Review Article International Ayurvedic Medical Journal ISSN:2320 5091

A REVIEW ON KARNINI YONI VYAPAT IN AYURVEDIC PERSPECTIVE Arige Sulochana Dept. of Prasuti evam Stree Roga, Dr. BRKR Govt. Ayurvedic College, Hyderabad, India ABSTRACT Karnini yoni vyapat (Cervical Erosion) is one among the vimshati yoni vyapats. This common ailment may present with symptoms like vaginal discharge to worst manifesta- tions like female infertility and thus gain importance in the gynaecological practice. This condition with its signs and symptoms can be correlated with cervical erosion. Though the conventional treatments like electro cautery, cryosurgery, and laser vaporisation are effective, they are not free from complications such as secondary haemorrhage, profuse discharge etc. While going through Ayurvedic literature, it becomes evident that is a treasure house for natural formulations which are devoid of side effects and offers holistic medicine in the management of karnini yoni vyapat. Hence, an attempt was made through this study to review the Ayurvedic literature regarding karnini yoni vyapat and its management and to enlighten the importance of Ayurveda in this era in improving the quality of life. Keywords: karnini yoni vyapat, cervical erosion, cryosurgery, electrocautery

INTRODUCTION racteristic feature is development of kar- A female’s multifaceted life under- nika, which means ‘round protuberance’, goes series of physiological changes in associated with excessive mucoid dis- each and every phase. Her active reproduc- charge, itching, sometimes even blood tive phase is bestowed with highest stained discharge. Charaka2 says that kar- orientation of physical and psychological nini yoni vyapat is caused due vitiation of balance for maintenance of harmony in her kapha and vata, while Sushruta3 said it is life. “yonishu shuddhasu evam garbha due to vitiation of kapha. This condition vindanthi yoshitham,adhyaste prakruthe can be correlated with cervical erosion. In beeje jeevopakramane sathi”1 this verse cervical erosion though small sprouts like indicates the importance of and fe- structures do grow, but there is no round male genital system of women being the protuberance, if it is accepted that cervix focus of family, maintenance of her repro- itself becomes rounded, protuberant due to ductive health is family expanding years congestion, hypertrophy and nabothian and overall health in later period is of cysts and assumes the shape of pericarp of prime importance. Majority of the women lotus or karnika, then congruence with are facing this problem of karnini yoni classical description can be established. vyapat mainly in the reproductive phase of Cervical erosion, a benign lesion is some- their life. times much troublesome due to its The word ‘karnini’ is derived from chronicity and recurrence. It is one of the karnin which refers to ‘having ears’, ‘relat- commonest gynaecological conditions ing to ears’, ‘barbed’,‘furnished with seen in day to day practice. About 85% of knots’ etc. In this condition, the main cha- women suffers from cervical erosion and Sulochana Arige: Karnini Yoni Vyapat in Ayurvedic Perspective can also show malignant changes in Indu while clarifying the descrip- chronic stage. tion says that due to premature ejaculation Etiology of fluid brought about by untimely strain- Abnormal dietetics and mode of ing, the aggravated withholding ka- life, abnormalities of artava (hormones), pha and raktha produces karnika in yoni abnormalities of beeja and curses or anger which obstructs the passage of raja. Here of god are causative factors of all the