Mehetre K, Jarange M. Effect of Agneya Aahara Dravyas in the management of Rajkshinata (Hypomenorrhea) - A Case Study. INTERNATIONAL JOURNAL OF RESEARCH IN AYURVEDA AND MEDICAL SCIENCES Peer Reviewed ISSN: 2582-2748 Indexed journal Vol 3, Issue 3. (Jul - Sept 2020) Case Study https://www.ijrams.com EFFECT OF AGNEYA AAHARA DRAVYAS IN THE MANAGEMENT OF RAJKSHINATA (HYPOMENORRHEA) - A CASE STUDY. Kaustubh Mehetre,1* Mangesh Jarange.2 1. M.S. (Prasutitantra-Streerog), Assistant Professor, Dept. of Prasutitantra-Streerog, SVNHT’s Ayurved College, Rahuri Factory, Dist. Ahmednagar, MS, India. 2. M.S. (Prasutitantra-Streerog), Associate Professor, Dept. of Prasutitantra-Streerog, PMT’s Ayurved College, Shevgaon, Dist. Ahmednagar. Received on: 28/08/2020; Revised on: 22/09/2020; Accepted on: 24/09/2020

ABSTRACT is a normal physiological periodic and cyclic process. Menstruation begins in teenag- er girls which starts at or after age of 11 years. Due hormonal changes different symptoms occur before , during the menstrual cycle and after menstrual cycle. Rajakshinata (Hypomenorrhea) is one of the menstrual diseases. In present case study a young unmarried female of Hypomenorrhea was suggested few dietary regimens viz. Kulitha (Macrotyloma uniflorum Lam.), Tila (Sesamum indicum Linn.) and Mash (Vigna mungo L.) in daily diet along with Drakshasava. All these foodstuffs are ushna (hot) in properties. Such Agneya dravyas (ushna gun- atmak) were used due to Santapanjanya samprapti observed in patient. Irregularity was improved by 66%, Amount of bleeding was improved by 50%, Period of menstruation was improved by 100% and Pain during menses was improved by 75%. Overall, we labeled it as moderate improve- ment. Large scale data is needed to have a strong evidence and to minimize biases. Dietary regi- mens explained in Ayurvedic classical texts are effective to treat various clinical conditions. Keywords: Rajkshinata, Hypomenorrhea, Menstrual disorders, Agneya ahara dravyas.

1. INTRODUCTION logical conditions in which female experience Woman is responsible of good and some difficulties such as , Amen- healthy generation. In that perspective Yoni orrhea, Menorrhagia, Hypomenorrhea, Poly- (vagina) should be healthy. Yoni is important menorrhagia, and Premenstrual organ in health of woman during and after her syndrome. reproductive life as vitiation of yoni is consid- Normal range of menstrual cycle is stat- ered as vitiation as Kshetra which hampers re- ed to be 28 to 35 days with difference of 2 to 3 productive life of female.1 Menstruation is a days. Normal range of duration of menstrual normal physiological periodic and cyclic pro- flow is 3-8 days. Expected average blood loss is cess. Menstruation begins in teenager girls 30-80 ml per day.3-6 Disorders of menstrual cy- which starts at or after age of 11 years. It is hor- cle regarding its irregularities are very common monal control process in which loss of blood in daily clinical practice among female of repro- through vaginal canal occurs. Due hormonal ductive age especially in adolescents before changes different symptoms occur before men- marriage. As per previous studies 27% of young strual cycle, during the menstrual cycle and af- females suffers from . ter menstrual cycle.2 Menstruation depends on Almost 22% young females suffer from men- general health status of the girl, nutritional con- strual abnormalities and almost 90% suffer dition and genetic factor. There are some patho- from dysmenorrhea.7 In dysmenorrhea periods

*Corresponding Author: Kaustubh Mehetre. Email: [email protected].

