Multidimensional scoring pattern)

48

1176

2.625

0.4892
0.4167

0.4982

<0.0001

Highly significant

2.

Duration

48

1120

2.563

0.5013

0.3333

0.4764

<0.0001

Highly significant

3.
Artava Pramana (by number of Pad)

48

1153

2.646

0.4833

0.4375

0.5013

<0.0001

Highly Significant

4.

Artavasrava Avadhi (Duration of menses)

48

1171

2.583

0.4982

0.3542

0.4833

<0.0001

Highly Significant

5..

Yatochitkala Adarshanam (interval)

48

1165

2.667
0.4764

0.3750

0.4892

<0.0001

Highly significant

6.

Praseka (Nausea)

48

1120

2.542

0.5035

0.3333

0.4764

<0.0001

Highly significant

7.
Chhardi (Vomiting)

48

1153

2.542

0.5035

0.3125

0.4684

<0.0001

Highly Significant

8.

Vibandha (Constipation
48

1171

2.583

0.4982

0.3750

0.4892

<0.0001

Highly Significant

9.

Atisara (Diarrhoea)

48
1157

2.688

0.4684

0.3125

0.4684

<0.0001

Highly Significant

10.

Shrama (Fatigue)

48

1151
2.604

0.4942

0.3750

0.4892

<0.0001

Highly Significant

11.

Shirashula (Headache)

48

1173

2.604
0.4942

0.3958

0.4942

<0.0001

Highly Significant

12.

2 Vankshana Shula (Tenesmus of the bladder), Kati and Janu Shula

48

1191

2.604

0.4942
0.4167

0.4982

<0.0001

Highly Significant

Table No. 35: Statistical Analysis for Group B (Control Group) by Wilcoxon Rank test-

(subjective criteria)

Sr.

No.

Variables

Number of Pairs (N)

Sum of all Ranks (W)

BT

Mean

SD

AT

Mean
SD

1.

2 Severity of pain (Multidimensional scoring pattern)

48

1142

2.500

0.5053

0.4792

0.5049

<0.0001

Highly significant

2.
Duration

48

1125

2.458

0.5035

0.3542

0.4833

<0.0001

Highly significant

3.

Artava Pramana (by number of Pad)

48

1141
2.521

0.5049

0.5000

0.5053

<0.0001

Highly Significant

4.

Artavasrava Avadhi (Duration of menses)

48

1131

2.500

0.5053
0.4375

0.5013

<0.0001

Highly Significant

5..

Yatochitkala Adarshanam (interval)

48

1148

2.438

0.5013

0.4583

0.5035

<0.0001

Highly significant

6.
Praseka (Nausea)

48

1127

2.479

0.5049

0.4583

0.5035

<0.0001

Highly significant

7.

Chhardi (Vomiting)

48

1146
2.417

0.4982

0.3750

0.4892

<0.0001

Highly Significant

8.

Vibandha (Constipation

48

1165

2.458
0.5035

0.4167

0.4982

<0.0001

Highly Significant

9.

Atisara (Diarrhoea)

48

1178

2.583

0.4982

0.4167
0.4982

<0.0001

Highly Significant

10.

Shrama (Fatigue)

48

1153

2.563

0.5013

0.4375

0.5013
<0.0001

Highly Significant

11.

Shirashula (Headache)

48

1175

2.479

0.5049

0.4792

0.5049

<0.0001

Highly Significant
12.

2 Vankshana Shula (Tenesmus of the bladder), Kati and Janu Shula

48

1184

2.438

0.5013

0.4583

0.5035

<0.0001

Highly Significant

STATISTICAL ANALYSIS IN BETWEEN THE TRIAL AND CONTROL GROUP

SUBJECTIVE PARAMETERS (BY MANN WHITNEYS U TEST)

1) Severity of pain (Multidimensional scoring pattern):

Table no. 37. Mann-Whitney’s Test in between Control and

Trial:

GROUP

NO OF PATIENTS

MEAN

SD

TRIAL

48

2.208

0.7426

1012

0.2981

CONTROL

48

2.021

0.8377

The calculated p value is 02981 which is not significant at 0.05 level of significance so,

there was no significant difference between the efficacy of Group a and group B drug. As

the mean of Group A drug was more than Group B drug . Group A drug was more

effective than Group B drug to reduce 2 Severity of pain (Multidimensional scoring

pattern) symptom.
2) Duration:

Table no. 37. Mann-Whitney’s Test in between Control and

Trial:

GROUP

NO OF PATIENTS

MEAN

SD

TRIAL

48

2.229

0.7784

1049

0.4429

CONTROL

48

2.104

0.7784
The calculated p value is 0.4429 which is not significant at 0.05 level of significance so,

there was no significant difference between the efficacy of Group a and group B drug. As

the mean of Group A drug was more than Group B drug. Group A drug was more effective

than Group B drug to reduce Duration symptom.

3) Artava Pramana (by number of Pad):

Table no. 37. Mann-Whitney’s Test in between Control and

Trial:

GROUP

NO OF PATIENTS

MEAN

SD

TRIAL

48

2.208

0.7426

996.5

0.2411

CONTROL

48

2.021

0.7576
The calculated p value is 0.2411 which is not significant at 0.05 level of significance so,

there was no significant difference between the efficacy of Group a and group B drug. As

the mean of Group A drug was more than Group B drug. Group A drug was more effective

than Group B drug to reduce Artava Pramana (by number of Pad).

4) Artavasrava Avadhi (Duration of menses)

Table no. 37. Mann-Whitney’s Test in between Control and

Trial:

GROUP

NO OF PATIENTS

MEAN

SD

TRIAL

48
2.229

0.7506

1013

0.2916

CONTROL

48

2.063

0.7553

The calculated p value is 0.2916 which is not significant at 0.05 level of significance so,

there was no significant difference between the efficacy of Group a and group B drug. As

the mean of Group A drug was more than Group B drug. Group A drug was more effective

than Group B drug to reduce Artavasrava Avadhi (Duration of menses) symptom.

5) Yatochitkala Adarshanam (interval):

Table no. 37. Mann-Whitney’s Test in between Control and

Trial:

GROUP

NO OF PATIENTS

MEAN

SD

TRIAL

48
2.292

0.7707

908.5

0.0637

CONTROL

48

1.979

0.8119

The calculated p value is 0.0637 which is not significant at 0.05 level of significance so,

there was no significant difference between the efficacy of Group a and group B drug. As

the mean of Group A drug was more than Group B drug. Group A drug was more effective

than Group B drug to reduce Yatochitkala Adarshanam (interval) symptom.

6) Praseka (Nausea)

Table no. 37. Mann-Whitney’s Test in between Control and

Trial:
GROUP

NO OF PATIENTS

MEAN

SD

TRIAL

48

2.208

0.7426

996.5

0.2411

CONTROL

48

2.021

0.7576

The calculated p value is 0.2411 which is not significant at 0.05 level of significance so,

there was no significant difference between the efficacy of Group a and group B drug. As

the mean of Group A drug was more than Group B drug. Group A drug was more effective

than Group B drug to reduce Praseka (Nausea) symptom.

7) Chhardi (Vomiting)
Table no. 37. Mann-Whitney’s Test in between Control and

Trial:

GROUP

NO OF PATIENTS

MEAN

SD

TRIAL

48

2.229

0.7217

994

0.2319

CONTROL

48

2.042

0.7426

The calculated p value is 0.2319 which is not significant at 0.05 level of significance so,

there was no significant difference between the efficacy of Group a and group B drug. As

the mean of Group A drug was more than Group B drug. Group A drug was more effective

than Group B drug to reduce Chhardi (Vomiting) symptom.

8) Vibandha (Constipation):

Table no. 37. Mann-Whitney’s Test in between Control and

Trial:

GROUP

NO OF PATIENTS

MEAN

SD

TRIAL

48

2.208

0.7426

1011

0.2844

CONTROL

48

2.042

0.7426
The calculated p value is 0.2844 which is not significant at 0.05 level of significance so,

there was no significant difference between the efficacy of Group a and group B drug. As

the mean of Group A drug was more than Group B drug. Group A drug was more effective

than Group B drug to reduce Vibandha (Constipation) symptom.

9) Atisara ( Diarrhoea) :

Table no. 37. Mann-Whitney’s Test in between Control and

Trial:

GROUP

NO OF PATIENTS

MEAN

SD

TRIAL

48

2.375

0.7614

988

0.2097

CONTROL

48

2.167
0.8078

The calculated p value is 0.2097 which is not significant at 0.05 level of significance so,

there was no significant difference between the efficacy of Group a and group B drug. As

the mean of Group A drug was more than Group B drug. Group A drug was more effective

than Group B drug to reduce Atisara (Diarrhoea) symptom.

10) Shrama (Fatigue)

Table no. 37. Mann-Whitney’s Test in between Control and

Trial:

GROUP

NO OF PATIENTS

MEAN

SD

TRIAL
48

2.229

0.7784

1068

0.5396

CONTROL

48

2.125

0.7889

The calculated p value is 0.5396 which is not significant at 0.05 level of significance so,

there was no significant difference between the efficacy of Group a and group B drug. As

the mean of Group A drug was more than Group B drug. Group A drug was more effective

than Group B drug to reduce Shrama (Fatigue) symptom.

11) Shirashula (Headache):

Table no. 37. Mann-Whitney’s Test in between Control and

Trial:

GROUP

NO OF PATIENTS

MEAN

SD

U
P

TRIAL

48

2.208

0.7426

972

0.1590

CONTROL

48

2.000

0.7146

The calculated p value is 0.4429 which is not significant at 0.05 level of significance so,

there was no significant difference between the efficacy of Group a and group B drug. As

the mean of Group A drug was more than Group B drug. Group A drug was more effective

than Group B drug to reduce Shirshula (Headache) symptom.

12) 2 Vankshana Shula (Tenesmus of the bladder), Kati and Janu Shula):

Table no. 37. Mann-Whitney’s Test in between Control and

Trial:

GROUP

NO OF PATIENTS

MEAN

SD

TRIAL

48

2.188

0.7623

966.5

0.1296

CONTROL

48

1.979

0.6681

The calculated p value is 0.1296 which is not significant at 0.05 level of significance so,

there was no significant difference between the efficacy of Group a and group B drug. As

the mean of Group A drug was more than Group B drug. Group A drug was more effective

than Group B drug to reduce 2 Vankshana Shula (Tenesmus of the bladder), Kati and

Janu Shula symptom.

