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Introduction

Women’s health is very important because it is very basis for a good family life. The derivation of the word “stree” itself denotes that the family begins with her. The disorders that affect her in the reproductive age have their impact on her reproductive life and also her family. Dysmenorrhea is one of the most common and incapacitating conditions in women’s life, which affect their normal day to day activities. According to classics, the word yoni has different meaning in different context i.e., vulva, vagina, uterus or collectively female reproductive organ. So, the ailments or Vyapad occurring in these parts are called as the Yonivyapad. [1] Without the association of Vata Dosha, Yoni Rogas will not occur. Acharyas specifically mentioned that, in the management of any Yoni Roga, Vata Dosha has to be treated initially. The condition characterised with pain and difficulty in expulsion of menstrual blood, is typically a characteristic of Dushta Vata which can cause Vataja Yonivyapad known as Udavartini Yonivyapad. It is specifically mentioned that “RAJA KRUCHREN MUNCHATI” is the typical symptom of Udavartini Yonivyapad. Basti is the most appropriate treatment modality for Vata Dushti. Dysmenorrhea literally means painful menstruation. It can be broadly classified into two types- primary and secondary dysmenorrhea. Primary dysmenorrhea is defined as painful menstrual cramps from the uterine origin, which is directly linked to menstruation without any visible pelvic pathology. It often begins with the menarche, especially after ovulation for 6 months to one year. The pain is usually felt a day before menstruation or over the first one or two days of menstruation. The pain is characterised by colicky nature and usually located in the mid line of the lower abdomen. But it may also be described as dull and may extend to the lower quadrants, lumbar area and the thighs.

Aim and objective- Detailed review on Udavartini Yonivyapad as Vyadhi

Material & method: References regarding Udavartini Yonivyapad and its Chikitsa were collected from Bruhatrayi, Laghutrayi Modern textbooks and Research articles and analysed them.

Need for the study: Menstrual pain of primary dysmenorrhea is mostly encountered in gynaecological practice. Typically starts within a year of the first menstrual period. When there is no underlying cause, often the pain improves with age or following having a child. [2]

Review of Literature: According to Ayurveda, the clinical entity characterized by pain, difficult expulsion of menstrual blood due to upward movement of rajas (menstrual blood) propelled by vitiated Vata. The upward movement is called as Udavrittam. [3-5] One of the Vimshati Yonivyapads told by all Acharyas. Vata is described as the causative Dosha of Udavartini Yonivyapad by all the Acharyas. This term Udavartini Yonivyapad is given by Acharya Charak. All other Acharyas gave different terms as Udavarta, Udavrutta.

Nirukti: UTTA+AANGA+VRUNTA= UDAVARTA

The act of going up.In Udavarta, Vata moves in upward and circular direction.

Derivation of Udavartini Yoni-Vyapad : The word Udavarta is derived from the root Uda Vartan means to ‘go upward’ as per Shabdakalpadruma,

Udavaritini – Charaka, Udavrutta – Vagbhata 

Udavarta- Sushruta, Madhavnidana, Bhavprakasha,Yogratnakara

Doshadhikya: Vataja [6]

Defination: [7]: Acharya Charak says that due to movement of flatus etc. natural urges in reverse direction, the aggravated Vayu moving in reverse direction fills the yoni. This yoni seized with pain, initially throws or pushes the raja upwards then discharges it with great difficulty. The woman feels relief immediately following discharge of menstrual blood. Since in this condition the raja moves upward or in reverse direction, hence it is termed as Udavaritini.[8]

Nidan-Panchaka

Hetu of Udaratini Yonivyapad [9,10,11]

Rupa of Udavartini Yonivyapad

Saphenil Raj krucchren vimunchyati (According to Aacharya Sushrut)

- Aartve sa vimukte tu tatkshanam labhate sukham (by Aacharya Charak)

- Kapha Sansrishta Aartav (Yogratnakar)

- Baddha Aartav (Ashtang-Sangrahakar)

Samprapti [12]: Apan Vayu is responsible for menstruation and naturally it is having Adho-Gati. But in some women due to Vatprakopaka Aahara Vihara, Vegavarodha causes excessive Vata Prakopa. Because of the Hetu-Sevana and Vegdharana, Vata is vitiated and Vigunta is seen in the Gati of Vata which moves the aggravated Vayu (Apana Vayu) in reverse direction and fills the Yoni. The Yoni seized with pain, initially throws or pushes the Raja upwards, then discharges it with great difficulty.

• Doshas - Vata, Apana Vata
• Dushya - Rasa, Rakta, Mamsa, Artava
• Agni - Jatharagni. Dhatvagni mandya
• Strotas - Rasa, Rakta, Artava vaha srotas
• Srotodushti - Vimarga Gamana
• Roga marga - Abhyantara
• Udbhava sthana - Amapakvashaya
• Sanchara sthana - Sarva shareera
• Vyaktasthana – Yoni

Upadrava: No specific but if the yoni is vitiated with doshas then updrava like Shoola, Stambha, Vandhyatva, Arsha, Pradara, Artava dosha may occur.

Sadhya-Sadhyatva: Yonivyapad occuring due to vitiation of single Dosha is Sadhya according to Acharya Sushrut. So Udavartini Yonivyapad occurring due to Vata vitiation is Sadhya.