232 Mehetre K, Jarange M. Effect of Agneya Aahara Dravyas in the management of Rajkshinata (Hypomenorrhea) - A Case Study. INTERNATIONAL JOURNAL OF RESEARCH IN AYURVEDA AND MEDICAL SCIENCES Peer Reviewed ISSN: 2582-2748 Indexed journal Vol 3, Issue 3. (Jul - Sept 2020) Case Study https://www.ijrams.com are painful along with severe spasmodic pain cant abnormality. She found hemodynamically during menstruation. If menstrual period is in- stable. Family history shown than both her frequent and gets delayed beyond 35 days it is Mother and Grandmother were suffering from termed as Oligomenorrhea. Hypomenorrhea is Oligomenorrhea and Dysmenorrhea. Obstetrics different condition in which volume of uterine family history was sound. bleeding is less (blood loss below 30 ml per 2.2. Examination cycle8) or duration of menstrual blood flow is less than 2 days or both. 2.2.1. Samanya Pariksha (General Examina- tion) In Ayurveda the pathological conditions related to menstruation are explained as ex-  Nadi: Vata Pradhan, Guru plained as rajdusthi, rajkshinata, raktapradar  Mala: Asamyaka, Kwachit malabaddhata and so on. Hypo menorrhea condition can be  Mutra: Avishesh considered and correlated as Rajkshinata. Irreg-  Jivha: Ishat sama ular menstruation, less amount of bleeding and  Angi: Manda and occasional Vishama pain are the characteristics of Rajkshinata.9 The  Koshtha: Madhyama Rajkshinata can be managed with the help of  Prakruti: Vata Pradhan, Pittanubandhi, Sanshodhan i.e. Panchakarma (body purifica-  Pulse: 76 per min tion) and use of Agneya dravya (drug having 10  BP: 124/78 mm of Hg. Ushna guna i.e. hot in properties). The variety  Weight: 54 kg. of medicinal treatment options are available to treat Rajkshinata (hypomenorrhea). Many fe- 2.2.2. Gynecological Examination males don’t like or are not willing to take  : At the age of 14 years drugs. Few don’t afford cost of treatment.  Marital status: Unmarried There are many side effects of the hormonal  Menstrual History: Menstrual cycle rang- treatment. Dietary regimens can be followed at ing from 28 to 34 days, Irregular, Painful home and very easy. Ahara (Diet) is important and Scanty. Duration: 1 to 2 days and Ir- as per Ayurveda philosophy. Diet is mentioned regular. as regimen in various diseases of Ayurveda as  Per vaginal examination: Not done proper diet balances Tridosha helps in cure.11 and Here in this case simple diet regimens were 2.2.3. Investigations used which having agnyeya property as men-  CBC: within normal limits 10 tioned by Sushrutacharya. We observed die-  Urine Routine and Microscopic: within tary regimens effective. The study will be help- normal limits ful for further research in the stream of Ayurve-  USG Abdomen and Pelvis: no significant da chikitsa in the management of Rajkshinata. abnormality 2. CASE REPORT  Thyroid function test: within normal limits 2.1. Case History 2.2.4. Dietary regimen advised (Ahara A young unmarried female patient of 18 chikitsa) years old having with Hypomenorrhea came to The Agneya dravya viz. Kulitha (Macrotyloma OPD of Strirog and Prasutitantra. She was hav- uniflorum Lam.), Tila (Sesamum indicum ing symptoms viz. Aniyamita Rutu (Irregular Linn.), Mash (Vigna mungo L.), Asava menstrual cycle), Alparajastrava matra (Less (Drakshyasav)12 were given in regular diet for amount of bleeding), Alparajastrava avadhi three months. Patient was allowed to prepare (Less bleeding period) and Kati-udar shool recipes of above food stuffs as per her choice (Low back and abdominal Pain). Details gyne- and advised to consume them at least once a cological examination revealed no other signifi- daily. Ushirasava was given 15 ml BD after