Table no. 42: PERCENTAGE IMPROVEMENT IN BOTH THE GROUPS:

Pt
No

TRIAL GROUP

CONTROL GROUP

BT

AT

RELIEVED

% IMPROVEMENT

BT

AT

RELIEVED

% IMPROVEMENT

36

36

100.00

34

34

100.00

30

24

80.00

30

6
24

80.00

30

24

80.00

28

22

78.57

30

24

80.00

30

23

76.67

30

24

80.00

29

23
79.31

36

31

86.11

34

29

85.29

36

31

86.11

33

28

84.85

30

24

80.00

30

23

76.67
9

24

24

100.00

24

22

91.67

10

36

36

100.00

34

34

100.00

11

30

12

18

60.00

30

12

18

60.00

12
30

30

100.00

29

29

100.00

13

30

30

100.00

30

28

93.33

14

30

24

80.00

30

24

80.00

15

30
6

24

80.00

30

24

80.00

16

30

30

100.00

30

29

96.67

17

30

24

80.00

28

21

75.00

18

36

0
36

100.00

34

34

100.00

19

36

30

83.33

35

28

80.00

20

30

24

80.00

30

24

80.00

21

25

25
100.00

25

25

100.00

22

36

31

86.11

35

30

85.71

23

36

12

24

66.67

35

12

23

65.71

24

30

30

100.00
29

29

100.00

25

30

24

80.00

30

23

76.67

26

35

29

82.86

35

29

82.86

27

26

20

76.92

26
6

20

76.92

28

30

25

83.33

29

24

82.76

29

30

24

80.00

28

22

78.57

30

30

24

80.00

30

6
24

80.00

31

30

23

76.67

29

21

72.41

32

30

29

96.67

26

24

92.31

33

35

31

88.57

33

27
81.82

34

32

26

81.25

30

22

73.33

35

29

29

100.00

29

27

93.10

36

30

24

80.00

28

22

78.57
37

31

25

80.65

27

19

70.37

38

36

34

94.44

34

31

91.18

39

31

22

70.97

28

11

17

60.71

40
30

25

83.33

29

22

75.86

41

35

10

25

71.43

34

10

24

70.59

42

26

25

96.15

24

22

91.67

43

36
4

32

88.89

30

23

76.67

44

29

29

100.00

25

23

92.00

45

30

25

83.33

28

20

71.43

46

29

1
28

96.55

26

24

92.31

47

30

21

70.00

28

11

17

60.71

48

33

30

90.91

30

24

80.00

Mean percentages

85.86

Mean percentages

82.34
Table no. 43: OVERALL ASSESMENT CRITERIA:

Sr.No

Assessment

Group A

Group B

Excellent Improvement

43

89.58

39

81.25

Marked Improvement

05

10.41

09

18.75

Mild Improvement

00

00

00
00

Poor Improvement

00

00

00

00

Unchanged

00

00

00

00

Total

48

100

48

100

X2=0.7526 P=0.3856 (p>0.05) NS

Above table shows that out of 96 patients, 43 (89.58%) and 39 (81.25%) patients showed

Excellent Improvement in Group A and Group B respectively. So, Group A drug is more
effective than Group B drug.

In Group A, 10.41% patients showed marked improvement. Similarily, In Group B, 18.75%

patients showed marked improvement.

It is clearly seen from table that Group A drug is more effective than Group B drug in

Kashtartava patients.

The Chi-Square value was 0.7526. The p-value was 0.3856. There is no significant

difference in overall assessment in both the groups as p>0.05.

RELIEF IN TERMS OF PARAMETERS:

RESULT-

Palash twak kashaya is more effective in reducing symptoms than Vrikshamla twak

kashaya in the management of Kashtartava w.s.r. to Primary Dysmenorrhea.

Kashtartava i.e. dysmenorrhea is most common gynaecological problem bringing the

women to clinician. Various studies in India revealed that prevalence of dysmenorrhoeal

varies from 33% to 79.67%

3 It is one of the leading causes of absenteeism from school and work and is responsible

for significant loss of earnings and diminished quality of life. Despite its high prevalence

and associated negative effects, many women do not seek medical care for this condition.

Palash Twak Kashaya and Vrikshamla Twak Kashaya is used in Practice but still no

research has been done comparatively. Palash Bark ( Butea monosperma (Lamk.)Taub. It

is also useful in abdominal tumours, colic, bleeding piles, haemorrhage, amenorrhoea and

dysmenorrhoea.9 also Vrikshamla is used in dysentery, diarrhoea, abdominal pain,

infected wounds, chronic ulcers, rheumatism, skin infections, bowel complaints, oedema,
and delayed menstruation.

For this study, 96 patients of Kashtartava were examined as per our case report format

and changes in sign and symptoms of the patients were noted. The observation of entire

study was discussed under the following headings:

 Discussion on Review of literature

 Discussion on Samprapti Vighatana

 Discussion on Observation

 Discussion on statistical analysis.

1. Discussion on Review of literature:

Discussion on Hetu:

Vata because of its swaprakopa karanas like vegavidharana attains prakopa

avastha and moving in reverse direction fills yoni. Yoni in turn 15 seized with pain, initially

throws or pushes the raja upward and then discharges.

42 Abnormal dietetics and mode of life, abnormalities of artava and bija (ovum or sperms)

and curses of god (in absence of another cause) are causative factors of all these 20

disorders of yoni , is the opinion of charaka .

Acharya Sushruta including above views has added that when a woman having ruksa

(dry) body or else a weak or very young women does excessive maithun with a man

having pravruddhalinga, then her vayu gets aggravated. 7 This vayu withholding pitta

and slesma already to their specific causes, goes to the region of yoni and produces

various vitiated due to their specific causes, reaches the region of yoni and produces

various disorders.

Both Vagbhatas accepting abnormalities of artava and beeja as well as and

daivajata, abnormal diet, having coitus in abnormal posture, excessive coitus and use of

iron made object etc. for sexual pleasure are also causes of the yonivyapad].

Acharya kashyapa says that when a woman takes nasya just after menstrual period is
over, she suffer from yonishosha.

Acharya madhav, bhavmishra and yogratnakar views are same like acharya charaka.

Acharya Bhela included disease of sacral region, yoni and garbhashya (uterus) due to

vata in yonivyapada.

Discussion on Samprapti:

Vata because of its swaprakopa karanas like vegavidharana attains prakopa

avastha and moving in reverse direction fills yoni. Yoni in turn 15 seized with pain, initially

throws or pushes the raja upward and then discharges.

Hetu Sevana (swaprakopa karana like vegvidharanaand vishamasana)

Vata dusti

Apan vayu dwara yonipidan

Fills yoni

Yoni seized with pain

Rajas moves towards reverse direction

Discharges artava with great difficulty

Painful menstruation (udavartini yonivyapad)

Samprapti Ghataka:

Dosha : Vata

Vata : Vyana Vayu, Apana Vayu

Dushya-dhatu : Rasa, Rudhir, Raja

Upadhatu : Raja

Agni : Jatharagni, Rasagni, Raktagni

Srotasa : Artavavaha Srotasa

Srotodushti : Vimargagamana And Sanga

Roga- marga : Abyantara

Sthana-samshraya : Garbhashaya

Vyakti-sthana : Garbhashaya

Udbhava -sthana : Pakvashaya

Probable mode of action (cause and effect relationship):

Palash twak kashaya

1. Anti-inflammatory Action: Palash has anti-inflammatory properties that help reduce

inflammation in the uterus and surrounding tissues, which can alleviate pain associated

with dysmenorrhea.

2. Analgesic Action: The analgesic properties of Palash help in reducing pain perception,

providing relief from the cramping and discomfort experienced during menstruation.

3. Regulation of Hormones: Palash may help regulate hormonal imbalances that contribute

to dysmenorrhea, potentially by influencing hormone levels such as prostaglandins, which

are known to play a role in menstrual pain.

4. Improvement of Blood Circulation: The Ushna (hot) and Tikshna (sharp) properties of
Palash improve blood circulation, which can reduce congestion in the pelvic area and

alleviate menstrual cramps.

5. Balancing Doshas: Ayurveda attributes dysmenorrhea to imbalances in Kapha and Vata

doshas. Palash's properties help balance these doshas, which is believed to be beneficial

in managing dysmenorrhea.

6. Toxin Removal: By removing toxins (Ama) from the body, Palash helps in maintaining a

healthy uterine environment, reducing the likelihood of menstrual disorders like

dysmenorrhea.

7. Improvement of Digestion: The light (laghu) quality of Palash fruit aids digestion, which

can indirectly benefit menstrual health by ensuring proper nutrient absorption and waste

elimination.

8. Nervine Tonic: Palash is also considered a nervine tonic, which may help reduce stress

and anxiety, factors that can exacerbate menstrual pain.

Vrikshamla twak Kashaya

Vrikshamla Twak kashaya is the single drug formulation mentioned in Sahasrayoga under

the context of Arthava shodana and Krichra arthava.

Based on Rasa, Guna, Veerya, Vipaka and Karma:

• The drug Vrikshamla Ttwak possess Kashaya Rasa, Madhura Vipaka and Ushna Veerya

which acts on Vata vikriti.

• It is Deepana and also acts as Vata Prashamana, Vata Anulomaka and Shoolahara in

action.

• Does Vata Anulomana and thus helps in Anuloma gati of Vata and Raja.

• This pacifies Vata and clears Kapha in the case of Upalepa of Arthava Vaha Srothas

caused due to Kaphaja Aharas. Hence helps in the easy flow of menstruation

• Its chemical constituents: volkensoflavone, ma-relloflavone which acts as anti-

inflammatory and analgesic in action.

Discussion on Observation and Statistical Analysis- Criteria for selection of patients:

The 96 Patients are selected having sign and symptoms of Kashtartava in age group 13-19

years irrespective of religion, diet etc. were selected.

Discussion on Methodology:

Total 96 patients were examined in our study. Patients were divided into 2 groups, Group A

and Group B. Group A containing

48 patients were treated with Palash Twak Kashaya 40 ml twice a day at morning and at

night for 8 weeks and Group B containing 48 patients were treated with Vrikshamla twak

Kashaya 40 ml twice a day for 8 weeks.

