Dysfunctional Uterine Bleeding (DUB) is irregular uterine bleeding that occurs in the absence of recognizable pelvic pathology, general medical diseases or pregnancy. It reflects a description in normal cyclic pattern of ovulatory phase hormonal stimulation to the endometrial lining. The bleeding is unpredictable in many ways. It may be excessively heavy or light or prolonged, frequent or random. The concept of Asragdar is most important and fundamental principle in understanding the physiopathology of the disease. In Ayurvedic classics Asrogdar in which affect the women physically and mentally. The sign and symptoms mention in modern text are too much similar to the symptoms and sign mentioned in Ayurvedic text.
Keywords: Asragdur, Dysfunctional Uterine Bleeding, Pradar, Menstrual blood etc.
Asrogdar is sanskrit word which literally means bleeding from vagina during menses or inter menses. The concept of Asragdar is most important and fundamental principle in understanding the physiopathology of the disease. In Ayurvedic classics Asrogdar in which affect the women physically and mentally. Excessive flow of the menstrual blood is known as Asrogdar or Pradara (Menorrhegia).
Due to pradiran (excessive excretion) of raja (menstrual blood), it is named as pradar and since, there is diranasive excretion of asrk (blood) hence it is known as Asrgdara. As per above definition and description according to other Acharyas Asrgdar correlate with Menorrhagia.According to Charak and Chakrapani, Rakta (blood) gets mixed with raja, which affects to increase the quantity of raja.[2] According to Dhalanacharya, excessive and/or pronged blood loss during menstrual period is known as Asrgdar.
To know Asrgdar as per Ayurvedic text in detail.
To correlate with modern science.
To know the line of treatment accoring to ayurveda and modern science.
To decrease the hazards of hormonal therapy.
According to Charakthe woman who co sumes the excessive salty, sour, heavy, katu,vidahi, and unctuous, meat of domestic, aquatic and fatty animals, yasa curd, sukta, mastu, wine,etcdue to thisvata gets aggravated and withholding vitiated rakta which increases the amount of carries by rajovahidhamanya of uterus. This increased raja follows in excessive amount and called as Asrgdar. [3] According to MadhavNidan, Bhavprakash and Yogratnakar, Asrgdar can cause due to use of incompatible diet and wine, eating before the previous meal is digested, indigestion, abortion, excessive coitus, riding, walking, grief, emaciation, weight lifting, trauma and day sleeping. [4]Charaka has mentioned that, abnormalities of Ahara is the cause of Asrgdar, which can produce emaciation or obesity (sthaulya), it can damage the liver and pelvic congestion also. These factors lead to produce characters of Meno-merorrhagia. Other Acharyas, mentioned that, it can be correlated with poymenorrhagia. This is types of Dysfunctional Uterine Bleeding. Harita mentioned that, the Asrgdar occurs in infertile women due to Stanya formation. According to modern science when the level of prolactin increase the may be breast section occurs which leads to irregular menstrual cycle and when menses occurs there may be excessive bleeding.
According to Charak there are four types of Asrgdar.[5]
Vataj
Pittaj
Kaphaj
Doundavaj
AcharyaSushruta mention in Shonitchikistaadhayaasrugdar is treating according to Raktapitta.According to AstangsangrahaAsrugdar mention in yonirogadhyay. Astangkarmentioned five typesviz. vataj,pittaj, kaphaj, doundvaj and asrgdar.[6] According to AstangRaktajyonivyapad and Asrgdar are same. He quoted dueimportance to the colour of blood while describing the treatment. The colour indicates predominance of the doshas.
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Sushrutamention all types of asrgdar under general clinical features has not given any classification but the dominance of doshaobserves by colour of discharge. Vagbhat also not actually classified it specifically and gives importance to colour of discharge. As per all above asrgdar is a similar entity for raktayoni or asrajayonivyapad. Thesemay unequivocal words.These are the gynecological disorders which are characterized by blood discharge from vagina. Excessive and or irregular bleeding per vagina is a symptom of irregular pathology of anatomic components of reproductive system. That is inflammation; tumors, myohyperplasia, pelvic congestion, endometriosis, etc are occurring due to estrogens progesterone imbalance. It may occur due to psychosis of women. Symptoms of dysfunctional uterine bleeding:
Intermenstrual PV spotting or bleeding.
Very short or prolong periods.
Heavier bleeding (such as passing large clots, needing to change protection during the night, soaking through a sanitary pad or tampon every hour for 2 - 3 hours in a row)
Bleeding more than normal or excessive.