233 Mehetre K, Jarange M. Effect of Agneya Aahara Dravyas in the management of Rajkshinata (Hypomenorrhea) - A Case Study. INTERNATIONAL JOURNAL OF RESEARCH IN AYURVEDA AND MEDICAL SCIENCES Peer Reviewed ISSN: 2582-2748 Indexed journal Vol 3, Issue 3. (Jul - Sept 2020) Case Study https://www.ijrams.com meal twice (Adhobhakta aushadha sevan Grade 0 to Grade 10 was used. 13 kala ). Follow up was taken every month and 4. RESULTS AND DISCUSSION progress was recorded. 4.1. Overview of Hypomenorrhea 2.2.5. Assessment of symptoms In hypomenorrhea less than 30 ml of blood is Aniyamita Rutu (Irregular menstrual cycle), Al- lost. Some causes and indicators of hypo men- parajastrava matra (Less amount of bleeding), orrhea can be enlisted as pregnancy, weight Alparajastrava avadhi (Less bleeding period) gain or loss, stress, hypothyroidism, use of birth and Kati-udar shool (Low back and abdominal control measures (OC pills, IUCD etc.), certain Pain) were symptoms under assessment. Symp- medical conditions (cervical stenosis, PCOS), toms were graded for ease of assessment as fol- menopausal syndrome etc. According Ayurveda lows. Assessment of symptoms was done for literature, Atisanshodhan, Atishaman, four consecutive cycles after administration of Vegdharan, Asatmya annasevan, Manastap, Ahariya dravyas. Avyayam, Anashan, Atimaithun are enlisted as Aniyamita Rutu (Irregular menstrual cycle)14 hetus (etiological factors) of Rajkshinata.17 Ab- normal variation in duration of menstrual cycle  Grade 0: Regular menses on defined date is termed as irregular menstrual cycle. Variation  Grade 1: Variation up to 8 days in men- in menstrual cycle up to maximum 8 days be- strual cycle tween shortest and longest menstrual cycle is  Grade 2: Variation of 8 days to 21 days in considered as mild variation, variation in men- menstrual cycle strual cycle ranging from 8 to 20 days is consid-  Grade 3: Variation of days 21 days or more ered as moderate variation and variation in in menstrual cycle menstrual cycle 21 days or above is considered Alparajastrava matra (Less amount of bleed- as severe variation.14 The average blood loss ing) with menstruation for normal women is ≤30 ml and menstrual blood loss more than 80 ml is  Grade 0: Blood loss about 35 to 50 ml8 (5 considered abnormal.18 The Normal duration of to 7 pads during period) menstruation is considered 4 to 8 days with av-  Grade 1: Blood loss about 20 to 35 ml (3 to erage duration 5 to 6 days.15 Mild-bearable pain 5 pads during period) before, during and after menses is common but  Grade 2: Blood loss about 05 to 20 ml (1 to increased severity of pain indicates abnormali- 3 pads during period) ty.  Grade 3: No or minimal blood loss up to 5 ml (No or 1 pad during period) 4.2. Assessment of symptoms Alparajastrava avadhi (Less bleeding period) In present case Irregularity of menstrual cycle 15 was Grade 3 at baseline which was reduced up to Grade 1 at the end of 4th cycle. Change ob-  Grade 0: Menstrual duration of 4 to 8 days served in Irregular menstruation was 66%.  Grade 1: Menstrual duration of less than 3 Amount of bleeding was Grade 2 at baseline days while Grade 1 at the end of 4th cycle. Change  Grade 2: Menstrual duration of less than 2 observed in Amount of bleeding was 50%. Peri- days od of bleeding was Grade 2 at baseline while  Grade 3: Menstrual duration of less than 1 Grade 0 at the end of 4th cycle. Change ob- day served in Period of bleeding was 100%. Pain during menses was Grade 8 at baseline while Kati-udar shool (Low back and abdominal th Pain)16 Grade 2 at the end of 4 cycle. Change ob- served in Pain during menses was 75% (Table  VAS pain assessment scale ranging from No. 1). Overall, we observed moderate relief in