A. DEMOGRAPHIC DISCUSSION:

1. Age:

maximum numbers of patients were found in (15-17 Years) age group having 52.08% in

trial group and 50% in control group. Combined percentage of this group was 51.04%.

It was found that, patients in 17-19 Years and 13-15 Years age group were 38.54% and

10.41% respectively.

2. Religion-

89 Hindu patients and 7 Muslim patients were affected by Kasthartava.

In trial group, 45 patients (93.75%) and 3 patients (6.25%) were included. In control group,

44 Hindu patients (91.66%) and 4 Muslim patients (8.33%) were included in study.

3. Residence-

Out of 96 patients, 48 patients i.e., 50% was residence of urban area and same number of

patients i.e., 50% were residence of rural area.

4. Prakruti-

According to prakruti, 48 patients (50%) were having Vatapitta prakruti, 20 patients

(14.58%) were having pittavata prakruti, 14 patients (6.66%) were having kaphapitta

prakruti.

B. STATISTICAL CLINICAL DISCUSSION:

Statistically significant (p<0.05) relief was observed in both the group of 48 patients by

applying “Chi-square test”. “Mann Whiteys test” was applied to test significance between

two groups. Patient of both groups were observed and difference noted before and after

treatment and in each follow up. Statistical analysis of parameters of Kashtartava is done.

For subjective parameters Wilcoxon sign rank test was applied. For subjective parameters,

Mann Whitney test was applied to compare the effect of treatment in both groups.

For subjective parameter-

1. Discussion on Severity of pain (Multi-dimensional scoring pattern)-

When wilcoxon signed-rank test was applied to both groups, Results observed given

below-

 For trial group Before treatment mean is 2.625 and it was reduced to 0.4166 after

treatment. So, p value was <0.0001 which is highly significant.

 For control group Before treatment mean is 2.5 and it was reduced to 0.4791 after

treatment. So, p value was < 0.0001 which was highly significant.

 Individuals of Trial group patients got 84.13% relief and similarly individuals of control

group patients got 80.84 % relief.

 So, Palash twak kashaya is more effective in Kashtartava than Vrikshamla twak

kashaya.

2. Discussion on Duration -

When wilcoxon signed-rank test was applied to both groups, Results observed given

below-

 For trial group Before treatment mean is 2.565 and it was reduced to 0.3333 after
treatment. So, p value was <0.0001 which is highly significant.

 For control group Before treatment mean is 2.458 and it was reduced to 0.3541 after

treatment. So, p value was < 0.0001 which was highly significant.

 Individuals of Trial group patients got 87.01% relief and similarly individuals of control

group patients got 85.59 % relief.

 So, Palash twak kashaya is more effective in Kashtartava than Vrikshamla twak

kashaya.

3. Discussion on Artava Pramana (by number of Pad)-

When wilcoxon signed-rank test was applied to both groups, Results observed given

below-

 For trial group Before treatment mean is 2.645 and it was reduced to 0.4375 after

treatment. So, p value was <0.0001 which is highly significant.

 For control group Before treatment mean is 2.520 and it was reduced to 0.5 after

treatment. So, p value was < 0.0001 which was highly significant.

 Individuals of Trial group patients got 83.46% relief and similarly individuals of control

group patients got 80.16% relief.

 So, Palash twak kashaya is more effective in Kashtartava than Vrikshamla twak

kashaya.

4. Discussion on Artavasrava Avadhi (Duration of menses)-

When wilcoxon signed-rank test was applied to both groups, Results observed given

below-

 For trial group Before treatment mean is 2.583 and it was reduced to 0.3541 after

treatment. So, p value was <0.0001 which is highly significant.

 For control group Before treatment mean is 2.5 and it was reduced to 0.4374 after

treatment. So, p value was < 0.0001 which was highly significant.

 Individuals of Trial group patients got 86.29% relief and similarly individuals of control

group patients got 82.50% relief.

 So, Palash twak kashaya is more effective in Kashtartava than Vrikshamla twak

kashaya.

5. Yatochitkala Adarshanam (interval)

When wilcoxon signed-rank test was applied to both groups, Results observed given

below-

 For trial group Before treatment mean is 2.666 and it was reduced to 0.375 after

treatment. So, p value was <0.0001 which is highly significant.

 For control group Before treatment mean is 2.437 and it was reduced to 0.4583 after

treatment. So, p value was < 0.0001 which was highly significant.

 Individuals of Trial group patients got 85.93% relief and similarly individuals of control

group patients got 81.19 % relief.

 So, Palash twak kashaya is more effective in Kashtartava than Vrikshamla twak

kashaya.

6. Discussion on Praseka (Nausea)-

When wilcoxon signed-rank test was applied to both groups, Results observed given

below-

 For trial group Before treatment mean is 2.541 and it was reduced to 0.3333 after

treatment. So, p value was <0.0001 which is highly significant.

 For control group Before treatment mean is 2.479 and it was reduced to 0.4583 after

treatment. So, p value was < 0.0001 which was highly significant.

 Individuals of Trial group patients got 86.88% relief and similarly individuals of control

group patients got 81.51 % relief.

 So, Palash twak kashaya is more effective in Kashtartava than Vrikshamla twak

kashaya.

7. Discussion on Chhardi (Vomiting)

When wilcoxon signed-rank test was applied to both groups, Results observed given
below-

 For trial group Before treatment mean is 2.541 and it was reduced to 0.3125 after

treatment. So, p value was <0.0001 which is highly significant.

 For control group Before treatment mean is 2.416 and it was reduced to 0.375 after

treatment. So, p value was < 0.0001 which was highly significant.

 Individuals of Trial group patients got 87.70% relief and similarly individuals of control

group patients got 84.48% relief.

 So, Palash twak kashaya is more effective in Kashtartava than Vrikshamla twak

kashaya.

8. Discussion on Vibandha (Constipation)

When wilcoxon signed-rank test was applied to both groups, Results observed given

below-

 For trial group Before treatment mean is 2.583 and it was reduced to 0.375 after

treatment. So, p value was <0.0001 which is highly significant.

 For control group Before treatment mean is 2.458 and it was reduced to 0.4166 after

treatment. So, p value was < 0.0001 which was highly significant.

 Individuals of Trial group patients got 85.48% relief and similarly individuals of control

group patients got 83.05% relief.

 So, Palash twak kashaya is more effective in Kashtartava than Vrikshamla twak

kashaya.

9. Discussion on Atisara ( Diarrhoea)

When wilcoxon signed-rank test was applied to both groups, Results observed given

below-

 For trial group Before treatment mean is 2.687 and it was reduced to 0.3125 after

treatment. So, p value was <0.0001 which is highly significant.

 For control group Before treatment mean is 2.583 and it was reduced to 0.4166 after

treatment. So, p value was < 0.0001 which was highly significant.

 Individuals of Trial group patients got 88.37% relief and similarly individuals of control
group patients got 83.87% relief.

 So, Palash twak kashaya is more effective in Kashtartava than Vrikshamla twak

kashaya.

10. Discussion on Shrama (Fatigue)-

When wilcoxon signed-rank test was applied to both groups, Results observed given

below-

 For trial group Before treatment mean is 2.604 and it was reduced to 0.375 after

treatment. So, p value was <0.0001 which is highly significant.

 For control group Before treatment mean is 2.562 and it was reduced to 0.4375 after

treatment. So, p value was < 0.0001 which was highly significant.

 Individuals of Trial group patients got 85.60% relief and similarly individuals of control

group patients got 82.92% relief.

 So, Palash twak kashaya is more effective in Kashtartava than Vrikshamla twak

kashaya.

11. Discussion on Shirashula (Headache)

When wilcoxon signed-rank test was applied to both groups, Results observed given

below-

 For trial group Before treatment mean is 2.604 and it was reduced to 0.3958 after

treatment. So, p value was <0.0001 which is highly significant.

 For control group Before treatment mean is 2.479 and it was reduced to 0.4791 after

treatment. So, p value was < 0.0001 which was highly significant.

 Individuals of Trial group patients got 84.80% relief and similarly individuals of control

group patients got 80.67% relief.

 So, Palash twak kashaya is more effective in Kashtartava than Vrikshamla twak

kashaya.

12. Discussion on 2 Vankshana shula (Tenesmus of the bladder),

When wilcoxon signed-rank test was applied to both groups, Results observed given

below-

 For trial group Before treatment mean is 2.604 and it was reduced to 0.4166 after

treatment. So, p value was <0.0001 which is highly significant.

 For control group Before treatment mean is 2.437 and it was reduced to 0.4583 after

treatment. So, p value was < 0.0001 which was highly significant.

 Individuals of Trial group patients got 85.48% relief and similarly individuals of control

group patients got 83.05% relief.

 So, Palash twak kashaya is more effective in Kashtartava than Vrikshamla twak

kashaya.

Overall assessment criteria

After the end of study by using subjective and objective parameter assessment has been

done. Significance of improvement has classified as following:

 Excellent improvement: 75-100%

 Marked improvement: 50-74.9%

 Mild improvement: 25-49.9%

 Poor improvement: 0-24.9 %

 Unchanged: 0%

 In Group A, 10.41% patients showed marked improvement. Similarly, In Group B,

18.75% patients showed marked improvement.

 Out of 96 patients, 43 (89.58%) and 39 (81.25%) patients showed Excellent

Improvement in Group A and Group B respectively. So, Group A drug is more effective

than Group B drug.

 The Chi-Square value was 0.7526. The p-value was 0.3856. There is no significant

difference in overall assessment in both the groups as p>0.05.

Finally, in group A, the number of patients with excellent improvement was more than in

group B. Number of moderate improved patients was less than control group. Patients
having mild improvement and no improvement were nearly same in both the groups.

The present study entitled “Randomized comparative Clinical Study of Palash Twak

Kashaya and Vrikshamla Twak Kashaya in the Management of Kashtartava w.s.r. to

Primary Dysmenorrhoea.” comprised of following points:

1) Introduction:

Kashtartava i.e. dysmenorrhea is most common gynecological problem bringing the

women to clinician. According to Ayurveda Kashtartava is correlated with Primary

Dysmenorrhea. Kashtartava is the Tridoshaja Vatapradhana Vyadhi, in which vitiation of

mainly Apana Vayu and Vyana Vayu takes place. Many researches have been done in

regards with Kashtartava but less works has been done in relation to its Specific

treatment. Enlisting opening view of chosen problem, about the drug and section of the

regimen while keeping the matter of the clinical study in mind have been mentioned.