premature ejaculation of fluid refers to ei- twenty disorders of yoni, is the opinion of ther normal excretion of reproductive sys- Charaka.4 Abnormal mode of life includes tem of woman coming at the end of or- excessive coitus leading to hyperaemia, gasm or else deliberate discharge of urine ulceration and infection; over straining by woman to deceive her husband. In a during labour in the absence of labour woman undesirous for coitus, above both pains. Artava dosha can be considered as the discharges i.e, secretion from hormonal imbalance. Hyper oestrogenism reproductive system and urine are seen. plays a major role. Beeja dosha acts as a Vitiated kapha solidifies raktha, giving it a congenital cause. shape of abnormal structures, which is pro- Concept of disease pelled by vayu. This structure obstructs or “akaale vaahamaanaayaa garbhena pihi- constricts the orifice of uterus, thus the tho anilaha deposited sukra (sperm) does not ascent karnika janayedhyonau sleshmarakthena upwards resulting into absence of fertiliza- moorchithaha tion. raktha maargaavarodhinyaa saa thaya Cervical erosion karnini matha”(cha.sam.chi30/27-28) Cervical ectopy is a condition Due to straining during labour in where the squamous epithelium of the the absence of labour pains, the vayu ob- ectocervix is replaced by coloumnar structed by fetus, withholding kapha and epithelium which is continuous with the getting mixed with raktha produces kar- endocervix. The squamocolumnar junction nika in yoni, which obstructs the passage is not static and its movement, either and of raja. Due to presence of karnika, this inwards or outwards is dependent on condition is termed as karnini yoni vya- oestrogen. When oestrogen level is high, it pat.5 moves, out so that the columnar epithelium “karninyaam karnika yonau slesh- extends onto the vaginal portion of cervix masrgbhyam prajaayathe replacing the squamous epithelium. This chathusrushvapi chadyasu sleshma state is observed during pregnancy and lingochchrithirbhaveth”(su.sam.ut- amongst pill users. The squamocolumnar 38/15,17) junction returns back to its normal position Sushruta says that vitiated kapha after 3 months following delivery and little along with raktha produces karnika (a earlier following withdrawal of pill. This small muscular ball) in yoni. Other fea- condition is characterised by 1) vaginal tures of vitiation of kapha i.e, unctuous- discharge which may be excessively mu- ness and itching etc are present.6 coid from the overgrowth or overactive Both the Vagbhatas7 have followed cervical crypts. It may be mucopurulent, Charaka. Madhava nidana8, Bhavapraka- offensive and irritant in the presence of sha9 and ratnakara etc have fol- infection may be blood stained due pre lowed Sushruta. menstrual congestion. 2) Contact bleeding 2 www.iamj.in IAMJ: Volume 1; Issue 4; July – Aug 2013

Sulochana Arige: Karnini Yoni Vyapat in Ayurvedic Perspective specially during pregnancy and pill use drugs should be placed in the vaginal canal either following coitus or defaecation may for the treatment of yoni rogas caused by be associated. 