Hormonal changes can cause Dysfunctional Uterine Bleeding which has symptoms like Hirsutism, felling of hot all over body, Change in the mood,dryness in vagina. A woman may feel tired or have fatigue if she loses too much blood over time this may cause anemia.
AcharyaCharaka has mentioned the specific etiology along with clinical feature with its types. Sushrut and Vagbhat also describe it in Shonivarnaniya and Shiravedhaadhaya.
When a woman consumes vata aggravated diet or vihar. The aggravated vata withholds the blood products to form vatajAsrgdar. The following sign and symptoms are seen asmenstrual blood is frothy, thin, rough, blackish, and reddish, like palashpushpadhavan, with or without pain, may pain at cardiac region, flanks, back and pelvis. [7]Sushrut and Vagbhat mentions frothy, reddish, blackish colour, rough, thin, limped, quicky, smell is like iron and cold. [8]VatajAsrgdar is charctarised with severe pain and pain due to hyperplasia of pelvic congetion syndrome.
According to Charak it is occur due to aggravation of pitta and pitta prakopak diet. Its symptoms and sign are as follows menstrual blood is blue, yellow, green, blackish in colour, hot, profuse amount, repeatedly and with pain. The associated symptoms are burning sensation, redness, thirst, mental confusion, fever, giddiness, etc. [9]Sushrut and Vagbhat mentions, yellow, green, blackish or resemble the water mixed smoke or colour of cow urine, fishy smell, and bitter tatse, do not coagulate.[10] Practically is very difficult to mention blue, yellow, green colour. But the other symptoms mention can correlate with menorrhagia due to inflammatory condition of reproductive system. But according to the description of other author it can correlate with menometrorrhagia.
According to Charak it is occur due to aggravation of kapha and kaphaprakopak diet. Its symptoms and sign are as follows Menstrual blood is slimy, pale, heavy, unctuous, mixed with mucous, thick, with pain, vomiting, anorexia, nausea, dyspnea, cough, intermentrual bleeding. [11]Sushrut and Vagbhat mentions water mixed with red ocher, unctuous, cold, thick, very slow, clotted, etc.[12] According to all sign and symptoms menorrhea can be correlate with tubercular or chronic endometritis. SannipatajAsrgdar According to Charak it is occur due to aggravation of tridosh and tridoshprakopak diet. Its symptoms and sign are as follows. Menstrual blood is forceful discharge, foul smelling, burning sensation, slimy, yellowish, unctuous, continuous, thirst, fever and anemia. [13]Sushrut and Vagbhat mentions featuresof all three doshas.[14] According to all sign and symptoms it can be correlate with cervical carcinoma with endometriosis.
According to Charak it is not mention Sushrut and Vagbhat mentions features of all two doshas.[15]
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| Menorrhagia | Prolonged or excessive bleeding at regular intervals |
| Metrorrhagia | Irregular,frequent,uterine bleeding of varying amount but |
| not excessive | |
| Polymenorrhea | Regular bleeding at intervals of less than 21 days |
| Amenorrhea | No uterine bleeding for at least 6 months |
| Intermenstrual | Uterine bleeding between regular cycles |
Sanipataj type is incurable othertypes are kastasadhya. Weakness ,excessive bleeding, giddiness, mental confusion, feeling of darkness, dyspnea, thirst, burning sensation, delibrium, anaemia, drowsiness and convulsion are some complications mentioned in the texts.
General treatment: - according to SharangharSamhita astringent drugs. Rakatastambhak and pitta shamak treatment is also useful.
Externally used drugs: - Vagranakhi, Satpushpa,etc.
Bastitherapy-Chandanadi, rasnadi, madhukadi, kushadi, rodharadi, mustadi drugs.
Internal medication:- darvyadikwath, dhatkyadi , tanduliyamulakalka, kushmulakalkabal, ashok, indrayav, etc
As per all above description from Ayurvedic Samhitas and discussion we are trying to evaluate the actual concept of Asrgdar. We try to correlate it on modern basis. Its sign, symptoms, types, etc are described as per all Acharyas. The sign and symptoms mention in modern text are too much similar to the symptoms and sign mentioned in Ayurvedic text. So as per this we may give treatment to cure it. The therapy mention inAyurveda is non-hormonal. Thehormonal therapy mention in modern can effect on woman’s health. By knowing Asrgdar we can reduce the hormonal hazards.
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