2) Aim and objectives:

To study efficacy of Palash Twak Kashaya and Vrikshamla Twak Kashaya in the

Management of Kashtartava w.s.r. to Primary Dysmenorrhoea.

OBJECTIVES:

Primary Objective: To study the clinical effect of Palash Twak Kashaya in the management

of Kashtartava w.s.r.to Primary Dysmenorrhoea.

Secondary Objective:

To explore the data related to Kashtartava in Ayurvedic and Modern texts in detail.

3) Review of literature:
Ayurvedic Review literature of Artava, Rutukala, Yonivyapada, Beeja dosha according to

various Samhitas was described.

In modern review of literature, we described General Etiology of Gynecological Disorders,

Abnormalities of Sperm or Ovum, Anatomy of Uterus, Ovaries, Menstruation. Features of

Primary Dysmenorrhea, etiology, pathogenesis, treatment was discussed.

We have been described detailed review of Drugs i.e. Palash Twak Kashaya and

Vrikshamla Twak Kashaya through the Ayurvedic as well as modern literature

4) Materials and method:

Patients, literary data, drugs and findings along with history recorded on specially prepared

case sheet were main materials of the study, this study 96 patients were clinically

diagnosed and selected.

They were equally divided into two groups-

 Group A- 48 patients treated with Palash Twak Kashaya 40 ml 2 times a day for 8

weeks.

 Group B- 48 patients treated with Vrikshamla Twak Kashaya 40 ml 2 times a day for 8

weeks.

They were clinically assessed and monitored carefully at the start and during treatment.

5) Observation- Result and Discussion:

Null Hypothesis (H0):

There is no significant difference Palash Twak Kashaya and Vrikshamla Twak Kashaya in

the management of Kashtartava w.s.r. to Primary Dysmenorrhoea.

Alternate Hypothesis (HA):

There is significant difference between Palash Twak Kashaya and Vrikshamla Twak

Kashaya in the management of Kashtartava w.s.r. to Primary Dysmenorrhea.

Subjective and Objective parameters were analyzed:

Considering statistical analysis, the overall effect of therapy was,

 In Group A, 10.41% patients showed marked improvement. Similarly, In Group B,

18.75% patients showed marked improvement.

 Out of 96 patients, 43 (89.58%) and 39 (81.25%) patients showed Excellent

Improvement in Group A and Group B respectively. So, Group A drug is more effective

than Group B drug.

 The Chi-Square value was 0.7526. The p-value was 0.3856. There is no significant

difference in overall assessment in both the groups as p>0.05.

Finally, in group A, the number of patients with excellent improvement was more than in

group B. Number of moderate improved patients was less than control group. Patients

having mild improvement and no improvement were nearly same in both the groups.

Conclusion:

Finally, we concluded, the present study provides the evidence in support of the potential

efficacy and safety of Palash Twak Kashaya in the treatment of Kashtartava.

Hence alternate hypothesis accepted i.e. There is significant difference between Palash

Twak Kashaya and Vrikshamla Twak Kashaya in the management of Kashtartava w.s.r. to

Primary Dysmenorrhea.

6) Summary:

In this section the study of topic “Randomized comparative Clinical Study of Palash Twak

Kashaya and Vrikshamla Twak Kashaya in the Management of Kashtartava w.s.r. to

Primary Dysmenorrhoea.” was summarized under the heads – Introduction, Aims and

Objectives, Review of Literature, Materials and Methods, Observation-Result and

Discussion, Conclusion, Summary, References and Annexures.

7) References:

References/Bibliography have been enlisted.

8) Annexures:
This chapter of present study included abbreviations, consent form, case record form,

certificate for standardization of trial drug and master chart.

 Due to similarity of symptoms, we can correlate Kashtartava with Primary

Dysmenorrhea.

 Kashtartava i.e. Primary Dysmenorrhea is frequently found in girls between 15 to 17 age

group.

 For Clinical Evaluation total 96 Patients were selected. Palash Twak Kashaya was given

to 48 Patients in Group A and Vrikshamla Twak Kashaya was given to 48 Patients in

Group B.

 The present study provides the evidence in support of the potential efficacy and safety of

Palash Twak Kashaya in Kashtartava.

 Palash Twak Kashaya was well tolerated by all the patients no any side effects or no

complications are observed during and after treatment.

 The contents of Palash Twak Kashaya are cheap and easily available. It was given

orally, so route of administration was also easy for patients.

 By statistical Analysis, it was concluded that Palash Twak Kashaya showed better

results as compared to Vrikshamla Twak Kashaya in all the parameters.

1. Tiwari Pramavati, editor. Ayurvediya Prasutitantra Evam Strirog, 2nd volume- Streerog,

Chapter 2, Artavavyapad, 2nd edition, Chaukhambha Orientalia, Varanasi. 2000, p.139.

2. Acharya J.T, editor, Charak Samhita,Charak samhita Commentry “ Ayurveda Deepika,

Chikitsa sthana, Chapter 30, Verse. 115, Chaukhambha Surabharati Prakashan, Reprint

ed. 2000.

3. Agrawal Anil., Agrawal Anju. 22 A study of Dysmenorrhea during Menstruation in

Adolescent girls. Indian J Community Med. 2010. January; 35(1):159-164.

4. Nag RM, Adolescent in India. Calcutta: Medical Allied Agency:1982. pp.18-26

5. Hillard PJ. Consultation with the specialist: Dysmenorrhea. Pediatr Rev. 2006; 27:64–71.

6. Rao KA. India: Elsevier, a division of reed Elsevier India Pvt. Limited; 2008. Textbook of

Gynaecology; p. 38

7. Ramnivas Sharma, editor, Sahastrayogam, kashaya Prakaran, Delhi; chowkhamba

Sanskrit pratisthan, 2007 pg. 261

8. Anil.K.Agrawal, Anju Agrawal, A study of Dysmenorrhea During Menstruation in

Adolscent girls.Indian J Community Med.2010 January; 35 (1): 159-164

9. MA, Kare, D. K. Londhe, and A. S. Bhuktar. "STUDY ON ASSESSEMENT OF PURITY

STANDARDS OF BUTEA MONOSPERMA (LAMK.) TAUB. BARK."

10. Das, Aparajita, Ilika Ghosh, and Anita Mukherjee. "Garcinia indica fruit extract induces

genotoxicity in mice." The Nucleus 59.1 (2016): 1-6.

11. Vagbhatta, Asthanga Hridaya, Sharira Sthana, 1/1, Commentary by Arundattta,

Reprinted. Chaukhamba Surbharti Prakashan raj Varanasi2007; p. 167

12. Ayurvediya Prasutitantra evam Striroga, part I, Prof. Remavati Tiweri, Chaukhmba

Orientalia, Varanasi, 2009; P. 63.

13. Vagbhatta, Asthanga Hridaya, Sharira Sthana, 1/1, Commentary by Arundattta,

Reprinted. Chaukhamba Surbharti Prakashan raj Varanasi2007; p. 167

14. Charak. Charak Samhita. Edited by Jadavaji Trikamji Aacharya. 1st

ed. Varanasi: Krishnadas Academy;2000.

15.

Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi

: Chaukhambha Orientalia;2005

16. Vagbhatta, Asthanga Hridaya, Sharira Sthana, 1/1, Commentary by Arundattta,

Reprinted. Chaukhamba Surbharti Prakashan raj Varanasi2007; p. 167

17. 11

Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi

: Chaukhambha Orientalia;2005

18. Kashyapa Samhita. 7th ed. Varanasi: Chowkhamba Sanskrit Pratisthana; 1994.
Vidyotini Hindi Commentary; p. 184.

19. Kashyapa Samhita. 7th ed. Varanasi: Chowkhamba Sanskrit Pratisthana; 1994.

Vidyotini Hindi Commentary; p. 184.

20. Charak. Charak Samhita. Edited by Jadavaji Trikamji Aacharya. 1st

ed. Varanasi: Krishnadas Academy;2000.

21.

Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi

: Chaukhambha Orientalia;2005

Vrdhda Vagbhaṭa. Shiv Prashad Sharma, editor. Ashtanga Sangraha with Sasilekha

commentary of Indu. 1st edition. Varanasi: Caukhamba Sanskrit Series Office; 2006.

Sharira

sthana chapter 1 verse 21. Pg 263.

22.

Vridhda Vagbhaṭa. Shiv Prashad Sharma, editor. Ashtanga Sangraha with Sasilekha

commentary of Indu. 1st edition. Varanasi: Caukhamba Sanskrit Series Office; 2006.

Sharira sthana chapter 1 verse 21. Pg 263.

23. Vagbhatta, Asthanga Hridaya, Sharira Sthana, 4/1, Commentary by Arundattta,

Reprinted. Chaukhamba Surbharti Prakashan raj Varanasi2007; p. 258

24. 11

Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi

: Chaukhambha Orientalia;2005

25. Kashyapa Samhita. 7th ed. Varanasi: Chowkhamba Sanskrit Pratisthana; 1994.

Vidyotini Hindi Commentary; p. 184.

26. Charak. Charak Samhita. Edited by Jadavaji Trikamji Aacharya. Chaper 30,verse 20,

Chikitsasthan, 1st ed. Varanasi: Krishnadas Academy;2000

27.

Sushrut. Garbhavyakaransharir Adhyaya. In: Shastri AD, editors. Susruta Samhita.

Revised edition. Sharirsthan, Chapter 5, Verse 55, Varanasi (India): Chaukhamba Sanskrit
Sansthan; 2016. p. 436.

28. Bhavamishra. Bhavaprakasha, Brahmasankara mishra, Rupalalji Vaishya, 1st and 2nd

part. Chaukhambha, Varanasi. 2004, 1st Volume-2, Chikitsa 70/74.

29.

Sushrut. Garbhavyakaransharir Adhyaya. In: Shastri AD, editors. Susruta Samhita.

Revised edition. Sharirsthan, Chapter 5, Verse 44, Varanasi (India): Chaukhamba Sanskrit

Sansthan; 2016. p. 421.

30.