3) Associated cervicitis may vitiation of slesma: A pessary prepared produce backache, pelvic pain and at times with a piece of cloth soaked several times infertility. in bile of hog.17 A pessary prepared with Signs – per speculum examination reveals powdered yava or masha mixed with a bright red area surrounding and extend- saindhava lavana and pestle with latex of ing beyond the external os in the ectocer- arka should be placed either repeatedly or vix. The outer edge is clearly demarcated. for a short time and should follow the The lesion may be smooth or having small irrigation of vaginal canal with luke warm papillary folds. It is neither tender nor water.17A pessary, of thickness of an index bleeds to touch. On rubbing with a gauze finger is prepared with pippali, maricha, piece, there may be multiple oozing spots. masha, satahwa, kustha and saindhava The feel is soft and granular giving rise to lavanam is beneficial.17,18 A research work a grating sensation.10 was done on cervical erosion by the use of Investigations: All the cases should be snuhi kshara, which has showed better re- subjected to cytological examination from sults than electro cautery. Post operative the cervical smear to exclude dysplasia or use of udumbara ointment is also noted in malignancy. In doubtful smear, colpos- this study, which has have good healing copy and or cervical biopsy should be action.19 done. Congenial diet: The woman afflicted with Management: sleshmajaasu cha yoni rogas should use according to predo- rookshoshnam kuryadhvichksha- minance of dosha 1) the sura (wine), naha”11 asava and arista. 2) swarasa of lashuna in In sleshmja yoni rogas, charaka has ad- the morning and 3) the diet having abun- vised prakshalana, poorana and dhoopana dance of and meat soup20. She should with rooksha and ushna prakruthi dravyas. take diet made with barley and use Uttaravasti with the oil treated with jeeva- abhayarista, sidhu, oil, powdered pippali, neeya group of drugs should be given.12 A pathya and loha bhasma with honey21, pessary prepared with kusta, pippali, ten- balataila, misrakasneha and sukumara der leaves or tip of twig of arka and saind- sneha.22 hava lavana pestled with urine of goat Non-congenial diet: Manda (scum of should be applied locally.13 “varti boiled rice) is contra indicated to the pradhadhyaath karninyaam sodhana- women suffering from yoni rogas. dravya sambhruthaam”14 Pessary prepared CONCLUSION with sodhana dravyas should be used. karnini yoni vyapat (cervical ero- “brhathi phala kalkasya dwiharidraa sion) was found more commonly in active yukthsya cha kandu mathi malpasparshaa reproductive life of women. It is a com- poorayedh dhoopayeth tadha”15Kalka of mon and incapacitating lesion and its clini- brhathi phala, haridra and daru haridra cal manifestations are not sufficiently are used as dhoopana and dharana, it recognised. This lack of appreciation of helps in relieving the pain and itching the symptoms leads to the failure to look sensation. All the measures capable of for, find and treat the cause of many suppressing the kapha should be used.16 gynaecological complaints, thus in many The pessary prepared with the following instances condemning the patient to 3 www.iamj.in IAMJ: Volume 1; Issue 4; July – Aug 2013

Sulochana Arige: Karnini Yoni Vyapat in Ayurvedic Perspective chronic ill health as a result of such symp- tara Sthana 33/50,51 & Atridev Gupta, As- toms as leucorrhoea, backache, abdominal tanga Sangraha, Chaukambha Orentalia, pain and dysuria. Hence, proper counsel- Varanasi 1979, Uttara Sthana38/51. ing to the women should be done about the 8.K.R. Srikanta Murthy, Madhava Nidana disease and its consequences. In this pers- With Madhu Kosha Commentary, Chau- pective, Ayurveda offers excellent reme- kambha Orientalia, Varanasi, 2009, Ni- dies which are safe, naturally available, dana 62/ 8. rejuvenating and finally improves the 9.M.Venkata Shastri, Bhava Prakasha, Sri whole health. Hence Ayurvedic manage- Pandu Ranga Printing Works, Vijaya- ment should be encouraged, so that it can wada,2nd/1959,Chikitsa Sthana70/11. serve the grieving narishakthi