234 Mehetre K, Jarange M. Effect of Agneya Aahara Dravyas in the management of Rajkshinata (Hypomenorrhea) - A Case Study. INTERNATIONAL JOURNAL OF RESEARCH IN AYURVEDA AND MEDICAL SCIENCES Peer Reviewed ISSN: 2582-2748 Indexed journal Vol 3, Issue 3. (Jul - Sept 2020) Case Study https://www.ijrams.com all symptoms by administration of dietary regi- ment dietary measures mentioned in Ayurveda mens. are effective. Proper detection of Hetus and proper diagnosis of samprapti of disease is al- 4.3. Mode of action of Agneya dravyas ways helpful in the management. Along with Rajakshinata (Hypomenorrhea) is Vata pra- dietary management Shodhan and Shaman dhan vyadhi. It reflects Rasa dhtwagnimandya chikitsa will give more promising results. and Rasa dhatukashaya as prime pathological REFERENCES factors. Hetu may be santarpan or apatarpan. In present case sedentary lifestyle, weight gain, 1. Jarange M, Mehetre K, Wagh K. Effect of habit of fast food and lack of exercise along Ayurveda management in Shweta Pradara – with stress were Hetus which gave rise to Rasa A Case Study. International Journal of Re- dhtwagnimandya and Rasa dhatukshaya due to search in Ayurveda and Medical Sciences Santarpanjanya samprapti. Hence it was decid- 2019; 2 (4): 271-276. ed to use Agneya dravyas as dietary regimen. 10 2. D.C. Dutta. Text book of Gynaecology. The dravya Kulitha, Tila, Mash, Asav Menstruation, 6th ed. New Delhi: Jaypee (Drakshyasav) are having tikshna, ushna, Brothers, 2014; p. 84 laghu, sukshma properties.19 These properties 3. Mehetre KD, Bhalgat MS - Randomized of dravyas leads to Strotoshodhan, Agnivruddhi Controlled Study to evaluate efficacy of and Pittavridhi. This help to improve jatharag- ‘Amalaki Rasanjana Haritaki Choorna’ in ni and in turn rasa dhatwagni of patient. After Asrigdara. International Journal of Research agnivruddhi and Strtoshodhan vitiated Vata in Ayurveda and Medical Sciences 2018; 1 returns to its normal space giving rise to Kapha (1): 27-35. vruddhi and balanced state of Tridosha is 4. Ibidem 2, Menstruation. p. 79 achieved. Sura (Drakshyasav) is having laghu, 5. Jarange MB, Shirsath AD. Randomized sukshma, sukshma strotogamitva and strosho- Controlled Study to evaluate efficacy of dhan properties. Mode of actions is the same as ‘Yashtimadhu-Sita Choorna with Tandu- explained earlier. lodak’ in Asrigdara. International Journal of 4.4. Scope and Limitations Research in Ayurveda and Medical Sciences 2018; 1 (2): 98-104. Present study was carried out in a single case of 6. Mehetre K, Jarange M, Wagh K. To study Rajkshinata (hypomenorrhea). Though we ob- effect of Boladi Vati in Atyartava – A Case served good result this cannot be considered as Study. International Journal of Research in an evidence. Study on large scale is much need- Ayurveda and Medical Sciences 2019; 2 ed. As Rajkshinata depends on various factors (4): 265-270. result may be very with these individual fac- tors. We have to consider Hetu, Prakruti, Type 7. Rafique N, Al-Sheikh MH. Prevalence of of samprapti etc. factors. Agneya dravyas may menstrual problems and their association not be useful in Rasakshaya due to pitta pra- with psychological stress in young female dhan samprapti or apatarpanjanya samprapti. students studying health sciences. Saudi To reduce error, we have to work on large scale Med J. 2018 Jan;39(1):67-73. doi: data. Single case study never provides conclu- 10.15537/smj.2018.1.21438. PMID: sive proof to deal with typical patients of typi- 29332111; PMCID: PMC5885123. cal illness, but new dimensions of research are 8. Long WN. Abnormal . In: definitely disclosed by such studies. Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, 5. CONCLUSION and Laboratory Examinations. 3rd edition. It can be concluded with the help of this single Boston: Butterworths; 1990. Chapter case study that rather than medicinal manage- 173. Available from: https://