Sushruta. Priyavrat Sharma editor. Sushruta Samhita with English translation of text

and Ghanekar commentary along with critical notes. Vol 2nd (Nidana, Shaarira, Chikitsa

Sthana). Varanasi: Caukhambha vishvabharati. Reprint 2000. Sharira sthana chapter 3

verse 6. Pg 141

31. Agnivesha, Charaka Samhita. Redacted by Charaka and Dridhabala with Ayurveda

Dipika commentary by Chakrapanidatta Translation by Dr. 32 Ram Karan Sharma and

Vaidya Bhagwan Dash, Chowkhamba Sanskrit Series Office, Reprint Varanasi, Uttar

Pradesh, Chikitsa Sthana, Chapt. 2010; V(30):131.

32. Sushruta, Sushruta Samhita of Maharshi Sushruta,Edited with Ayurvedic –Tattva-

Sandipika 6 Hindi Commentry, by Kaviraja Ambika Dutta Shastri, Reprint Edition

Publishers- Chaukambha Sanskrit Sansthana, Varanasi, Su.Utt. 2011; 38(12-14):205

33. Vagbhata’s, Ashtang Hridayam 39 translated by Prof. K.R. Srikantha Murthy,

Chowkhambha Krishnadas Academy Varanasi Uttara sthana, 33, 313.

34. Madhavakara: Madhav Nidan, Vol. II, edited by Dr. Bramhananda Tripathi,

Chaukhamba Surbharati Prakashan, Varanasi, Ma.Ni.62/6,7.

35. Sharangadhar: Sarangadhar Samhita, by Dr Bramhananda Tripathi, Chaukhamba

Surbharati Prakashan, Varanasi, Sar.S.Purva.kha.7/88-91.

36. Kashyapa Samhita. 7th ed. Varanasi: Chowkhamba Sanskrit Pratisthana; 1994.

Vidyotini Hindi Commentary; p. 184

37. 5 Bhava Mishra: Bhava Prakash, Vol.II, by Pandit Sri Brahma Shankar Mishra,
Chaukhambha Sanskrit Bhawan, Varanasi, B.P.Ma.Kha.70/8.

38. Yoga Ratnakar, Vaidyaprabha Hindi Commentary, by Dr Indradev Tripathi and Dr Daya

Shankar Tripathi, Chaukhamba Krishnadas Academy, Varannasi, Y.R.Yonirogadhikar 9.

39. Charak. Charak Samhita. Edited by Jadavaji Trikamji Aacharya. Chaper 19,verse 03,

Sutrasthan, 1st ed. Varanasi: Krishnadas Academy;2000

40. Charak. Charak Samhita. Edited by Jadavaji Trikamji Aacharya. Chaper 30,verse 7,

Chikitsasthan, 1st ed. Varanasi: Krishnadas Academy;2000

41. Charak. Charak Samhita. Edited by Jadavaji Trikamji Aacharya. Chaper 30,verse 08,

Chikitsasthan, 1st ed. Varanasi: Krishnadas Academy;2000

42. Sushruta, Sushruta Samhita of Maharshi Sushruta,Edited with Ayurvedic –Tattva-

Sandipika 6 Hindi Commentry, by Kaviraja Ambika Dutta Shastri, Reprint Edition

Publishers- Chaukambha Sanskrit Sansthana, Varanasi, Su.Utt. 2011; 38(12-14):205

43. Vagbhata’s, Ashtang Hridayam 39 translated by Prof. K.R. Srikantha Murthy,

Chowkhambha Krishnadas Academy Varanasi Uttara sthana, 33, 313.

44. Kashyapa Samhita. 7th ed. Varanasi: Chowkhamba Sanskrit Pratisthana; 1994.

Vidyotini Hindi Commentary; p. 184

45. Agnivesha, Charaka Samhita. 6 Redacted by Charaka and Dridhabala with Ayurveda

Dipika commentary by Chakrapanidatta Translation by Dr. Ram Karan Sharma and Vaidya

Bhagwan Dash, Chowkhamba Sanskrit Series Office, Reprint Varanasi, Uttar Pradesh,

Chikitsa Sthana, Chapt. 2010; V(30):131

46. 27 Sushruta, Sushruta Samhita of Maharshi Sushruta,Edited with Ayurvedic –Tattva-

Sandipika Hindi Commentry, by Kaviraja Ambika Dutta Shastri, Reprint Edition Publishers-

Chaukambha Sanskrit Sansthana, Varanasi, Su.Utt. 2011; 38(12-14):205

47. Ayurvediya Prasutitantra evam Striroga, part I, Prof. Remavati Tiweri, Chaukhmba

Orientalia, Varanasi, 2009; P. 63.

48. Ayurvediya Prasutitantra evam Striroga, part I, Prof. Remavati Tiweri, Chaukhmba

Orientalia, Varanasi, 2009; P. 63.

49. 8 Ayurvediya Prasutitantra evam Striroga, part I, Prof. Remavati Tiweri, Chaukhmba
Orientalia, Varanasi, 2009; P. 63.

50. Agnivesha, Charaka Samhita. Redacted by Charaka and Dridhabala with Ayurveda

Dipika commentary by Chakrapanidatta Translation by Dr. 32 Ram Karan Sharma and

Vaidya Bhagwan Dash, Chowkhamba Sanskrit Series Office, Reprint Varanasi, Uttar

Pradesh, Chikitsa Sthana, Chapt. 30. Verse 25-26. 2010; V (30):p.635

51. Sushruta, Sushruta Samhita of Maharshi Sushruta,Edited with Ayurvedic –Tattva-

Sandipika Hindi Commentry, by Kaviraja Ambika Dutta Shastri, Reprint Edition Publishers-

Chaukambha Sanskrit Sansthana, Varanasi, Su.Utt. 2011; 38(9-11):204

52. Sushruta, Sushruta Samhita of Maharshi Sushruta,Edited with Ayurvedic –Tattva-

Sandipika 6 Hindi Commentry, by Kaviraja Ambika Dutta Shastri, Reprint Edition

Publishers- Chaukambha Sanskrit Sansthana, Varanasi, Su.Utt. 2011; 38(36):209

53. 5 Yoga Ratnakar, Vaidyaprabha Hindi Commentary, by Dr Indradev Tripathi and Dr

Daya Shankar Tripathi, Chaukhamba Krishnadas Academy, Varannasi,

Y.R.Yonirogadhikar 9.

54. Ayurvediya Prasutitantra evam Striroga, part I, Prof. 8 Remavati Tiweri, Chaukhmba

Orientalia, Varanasi, 2009; P. 63.

55. Ayurvediya Prasutitantra evam Striroga, part I, Prof. Remavati Tiweri, Chaukhmba

Orientalia, Varanasi, 2009; P. 63

56. Ayurvediya Prasutitantra evam Striroga, part I, Prof. Remavati Tiweri, Chaukhmba

Orientalia, Varanasi, 2009; P. 63

57. Sharghi M, Mansurkhani SM, Larky DA, Kooti W, Niksefat M, Firoozbakht M, et al. An

update and systematic review on the treatment of primary dysmenorrhea. JBRA Assist

Reprod. 2019;23:51–7. [PMC free article] [PubMed] [Google Scholar]

58. Dutta, D.C. (2015) DC Dutta’s Textbook of Obstetrics Including Perinatology and

Contraception. 8th Edition, Jaypee Brothers Medical Publisher’s Ltd., New Delhi, 369.

https://doi.org/10.5005/jp/books/12540

59. Dutta, D.C. (2015) DC Dutta’s Textbook of Obstetrics Including Perinatology and

Contraception. 8th Edition, Jaypee Brothers Medical Publisher’s Ltd., New Delhi, 369.
https://doi.org/10.5005/jp/books/12540

60. Dutta, D.C. (2015) DC Dutta’s Textbook of Obstetrics Including Perinatology and

Contraception. 8th Edition, Jaypee Brothers Medical Publisher’s Ltd., New Delhi, 369.

https://doi.org/10.5005/jp/books/12540

61. Dutta, D.C. (2015) DC Dutta’s Textbook of Obstetrics Including Perinatology and

Contraception. 8th Edition, Jaypee Brothers Medical Publisher’s Ltd., New Delhi, 369.

https://doi.org/10.5005/jp/books/12540

62. Dutta, D.C. (2015) DC Dutta’s Textbook of Obstetrics Including Perinatology and

Contraception. 8th Edition, Jaypee Brothers Medical Publisher’s Ltd., New Delhi, 369.

https://doi.org/10.5005/jp/books/12540

63. Dutta, D.C. (2015) DC Dutta’s Textbook of Obstetrics Including Perinatology and

Contraception. 8th Edition, Jaypee Brothers Medical Publisher’s Ltd., New Delhi, 369.

https://doi.org/10.5005/jp/books/12540

64. Dutta, D.C. (2015) DC Dutta’s Textbook of Obstetrics Including Perinatology and

Contraception. 8th Edition, Jaypee Brothers Medical Publisher’s Ltd., New Delhi, 369.

https://doi.org/10.5005/jp/books/12540

65. Ramnivas Sharma, editor, Sahastrayogam, kashaya Prakaran, Delhi; chowkhamba

Sanskrit pratisthan, 2007 pg. 261.

66. Pandit Sharangadhara Acharya, Sharandhar Samhita, Choukhambha Surbharti

Madhyamkhanda, chapter 2, p133.

67. Dravayaguna Vijnana: Prof. P.V.Sharma, part I & II, Chaukhambha Bharati Academy,

Varanasi, 2001 (reprint) 208. Palasha, page no. 508.

68. Rakesh Mishra- Krimi in Children- Palashabijadi Churna-Kb-2004 Ipgt&Ra, Gujarat

Ayurved University, Jamnagar Page No. 198-204.

69. Dravayaguna Vijnana: Prof. P.V.Sharma, part I & II, Chaukhambha Bharati Academy,

Varanasi, 2001 (reprint) 136. Vrikshamla, page no. 337.

70. Peres V, Nagem T. J, Oliveira F. F. Tetraoxygenated naturally occurring xanthones,

Phytochemistry, 55(7), 2000, 683-710.

71. Andersen O. M and Markham K. R. Flavonoids Chemsitry, Biochemistry and

Applications, CRC press, Taylor & Francis group, 2006, 37-142.