and finally 10.D C Dutta, Edited By Hiralal Konar, the humanity. Text Book Of Gynaecology Including REFERENCES Contraception, Fifth Edition, New Central 1.Pt.Kashinath Shastri and Dr. Goraknatha Book Agency Pvt Ltd,2008,Chapter 18; Chaturvedi, , Vidyotini Pages 257-259. Hindi Commentary, Varanasi Chau- 11.Pt.Kashinatha Shastri, Charaka Samhi- kambha Academy, 2011 Chikitsa tha, Chakrapani Datta Virachitha Ayur- Sthana30/175. veda Deepika Vyakya, Chaukambha 2.Pt.Kashinatha Shastri, Charaka Samhi- Orientalia, Varanasi, 1970, Chikitsa tha,Chakrapani Datta Virachitha Ayurveda Sthana 30/42. Deepika Vyakya,Chaukambha Orienta- 12.Pt.Kashinatha Shastri, Charaka Samhi- lia,Varanasi, 1970 ,Chikitsa Sthana tha,Chakrapani Datta Virachitha Ayurveda 30/39,40,41. Deepika Vyakya,Chaukambha Orienta- 3. Kaviraj Dr Ambika Datta Sastry, Su- lia,Varanasi, 1970 ,Chikitsa Sthana sruta Samhita, Hindi Vyakya-Vaignanika 30/102. Vimarsha-Tippani Sahitha, Chaukambha 13Pt.Kashinatha Shastri, Charaka Samhi- Samskritha Samsthan, Varanasi tha,Chakrapani Datta Virachitha Ayurveda 1970,Uttara Sthana 38/6-9. Deepika Vyakya,Chaukambha Orienta- 4. Pt.Kashinatha Shastri, Charaka Samhi- lia,Varanasi, 1970 ,Chikitsa Sthana tha,Chakrapani Datta Virachitha Ayurveda 30/109. Deepika Vyakya,Chaukambha Orienta- 14.Kaviraj Dr Ambika Datta Sastry, Su- lia,Varanasi, 1970 ,Chikitsa Sthana 30/8,9. sruta Samhitha,Hindi Vyakya-Vaignanika 5 Pt.Kashinatha Shastri, Charaka Samhi- Vimarsha-Tippani Sahitha, Chaukambha tha,Chakrapani Datta Virachitha Ayurveda Samskritha Samsthan, Varanasi 1970, Ut- Deepika Vyakya,Chaukambha Orienta- tara Sthana 38/28. lia,Varanasi, 1970 ,Chikitsa Sthana 15 Kaviraj Dr Ambika Datta Sastry, Su- 30/27,28. sruta Samhitha, Hindi Vyakya- Vaigna- 6. . Kaviraj Dr Ambika Datta Sastry, Su- nika-Vimarsha-Tippani Sahitha, Chau- sruta Samhita, Hindi Vyakya-Vaignanika kambha Samskritha Samsthan, Varanasi Vimarsha-Tippani Sahitha, Chaukambha 1970, Uttara Sthana 38/27. Samskritha Samsthan, Varanasi 16.Pt.Kashinatha Shastri, Charaka Samhi- 1970,Uttara Sthana 38/25,27. tha, Chakrapani Datta Virachitha Ayur- 7.Aruna Datta, Astanga Hridayam With veda Deepika Vyakya, Chaukambha Sarvanga Sundaram Commentary. Chau- Orientalia, Varanasi, 1970, Chikitsa kambha Orientalia, Varanasi,7th/1982, Ut- Sthana 30/109. 4 www.iamj.in IAMJ: Volume 1; Issue 4; July – Aug 2013

Sulochana Arige: Karnini Yoni Vyapat in Ayurvedic Perspective 17 Pt. Kashinatha Shastri, Charaka Samhi- 22.K.R Srikantha Murthy(English trans- tha, Chakrapani Datta Virachitha lated), Vagbhata Astanga Hridayam,Vol- Ayurveda Deepika Vyakya, Chaukambha III Series 27, Chaukamba Das Orientalia, Varanasi, 1970, Chikitsa Academy, Varanasi. Sthana 30/70-73. CORRESPONDING AUTHOR 18. Atridev Gupta, Astanga Sangraha, Dr. Sulochana A. Chaukambha Orentalia, Varanasi 1979, Asst. Prof. of Prasuti&StreeRoga, Uttara Sthana39/64-66. Dr. B. R. K. R. Govt. Ayurvedic College, 19. Neelam, Mishra d.n et al M.D (Ayu) Hyderabad, Thesis, Ayu- Vol 30, No.2(Apr-June) #16-9-640/6/1, 2009, p 171-4, www. ayurveduniversity. Raghumareddy Street, edu.in/newsletters /ayu/ 2009_2/ 30212 Opp. Agriculture Training Institute, 20 . Kaviraj Dr Ambika Datta Sastry, Su- Race course road, Old Malakpet, sruta Samhita, Hindi Vyakya-Vaignanika Hyderabad – 500036, AP, India Vimarsha-Tippani Sahitha, Chaukambha Email:[email protected] Samskritha Samsthan, Varanasi 1970,Uttara Sthana 38/29-30 Source of support: Nil 21. Atridev Gupta, Astanga Sangraha, Conflict of interest: None Declared Chaukambha Orentalia, Varanasi 1979, Uttara Sthana39/72.

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