235 Mehetre K, Jarange M. Effect of Agneya Aahara Dravyas in the management of Rajkshinata (Hypomenorrhea) - A Case Study. INTERNATIONAL JOURNAL OF RESEARCH IN AYURVEDA AND MEDICAL SCIENCES Peer Reviewed ISSN: 2582-2748 Indexed journal Vol 3, Issue 3. (Jul - Sept 2020) Case Study https://www.ijrams.com www.ncbi.nlm.nih.gov/books/NBK282/. Pattern of Menstrual Irregularities amongst Last accessed on 12.8.2020. Women Presenting to Gynecological Outpa- 9. Dr Ambikadatta Shashtri Editor (Reprint tient Department. Journal of Islamabad ed.). Shushruta Samhita of Sushruta (Vol Medical & Dental College (JIMDC); 2013:2 1), Sutrasthana: Chapter 15, Verse 16. Va- (1):9-12 ranasi: Chaukhambha Sanskrit Sansthan, 16. Haefeli M, Elfering A. Pain assessment. Eur 2005; p. 59. Spine J. 2006 Jan;15 Suppl 1(Suppl 1): S17- 10. Ibidem 8 (Vol 1), Sutrasthana: Chapter 15, 24. doi: 10.1007/s00586-005-1044-x. Epub Verse 16. p. 59. 2005 Dec 1. PMID: 16320034; PMCID: 11. VS Kad, MB Tupe, SB Pawade. A Review PMC3454549. on Basic Principals of Balanced Diet by 17. Shri Dalhanacharya, Nibandh samgraha, Ayurveda: Ahara Vidhi Vishesh Ayatan. Sushrut Samhita, Chaukhamba surbharti International Journal of Research in Ayur- prakashan, Varanasi, 2003, su.15-7, p.68. veda and Medical Sciences 2019; 2 (2): 88- 18. Marret H, Fauconnier A, Chabbert-Buffet 93. N, Cravello L, Golfier F, Gondry J, et al. 12. Ibidem 8 (Vol 2), Sharirasthana: Chapter 2, Clinical practice guidelines on menorrhagia: Verse 23. p. 13. management of abnormal uterine bleeding 13. Gite YA, Bangar SK. A Conceptual Study before . European Journal of Ob- to Review Clinical Approach of stetrics & Gynecology and Reproductive Biology 2010;152(2):133–137. ‘Adhobhakta’ Aushadha Sevana Kala. nd Ayurlog: National Journal of Research in 19. Dr. Ganesh krushna Garde Editor (2 ed.). Ayurved Science-2014; 2(4):11-20. Sartha Vaghbhat Marathi Commentary on 14. Hypomenorrhea. Available from https:// Ashtang Hruday of Vagbhat. Sutrasthana: en.wikipedia.org/wiki/Hypomenorrhea. Chapter 9. Pune: Amol Prakashan, 1999; Last accessed on 12.8.2020. p.45. 15. Mahreen Mahmood1 and Nadia Jabeen2. TABLES

S Symptoms Follow up wise grade N Baseline 1st cycle 2nd cycle 3rd cycle 4th cycle 1 Aniyamita Rutu 3 3 2 2 1 (Irregular menstrual cycle) 2 Alparajastrava matra 2 2 2 1 1 (Less amount of bleeding) 3 Alparajastrava avadhi (Less 2 2 1 1 0 bleeding period) 4 Kati-udar shool 8 7 6 4 2 (Low back and abdominal Pain)

Table No. 1 Follow up wise observation table Cite this article as: Mehetre K, Jarange M. Effect of Agneya Aahara Dravyas in the management of Rajkshinata (Hypomenorrhea) - A Case Study. International Journal of Research in Ayurveda and Medical Sci- ences 2020; 3 (3): 232-236. Source of Support: Nil; Conflict of Interest: None declared.

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