72. Masullo M, Bassarello C, Suzuki H, et al. 33 Polyisoprenylated Benzophenones and an

unusual Polyisoprenylated Tetracyclic Xanthone from the Fruits of Garcinia cambogia,

Journal of Agricultural and Food chemistry, 56, 2008, 5205-5210.

73. Sullivan A. C, Hamilton J. G, Miller O. N and Wheatley V. R, Inhibition of lipogenesis in

rat liver by (-)-hydroxycitrate. Archives of Biochemistry and Biophysics, (1977), 150(1),

183-190.

74. 1 Soni MG, Burdock GA, Preuss HG, Stohs SJ, Ohia SE, Bagchi D:Safety

assessment of (-)-hydroxycitric acid and Super CitriMax, a novel calcium/potassium salt.

Food Chem Toxicol. 2004 Sep;42(9):1513-29.

75. Young-Je Kim, Myung-Sook Choi, Yong Bok Park et al. Garcinia Cambogia attenuates

diet-induced adiposity but exacerbates hepatic collagen accumulation and inflammation,

World J Gastroenterol. Aug 7, 2013; 19(29): 4689–4701).

76. Leonhardt M, Hrupka B, Langhans W: Effect of hydroxycitrate on food intake and body

weight regain after a period of restrictive feeding in male rats. Physiol

Behav.2001;74:191–196.

77. Kim KY, Lee HN, Kim YJ, Park T. Garcinia cambogia extract ameliorates visceral

adiposity in C57BL/6J mice fed on a high-fat diet. Biosci Biotechnol Biochem.2008;

72:1772–1780.

78. Ranjani R, Khadira SA, Priya N & Vijaylkshmi K: Antioxidant profile of the fruit 56 of

Garcinia cambogia and leaves of Bauhinia variegate- An invitro investigation. IJPRBS.

2014; Volume 3(3): 528-538)

Ayurvedic books:
1. Charak Samhita of Agnivesa Edited by ‘Vaidya Manorama’ Hindi Comentary, Edited By

professor Ravidatta Tripathi, Vol.1 and 2, Chaukhambha Sanskrit Pratishthan, Delhi,

Reprint year 2012.

2. Sushruta Samhita with ‘Ayurveda Tattva-sandipika’ Hindi Commentary, part I and II, By

Kaviraja Ambikadatta Shastri, Chaukhamba Sanskrit Sansthan, Varanasi, Reprint year

2013, 2014.

3. Ashtanga Sangraha, volume I and II, Edited by Kaviraj Atridev Gupta, Chaukhambha

Sanskrit Sansthan, Varanasi, Reprint Year 2016.

4. Ashtanga Sangraha – of Vahata Or Vraddha Vagbhata with Sasilekha Sanskri

Commentary by Indu, edited by Dr. Shivprasad Sharma, Chaukhambha Sanskrit Series

Office, Varanasi, Reprint Year 2006.

5. Astanga Hrdayam with ‘Nirmala’ Hindi Commentary, edited by Dr. Brahmanand Tripathi,

Chaukhambha Sanskrit Pratishthan, Delhi, Reprint Year 2014.

6. Yogratnakar with ‘Vidyotini’ Hindi Commentary by Vd. Shri Laksmipati 57 Sastri, edited

by Bhisagratna brahmasankar sastri, Chaukhambha Sanskrita Sansthan, Varanasi, Reprint

Year 2015.

7. Sharangdhara Samhita with ‘Dipika’ Hindi Commentary Edited by Dr. Brahmanand

Tripathi, 19th Edition, published by Chaukhambha Surbharati Prakashan, Varanasi, 2007.

8. Madhav Nidan with commentary by Shri. Vijayarakshit and Shikanth data, edited by

Vaidya Yadunandan Upadhyaya, 2003, Chaukhamba Sanskrit Bhavan, Varanasi.

9. Bhavprakasha edited with ‘Vidyotini’ Hindi Commentary, edited by Bhisagratna Pandit

Sri Brahma Sankara Misra, Chaukhambha Sanskrit Samsthan, Varanasi, XI Edition, 2004.

10. Bhavprakasha Nighantu G.S. Pandey, Chaukhamba Bharti Acadami New Delhi edition,

2015.

11. 43 Rasaratna samuchchaya of Sri Vagbhatacharya, Edited with The Suratnojjvala

Hindi Commentary, by Kaviraj Ambikadatta Sastri, Chaukhamba Amarabharati Prakashan,

Varanasi, 10th Edition 2015.

12. Ayurvedeey Rasashastra by Professor Siddhinand Mishra, Chaukhmabha Orientalia,

Varanasi, 15th edition, Reprint Year 2006.

Website-

 Healthengine.com.au/info.

 https://en.m.wikipedia.org.

 www.planet Ayurveda.com.

 www.researchgate.net.

 www.medscape.org.

 www.wikipedia.com.

ABBREVIATIONS:

cÉ. xÉÇ. (Ch. Sa.) - Charak Samhita

cÉ. xÉÔ. (Ch.Su.) - Charak Sutrasthana cÉ. zÉÉ. (Ch.Sha.) - Charak Sharirsthana

xÉÑ. xÉÇ. (Su. Sa.) - Sushruta Samhita

xÉÑ. xÉÔ. (Su.Su.) - Sushruta Sutrasthana

xÉÑ. zÉÉ. (Su. Sha) - Sushruta Sharirsthana xÉÑ. ÍcÉ. (Su.Chi.) - Sushruta Chikitsasthana

xÉÑ. E. (Su. Utt.) - Sushruta Uttartantra

A. ¾û. (A.H.) - Ashtang Hridaya

A. ¾û. xÉÔ. (A.H.Su.) - Ashtang Hridaya Sutrasthana

A. ¾û. zÉÉ. (A.H. Sha.) - Ashtang Hridaya Sharirsthana

A. ¾û. E. (A.H.U.) - Ashtang Hridaya Uttarsthana

A. xÉÇ. (A.S.) – Ashtang Sangraha

A. xÉÇ. xÉÔ. (A.S.Su.) – Ashtang Sangrah Sutrasthana

A. xÉÇ. zÉÉ. (A. S. Sha.) - Ashtang SangrahaSharirsthana

A. xÉÇ. E. (A.S.U.) – Ashtang Sangraha Uttarsthana

qÉÉ. ÌlÉ. (M.N.) - Madhava Nidan

pÉÉ. mÉë. (B.P.) - Bhav Prakash

rÉÉå. U. (Y.R.) - Yog Ratnakar

zÉÉUÇ. (Shar) - Sharangdhara

zÉÉUÇ. xÉÇ (Shar. Sa.) - Sharangdhara Samhita

U. U. xÉ. (R.R.Sa.) - Rasa Ratna Samucchyaya.

Abbreviations for CRF and Master Charts:

Probability Student t’ Test Chi-Square

Standard Deviation Standard Error Before Treatment After Treatment Case Record Form

Blood sugar level Male

Female Right Left

bilateral eyes right eye

left eye Unilateral Bilateral

No Improvement Moderate Improvement Complete Improvement etcetera

INFORM CONSENT FORM FOR PATIENT

Name of Research Study: “Randomized comparative Clinical Study of Palash Twak

Kashaya and Vrikshamla Twak Kashaya in the Management of Kashtartava w.s.r. to

Primary Dysmenorrhoea”

Name of Researcher:

Name of Guide:

This is consent form. I read it properly and /or I have given information in the language I

understand by concerned Doctor.

I desire to participate for this research study entitled as “Randomized comparative Clinical
Study of Palash Twak Kashaya and Vrikshamla Twak Kashaya in the Management of

Kashtartava w.s.r. to Primary Dysmenorrhoea”

as a patient, willingly.

1. It is fully explained by the concerned doctor to me about the therapy and its effects and

side effects, in the language I understand.

2. I understand that the medicine which will be given to me for my disease condition also

explained its advantage as well as disadvantage with method and duration.

3. I also clarified that my participation is this study fully voluntary and I can take withdrawal

from any time & it will not affect my future service from this hospital.

Declaration:

This is consent form, I read it properly and /or I have given information in the language I

understand by concerned Doctor. I understood the consent and I am ready to take part in

this research study.

Date: Patient’s Name:

Place: Signature

Date: Study Doctor:

Place: Signature

INFORM CONSENT FORM FOR PARENTS

Name of Research Study: “Randomized comparative Clinical Study of Palash Twak

Kashaya and Vrikshamla Twak Kashaya in the Management of Kashtartava w.s.r. to

Primary Dysmenorrhoea”

Name of Researcher:

Name of Guide:

This is consent form. I read it properly and /or I have given information in the language I

understand by concerned Doctor.

I desire to allow my offspring for this research study entitled as “Randomized comparative

Clinical Study of Palash Twak Kashaya and Vrikshamla Twak Kashaya in the Management

of Kashtartava w.s.r. to Primary Dysmenorrhoea”

as a parent, willingly.

1. It is fully explained by the concerned doctor to me about the therapy and its effects and

side effects, in the language I understand.

2. I understand that the medicine which will be given to me for my disease condition also

explained its advantage as well as disadvantage with method and duration.

3. I also clarified that my offsprings participation is this study fully voluntary and I can take

withdrawal of my offspring from any time & it will not affect my future service from this

hospital.

Declaration:

This is consent form, I read it properly and /or I have given information in the language I

understand by concerned Doctor. I understood the consent and I am ready to allow my

offspring to take part in this research study.

Date: Patient’s Name:

Place: Signature

Date: Study Doctor:

Place: Signature

समंतीपत्रक

संशोधनाचे नाव :- mÉsÉÉzÉ iuÉMü MüwÉÉrÉ uÉ uÉפÉÉqsÉ iuÉMü MüwÉÉrÉ rÉÉÇcÉå Mü¹ÉiÉïuÉ

rÉÉ urÉÉkÉÏuÉU iÉÑsÉlÉÉiqÉMü AkrÉrÉlÉ.

संशोधकाचे नाव:

मार्गदर्शक:
1.हे समंती पत्रक असून, मी हे पूर्ण वाचले आहे/ मला वाचून दाखविले आहे आणि मला समजेल अशा

भाषेत संबधित डॉक्टरांनी समजून सांगितले आहे.