Chikitsa: [13]

a. Nidan Parivarjana

b. Vatshamaka, Shoolaghna Chikitsa: All the disorders of Yonivyapada do not occur without vitiation of Vata. So first of all, Vata should be normalized, only then treatment of other Doshas should be done. According to Aacharya Charak oleation with Trivrutta Sneha (Ghrita, oil or fat), sudation (Swedana), Use of meat soup of Gramya, Anupa and Audaka animals, Basti of milk medicated with Dashmoola and its oral use, Anuvasana basti and Uttarbasti with Trivrutta Sneha should be done. According to Ashtanga Sangraha use of meat soup of aquatic animals, sudation with milk, oral use or use in the form of Anuvasana and Uttarbasti of Sneha medicated with decoction and paste of Dashmoola and Trivritta is beneficial.

c. Margavrodha Nashaka Chikitsa:

- Snehana, Swedana, Shodhana

- Basti

d. Dhatukshaya Chikitsa:     

- Siddha Kshirpaka

- Dhatuvruddhikara Chikitsa

Specific treatment: Rajah Pravartini Vati [14], Kaseesadi Vati, Dasha Moola Trivrit Taila [15] for oral and Basti. Vata is responsible for all Yoni Rogas especially of Udaavartini. In Ayurveda various treatment modalities are mentioned for the treatment of Vata Rogas. Among them Basti is the better treatment modality for Vata. [16]. Basti is of two types based on the drug taken. Niruha or Kashaya Basti in which decoction is taken, Anuvasana or Sneha Basti in which oil is taken as main drug. Matra Basti is a sub-type of Anuvasana Basti.

Yogasana [17]

Yoga Asanas helpful during menstrual cycle

? Swastikasana

? Virasana

? Padmasana

? Gomukhasana

? Paschimothasana

? Badha-konasana

? Janu sirasana - recommended to perform the asana without coming forward, keeping the back spine concave. This pose is calming. Lower abdominal and pelvic compression aids cramps.

? Trikonasana

? Ardhachandrasana

? Supported Setubandhasana - pose is calming, relieves menstrual discomfort Supta vajrasana, Matsyasana

? Shavasana

? Pranayama: Ujjayi and Viloma pranayama

Pathya [18]

Aaharaja

- Shali rice and barley   

- Lohbhasma with honey         

- Diet having milk        

- Regularly use ginger food preparation

Viharaja

- Yogasana

- Vajrasana, Matyasana, Marjarasana Pranayama

– Anuloma

– viloma, Bhramari                                                      

Apathya

Aaharaja

- Hot, spicy, salty, oily food

- Alcohol

-Reduce caffeine intake

Viharaja

- Fast running, excessive talking, laughing

- Sleeping during day

- Coitus during menstrual period      

- Use of Nasya, Svedana, Vamana     

These Pathya-Apathya like Asanas relax the muscles and nerves which are under constant stress, strain and irritation soothes the abdomen. these asanas help those who suffer from headache, backache, abdominal cramps and fatigue. At present time, the families are undergoing rapid changes due to increase urbanization and modernization. In IT sectors and basically in all working fields the women go through job stress, working load, inappropriate dietary habits, sleeping time etc. In today’s sedentary life, women have to play multiple role which causes adverse effects on women physical and mental health including menstrual disorders, loss of appetite, insomnia etc. Therefore, to tackle these challenges, Ayurvedic classics describes “Rajswala Paricharya”. It helps women to adapt the physiological changes taking place in the body during menstruation

Discussion

Charak has explained that due to forceful Dharana of Adharniya Vega like urine, stool, etc. this leads to Apana Vayu gets Urdhva-Gati so the Raja which has to move in downward direction moves in upward direction so there is painful Raja Nirgaman and the pain get immediately subsides after Rajastrava. So as the raja moves in upward direction this Vikara is named as Udavartini. Sushruta says that besides painful and frothy menstruation there are other symptoms such as Angamarda, Daurbalya etc. Indu-Tika has mentioned clotted blood discharge. Yogratnakar has mentioned that frothy menstrual discharge with pain associated with Kapha Dosha. Both Vagbhat followed Charak. Bhavprakash and Madhavnidankar has followed Sushruta.[19] Dysmenorrhea painful menstruation but more realistic and practical definition is painful menstruation of sufficient magnitude so as to incapacitate day to day activities. [20] Frequently associated symptoms include nausea, vomiting, diarrhoea, fatigue, head ache, dizziness. Sometimes, syncope and fever can also be seen. Primary dysmenorrhea decreases with increasing age. Prevalence is highest in the age group of 20-24 years and decreases progressively thereafter.

The identified risk factor for dysmenorrhoea includes teenage, heavy menstrual flow, nulliparity, smoking, attempts to lose weight, upper socio-economic status, physical inactivity, disruption of social networks, depression and anxiety etc. In secondary dysmenorrhoea the pain classically proceeds with the start of the period by several days and may last throughout the period. It is an indication of a separate disease. So, it requires a different diagnosis and treatment other than analgesics by which the underlying disorder will get treated and eventually reduce the pain.

Conclusion

Ayurveda being a holistic medicine offers potential remedies which are proved beyond doubt in solving the problem successfully. Udavartini Yonivyapad which has been described in our ancient Ayurveda matches all the symptoms of dysmenorrhea.

As the Acharya has mentioned pain during menstruation which get immediately relived after menstrual blood discharge resembles with spasmodic dysmenorrhea. Basti is the best treatment for Vata Vyadhi and hence for dysmenorrhoea also.