मी रुग्ण म्हणून स्वेच्छेने “mÉsÉÉzÉ iuÉMü MüwÉÉrÉ uÉ uÉפÉÉqsÉ iuÉMü MüwÉÉrÉ rÉÉÇcÉå

Mü¹ÉiÉïuÉ rÉÉ urÉÉkÉÏuÉU iÉÑsÉlÉÉiqÉMü AkrÉrÉlÉ.” ह्या शोध अभ्यासात सहभागी होण्यास तयार

आहे.

मला ह्या अभ्यासात वापरणारे औषध व चिकित्सा पद्धतीचे फायदे व तोटे पूर्णपणे संबधित डॉक्टरांनी

समजेल अशा भाषेत सांगितले आहे.

2.मला ज्या औषधी देण्यात येईल व त्याविषयी संपूर्ण माहिती व देण्याची पद्धत या बद्दल सांगितले आहे.

3.ह्या अभ्यासातील माझा सहभाग पूर्णपणे ऐच्छिक असून कुठलीही पूर्वसूचना न देता मी यातून बाहेर पडू

शकतो आणि माझ्या ह्या निर्णयाचा ह्या दवाखान्यातील सेवेवर कुठलाही परिणाम होणार नाही.

जाहीरनामा:

मी ह्या अभ्यासात सहभाग घेण्यास स्वेच्छेने तय्यार होत आहे.

दिनांक: रुग्णाचे नाव:

स्थळ : सही /अंगठा :

दिनांक : अभ्यासकाचे नाव :

स्थळ : सही :

समंतीपत्रक

संशोधनाचे नाव :- mÉsÉÉzÉ iuÉMü MüwÉÉrÉ uÉ uÉפÉÉqsÉ iuÉMü MüwÉÉrÉ rÉÉÇcÉå Mü¹ÉiÉïuÉ

rÉÉ urÉÉkÉÏuÉU iÉÑsÉlÉÉiqÉMü AkrÉrÉlÉ.

संशोधकाचे नाव:
मार्गदर्शक:

1.हे समंती पत्रक असून, मी हे पूर्ण वाचले आहे/ मला वाचून दाखविले आहे आणि मला समजेल अशा

भाषेत संबधित डॉक्टरांनी समजून सांगितले आहे.

मी ÂahÉÉcÉå mÉÉsÉMü म्हणून स्वेच्छेने “mÉsÉÉzÉ iuÉMü MüwÉÉrÉ uÉ uÉפÉÉqsÉ iuÉMü

MüwÉÉrÉ rÉÉÇcÉå Mü¹ÉiÉïuÉ rÉÉ urÉÉkÉÏuÉU iÉÑsÉlÉÉiqÉMü AkrÉrÉlÉ.” ह्या शोध

अभ्यासात माझ्या पाल्याला सहभागी करण्यास तयार आहे.

मला ह्या अभ्यासात वापरणारे औषध व चिकित्सा पद्धतीचे फायदे व तोटे पूर्णपणे संबधित डॉक्टरांनी

समजेल अशा भाषेत सांगितले आहे.

2. माझ्या पाल्याला ज्या औषधी देण्यात येईल व त्याविषयी संपूर्ण माहिती व देण्याची पद्धत या बद्दल

सांगितले आहे.

3.ह्या अभ्यासातील माझ्या पाल्याचा सहभाग पूर्णपणे ऐच्छिक असून कुठलीही पूर्वसूचना न देता मी

यातून माझ्या पाल्याला बाहेर पडायला सांगू शकतो आणि माझ्या ह्या निर्णयाचा ह्या दवाखान्यातील

सेवेवर कुठलाही परिणाम होणार नाही.

जाहीरनामा:

माझा पाल्य ह्या अभ्यासात सहभाग घेण्यास तय्यार आहे.

दिनांक: रुग्णाचे नाव:

स्थळ : सही /अंगठा :

दिनांक : अभ्यासकाचे नाव :

स्थळ : सही :
Maharashtra University of Health Sciences, Nashik.

RUGNA PARIKSHA PATRAKAM

“Randomized comparative Clinical Study of Palash Twak Kashaya and Vrikshamla Twak

Kashaya in the Management of Kashtartava w.s.r. to Primary Dysmenorrhoea”

Scholar: Guide:

Aturvrittapatra:

Name of the patient:

Age: OPD. No. :

Address: IPD No. :

Religion: Ward No :

Occupation: Bed No. :

Education: DOA (Pravesh Tithi):

Marital Status: DOD (Nirgaman Tithi):

Economical Status:

1. Vartman Vyadhi Vritt / Pramukha vedana

Duration

2. Poorva Vritta (H/o)

A) Past history -

B) Medicinal History –
C) Family History –

D) Personal History – onset of disease, Progressive aggravating factors diet, diets intake

etc.

E) Menstrual History- LMP:

Menstrual Cycle- Duration/ Interval/ Amount ( No. of Pads) / Pain

3. Vyaktigat Itihas

I) Ahar –

 Pramana – Alpa./ Ati / Madhyam

 Dominant Rasa – M/A/L/K/T/Ks

 Guna – Ruksha/Samshan /Vishmashan

/Adhyashan / Virudhashan

 Type of food - Shakahar / Mishrahar

II) Vihar

 Working time – Day / Night

 Nature of work – Manual/Sedentary/ Travelling/ Standing /

Sitting.

III) Vyasan - Alcohol / Tobacco / Smoking/ another

IV) Kshudha - Alpa / Madhya / Visham

V) Pipasa - Alpa / Madhya / Visham

VI) NIdra - Alpa / Madhya / Visham

VII) Koshtha - Manda/ Madhya/ Tikshna / Krur

VIII) Wt. -

IX) Pulse /min-

X) BP: mm of Hg

XI) Temp.

3. Kul – Vritta :

 Matraj:

 Pittruj:

 Swakula :

4. Ashthvidha Parikshan

 Nadi : /min.

 Mala : Varna ………… Gandha, Rashi Sam / Niram

 Mutra:

 Jivha: Sam / Niram / Lipta / Panduta

 Shabda:

 Sparsha: Sheet/ushna/Samsheet/ushna.

 Druk:

 Akriti:

5. Laboratory Investigation:

Blood Exam - CBC

Urine - Routine and Microscopic

6. Local Examination:

7. Nidan Panchak :

i) Hetu

ii) Poorva-ropa

iii) Samprapti

iv) Roop (Lakshan)

v) Vyadhi vinischhay

vi) Upasaya/ Anupashya

vii) Sadhya Asadhyatva

viii) Upadrava

11. Chikitsa (Group Management)

Group A

Group B

Observation Table: -

Sr.No

symptoms

0 day

4th week
8th week

5
Scholars sign Guide sign

MASTER CHART TRIAL GROUP

SR. NO.

OPD.NO.

AGE

DIET
RELIGION

PRAKRUTI

RESIDENCE

Severity of pain

duration

Artavpramana ( No. of Pad)

Artavastrava Avadhi

YathochitkalAdarshanam (interval)

Praseka 46 (Nausea)

Chhardi (Vomiting)

Vibandha (constipation)

Atisara (diarrhoea)

Shrama (Fatigue)

Shirashula (Headache)

Vankshana shula, kati, Janu shula

0 day

4th week

8th week

0 day

4th week

8th week

0 day

4th week

8th week

0 day

4th week

8th week

0 day
4th week

8th week

0 day

4th week

8th week

0 day

4th week

8th week

0 day

4th week

8th week

0 day

4th week

8th week

0 day

4th week

8th week

0 day

4th week

8th week

0 day

4th week

8th week

2694

13

H
VP

2
0

2948

13

KP

2
0

3202

14
MX

PK

1
3

22461

14

VP

0
2

5
22516

16

VP

3
1

22701

16

MX

PK

3
2

2
0

22029

16

VP

2
0

22109

17

VP

1
0

1
2

23077

17

MX

PV

0
2

10

24849

17

VP

0
3

3
2

11

25134

17

MX

KP

3
1

12

25404

17

MX

VP

3
2

1
0

13

25301

17

PV

1
0

14

25510

17

MX

VP
R

0
2

15

26163

17

VP

0
2

16

26777

17

MX
H

VP

3
2

17

26924

17

MX

PV

3
1

18

25316
17

KV

1
0

19

27105

17

VP

2
1

0
20

27034

17

MX

VP

0
2

21

39347

17

MX

VP

0
2

2
2

22

39773

17

MX

PV

3
2

23

40589

17

VP

3
2

2
1

24

40757

17

KP

1
0

25

41865

17

VP

1
0

1
2

26

41941

17

MX

VP

1
3

27

43225

17

MX

VP

U
2

2
1

28

43314

17

VP

2
2

29

43720

17

MX

H
PV

2
0

30

44373

18

VP

2
0

31

44402

18
V

VP

1
2

32

44423

18

KP

0
2

33
44513

18

MX

VP

3
2

34

44583

18

VP

2
1

2
1

35

44213

18

VP

1
0

36

44718

19

MX

VK

1
1

0
2

37

44020

19

VP

0
2

38

45033

19

VK

0
3

3
2

39

45271

19

MX

VP

2
2

40

44431

19

VK

3
1

1
1

41

45519

19

PV

2
1

42

46628

19

MX

KV
U

0
2

43

19

MX

PV

0
3

44

164

19

MX
H

VP

2
1

45

46523

19

PV

2
1

46

45873
19

KV

2
0

47

556

19

MX

PV

2
1

1
48

46208

19

VP

0
2

V-VEG, MX- MIXED, H-HINDU, M-MUSLIM, R-RURAL, U-URBAN

MASTER CHART CONTROL GROUP

SR. NO.

OPD.NO.

AGE

DIET

RELIGION

PRAKRUTI
RESIDENCE

Severity of pain

duration

Artavpramana ( No. of Pad)

Artavastrava Avadhi

Yathochitkala Adarshanam (interval)

Praseka (Nausea)

Chhardi (Vomiting)

Vibandha (constipation)

Atisara (diarrhoea)

Shrama (Fatigue)

Shirashula (Headache)

Vankshana shula, kati, Janu shula

0 day

4th week

8th week

0 day

4th week

8th week

0 day

4th week

8th week

0 day

4th week

8th week

0 day

4th week

8th week
0 day

4th week

8th week

0 day

4th week

8th week

0 day

4th week

8th week

0 day

4th week

8th week

0 day

4th week

8th week

0 day

4th week

8th week

0 day

4th week

8th week

1277

19

MX

PV

R
3

3
2

1634

17

PK

2
2

1773

17

MX

H
KP

2
0

2049

19

MX

PV

1
1

2096

16
V

VP

0
2

13524

17

VP

1
3

7
13556

14

MX

KP

2
2

26777

17

KP

3
2

1
0

26924

19

VP

2
0

10

27105

17

MX

PV

1
0

0
3

11

27835

17

KP

1
2

12

27511

19

MX

VP

0
2

2
2

13

27964

18

PV

3
1

14

28063

16

MX

VP

3
2

1
1

15

28932

18

VP

2
1

16

34195

17

MX

VP
U

0
2

17

35019

17

MX

KP

0
2

18

37143

17

MX
H

KV

3
2

19

37877

17

VP

3
2

20

38187
18

VP

1
1

21

13524

17

VP

1
0

0
22

13596

14

PV

1
3

23

13594

18

KP

1
3

3
2

24

16237

15

VP

3
2

25

16335

16

VP

3
2

1
0

26

16512

16

MX

VP

2
0

27

16624

17

KP

2
0

1
2

28

16786

17

VP

1
3

29

16948

18

PV

U
3

2
1

30

17079

18

MX

PV

2
1

31

12250

18

H
VP

1
0

32

17638

18

KP

1
0

33

17648

13
MX

VP

1
3

34

17618

13

KP

0
3

35
19729

19

VP

2
1

36

19762

18

VP

3
1

1
1

37

19760

13

MX

VP

1
1

38

20182

17

MX

VK

1
0

0
3

39

12827

18

MX

VP

1
2

40

21987

17

VK

0
2

2
2

41

22324

19

PV

3
2

42

21675

19

MX

KV

2
1

1
0

43

21223

16

PV

1
1

44

21118

17

MX

VP
R

1
2

45

23222

16

PV

1
3

46

23154

18

MX
H

KP

2
2

47

25435

17

PV

2
1

48

26572
14

MX

VK

2
0

V-VEG, MX- MIXED, H-HINDU, M-MUSLIM, R-RURAL, U-URBAN

2
Page 2 of 2

2
2

Page 2 of 2

Page 2 of 2

Page 2 of 2

Page 2 of 2

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Sources
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732841/
1 INTERNET
1%
https://ncbi.nlm.nih.gov/pmc/articles/PMC3221063/
2 INTERNET
<1%
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939234/
3 INTERNET
<1%
https://pubmed.ncbi.nlm.nih.gov/15234082/
4 INTERNET
<1%
https://www.wjpmr.com/download/article/116112023/1701327591.pdf
5 INTERNET
<1%
https://www.researchgate.net/publication/352366682_A_comprehensive_review_on_categori
6 zation_of_Yonivyapada_in_Brihatrayee
INTERNET
<1%
https://ayurlog.com/index.php/ayurlog/article/download/1062/1404/
7 INTERNET
<1%
https://www.researchgate.net/publication/366324085_CONCEPT_OF_ARTAVA_AND_ARTAVA
8 _CHAKRA_AN_AYURVEDA_AND_MODERN_PERSPECTIVE
INTERNET
<1%
https://storage.googleapis.com/journal-uploads/wjpps/article_issue/1630752297.pdf
9 INTERNET
<1%
https://www.journalcra.com/sites/default/files/issue-pdf/20187.pdf
10 INTERNET
<1%
https://www.carakasamhitaonline.com/index.php?title=Ayurveda
11 INTERNET
<1%
https://ijisrt.com/assets/upload/files/IJISRT23DEC873.pdf
12 INTERNET
<1%
https://www.jaypeedigital.com/eReader/chapter/9789350257814/ch1
13 INTERNET
<1%
https://globalresearchonline.net/journalcontents/v19-2/20.pdf
14 INTERNET
<1%
 http://ijapc.com/volume7-third-issue/MNAPC-V7-I3-16-p-78-84.pdf
15 INTERNET
<1%
https://www.iamj.in/current_issue_print/images/upload/153_159_2.pdf
16 INTERNET
<1%
https://pharmacologymentor.com/pharmacology-definitions-and-terminology/
17 INTERNET
<1%
https://ijprajournal.com/issue_dcp/Literary Review of Pittaja Yonivyapad.pdf
18 INTERNET
<1%
https://link.springer.com/chapter/10.1007/978-3-319-71964-1_9
19 INTERNET
<1%
https://www.ayurvedjournal.com/JAHM_201624_07.pdf
20 INTERNET
<1%
https://www.tandfonline.com/doi/abs/10.1271/bbb.80072
21 INTERNET
<1%
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8943241/
22 INTERNET
<1%
https://www.easyayurveda.com/2018/11/22/causes-gynecological-disorder/
23 INTERNET
<1%
https://www.slideshare.net/ArvinderKaur20/anatomy-of-female-reproductive-system-
24 ayurvedic-and-modern-perspective
INTERNET
<1%
https://www.researchgate.net/publication/350122042_A_COMPREHENSIVE_REVIEW_KRUCHC
25 HARTAVA_WSR_DYSMENORRHOEA
INTERNET
<1%
https://ijaar.in/index.php/journal/article/download/931/878
26 INTERNET
<1%
https://www.researchgate.net/publication/352366752_AN_OVERVIEW_OF_SHWETA_PRADAR
27 A_IN_AYURVEDA_WSR_TO_ITS_TREATMENT_PRINCIPLES
INTERNET
<1%
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3877456/
28 INTERNET
<1%
 https://storage.googleapis.com/journal-uploads/wjpps/article_issue/1633090788.pdf
29 INTERNET
<1%
https://www.studocu.com/in/document/university-of-kerala/introduction-to-
30 obstetric/assessment-and-management-of-intranatal-period/63505558
INTERNET
<1%
https://ijaar.in/index.php/journal/article/download/618/577
31 INTERNET
<1%
https://www.ncbi.nlm.nih.gov/nlmcatalog/101143027
32 INTERNET
<1%
https://europepmc.org/article/MED/18533663
33 INTERNET
<1%
https://storage.googleapis.com/journal-uploads/ejpmr/article_issue/1672479283.pdf
34 INTERNET
<1%
https://www.jpsionline.com/articles/role-of-zingiber-officinale-r-in-dysmenorrhoea-a-
35 selective-ayurvedic-and-contemporary-medicine-documentation.pdf
INTERNET
<1%
https://www.researchgate.net/publication/360086522_A_CONCEPTUAL_STUDY_OF_ASHTART
36 AVA_DUSHTI_MENSTRUAL_DISORDERS
INTERNET
<1%
https://core.ac.uk/download/pdf/333820059.pdf
37 INTERNET
<1%
https://www.worldwidejournals.com/global-journal-for-research-analysis-
GJRA/recent_issues_pdf/2020/December/a-review-study-of-ashaya-sharir-wsr-to-
38 gharbashayauterus_December_2020_0389181063_9608903.pdf
INTERNET
<1%
https://www.amazon.com/Vagbhatas-Hrdayam-Translation-Appendix-Indices/dp/8121800226
39 INTERNET
<1%
https://ijrap.net/admin/php/uploads/2832_pdf.pdf
40 INTERNET
<1%
https://core.ac.uk/download/pdf/333809486.pdf
41 INTERNET
<1%
http://www.aiirjournal.com/uploads/Articles/2020/01/4379_47.Dr. Snehal Ram Rathod.pdf
42 INTERNET
<1%
 https://www.saujanyabooks.com/details.aspx?id=44533
43 INTERNET
<1%
https://wjpmr.com/download/article/80042021/1619693458.pdf
44 INTERNET
<1%
https://www.wjpmr.com/download/article/112082023/1693374845.pdf
45 INTERNET
<1%
https://www.wjpmr.com/admin/assets/article_issue/87082021/1630749098.pdf
46 INTERNET
<1%
https://www.iamj.in/prposts/2017/images/upload/490_498_1.pdf
47 INTERNET
<1%
https://radiopaedia.org/articles/uterus
48 INTERNET
<1%
https://www.sciencedirect.com/science/article/pii/S0367326X00003336
49 INTERNET
<1%
https://pubmed.ncbi.nlm.nih.gov/9308868/
50 INTERNET
<1%
https://www.easyayurveda.com/2018/11/29/artava-menstrual-blood/
51 INTERNET
<1%
https://www.easyayurveda.com/2019/05/23/udavartini/#:~:text=When the natural urges like
52 that for flatus,contaminates them and causes abnormalities i.e. painful conditions.
INTERNET
<1%
https://quizlet.com/836447234/f-menstrual-and-ovaries-flash-cards/
53 INTERNET
<1%
https://www.kenhub.com/en/library/anatomy/fundus-of-uterus
54 INTERNET
<1%
https://ijcmas.com/vol-3-5/Vijayalakshmi Krishnamoorthy, et al.pdf
55 INTERNET
<1%
https://www.researchgate.net/publication/320798789_Phytochemicals_and_bioactivities_of_
56 Garcinia_gummi-gutta_L_N_Robson-A_review
INTERNET
<1%
https://www.researchgate.net/publication/375866325_CLINICAL_EVALUATION_OF_SUVARNA
57 SOOTSHEKHAR_RASA_AND_PATHYADHI_KASHAYA_IN_THE_MANAGEMENT_OF
INTERNET
 <1%

https://ssam.in/Pdf Documents/Academic
58 Syllabus/UG/Syllabus_Third_BAMS_PRASUTI_TANTRA_EVUM_STRI_ROGA.pdf
INTERNET
<1%
https://storage.googleapis.com/journal-uploads/ejpmr/article_issue/1540968967.pdf
59 INTERNET
<1%
https://www.wjpmr.com/download/article/36062018/1530262801.pdf
60 INTERNET
<1%
https://wjpr.s3.ap-south-1.amazonaws.com/article_issue/1601453141.pdf
61 INTERNET
<1%
https://emedicine.medscape.com/article/270450-overview
62 INTERNET
<1%
https://pubmed.ncbi.nlm.nih.gov/11564468/
63 INTERNET
<1%
https://www.sanctumbooks.com/product/41873/Bhavaprakasa-of-Sri-Bhavamisra-Edited-
64 with-the-Vidyotini-commentary-notes-introduction-index-Etc-2-Vols
INTERNET
<1%
https://targetstudy.com/university/16336/maharashtra-university-of-health-sciences/
65 INTERNET
<1%

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