Role of Sharapunkha moola churna with Tandulodaka Anupana in Menorrhagia (Asrigdara)-A Case report

EISSN: 2320-7329 ABSTRACT Menorrhagia is a most common gynecological problem found in gynaec OPD. It is not a disease but it is symptom found in many gynecological disorders. Menorrhagia is characterized by the excessive bleeding per vaginum in amount and duration both. In Ayurvedic classics, Menorrhagia is termed as ‘Asrigdara’, means excessive discharge of blood per vaginum, backache, pain in lower abdomen and weakness are also present in this disease. Asrigdara, also known as Raktapradara, is mainly due to vitiation of Vata, Pitta and Rakta dosha hence, the treatment should be based on the use of drugs which are having predominance of Kashaya and Tikta rasa. They are known as best astringent and because of this property they plays important role in relieving bleeding discharge due to its Stambhana action. In Ayurveda classics, many preparations can be used for management of Asrigdara by considering factors such as parity, age & desire of patient with regard to contraception, future pregnancy etc. Which are nonhormonal, non-surgical & most effective without side effects and also cost effective. In this case, Sharapunkha (i.e. Tephrosia purpurea, Pers) mula Churna with Tandulodaka was selected for screening and re-establishing its specific effect in the management of Menorrhagia.


INTRODUCTION
Normal menstrual bleeding is cyclic, 3-5 days durations and 50-60 ml with its normal color as described in Ayurvedic classics. But when normal menstrual bleeding pattern is altered in reference of duration, amount, color and cycle, the conditions are called Artavadushti and Menorrhagia is being one of them. Menorrhagia can occur due to many reasons, including menstrual cycle, emotional stress, nutritional status, infections, pregnancy, usage of medications including birth control pills, and sexual arousal. In Ayurvedic classics, all the gynecological disorders come under the heading of 'Yonivyapad'. Most of the Yonivyapada have characteristic features of menorrhagia such as Raktayoni, Rudhirkashara, Putraghni, Apraja etc. Among Ashtaartavadushti, in Raktaja artava-dushti, menorrhagia is also found as prominent symptom .The word Asrigdara has described in Bruhattrayee for excessive bleeding per vaginum. Asrigdara (Menorrhagia) is not a disease, but a

Role of Sharapunkha moola churna with Tandulodaka Anupana in Menorrhagia (Asrigdara) -A Case report
Pradipkumar B. Giri 1 *, Jaimala Annasaheb Jadhav 2   But these treatments may cause many side effects; also these are very expensive and invasive. To minimize such side effects as well as to cure disease and to prohibit occurrence of secondary disease, an attempt is made to manage this condition by ayurvedic approach which is less expensive and non invasive also. Sharapunkha moola having vata-pitta alleviating properties; it is claimed as possessing Raktastambhana karma. Therefore, Sharapunkha moola was selected for the study for screening and reestablishing its specific effect in the management of Menorrhagia.

AIM:
To study the effect of Sharapunkha moola churna in Menorrhagia (Asrigdara)

OBJECTIVES:
 Dalhana tika on S.S. [9] burning sensation in lower portion of groin, pelvic region, back, renal region and flanks and severe pain in uterus 4 Ashtanga Sangraha [10] excessive bleeding during menstrual or intermenstrual period as symptom of Asrigdara Classification of Raktapradara: Most of acharyas have mentioned four types of Asrigdara in their texts. Charaka has described four types of Asrigdara i. e.

Vataja, Pittaja, kaphaja and Sannipataja
Asigdara. [11] Sushruta has mentioned all types of Asrigdara along with general clinical features of Arigdara but has not described any classification. [12] Management of Asrigdara: The drugs used in treatment of Asrigdara are mainly rich in Kashaya rasa and Tikta rasa because both of these have the property of astringent i. e. Stambhana guna, due to astringent property, bleeding will be checked. Then the next aim of treatment should be rising of blood for that Raktasthapana drugs should be used.  According to Bhaishajya ratnavali, [13] Sharapunkha moola churna 5 gm twice a day with Tandulodaka (rinsed rice water) Anupana before meal for 7days. Advised healthy diet and hetu (causative factors) was avoided which observed in patient. Preparation method of Tandulodaka: 20gm rice + 160 ml drinking water added and kept for whole night. Then it used as Tandulodaka.

DISCUSSION
Menorrhagia is one of the common symptoms seen in gynecology. Menorrhagia have effects on personal, physical, mental, social family and work life of women and thereby reduces their quality of life. [15] In some cases, the cause of heavy bleeding is unknown, but a number of conditions may cause menorrhagia like Hormonal imbalance, PCOS, Adenomyosis, Dysfunction of ovaries, Uterine fibroid, Polyp, Endometrial cancer, DUB, inherited bleeding disorders etc. [16] Excessive or prolonged bleeding can be lead to Anemia and more complications. So need to care, early diagnosis and management. Today's sedentary lifestyle affects woman's reproductive health it is one cause behind Menorrhagia. In Ayurvedic classics, Asrigdara is very well correlated with menorrhagia in modern medicine. Asrigdara is very severe and life threatening condition which may be fatal to the patient if not treated properly and timely. In Asrigdara management, Sharapunkha drug has advised with rinsed rice water (1pal rice + 8 fold water), termed as Tandulodaka. It is the subtype type of Hima kalpana described by Acharya Sharangadhara. [17] Tandulodaka is kashaya and madhura in rasa, therefore helpful to increase the haemostatic action (Rakta-stambhaka) of Sharapunkha. Sharapunkha mula has Tikta and kashaya rasa (both have astringent property) with laghu-ruksha guna and pleehaghna prabhava, so it act as haemostatic by constricting the capillaries and prevents the bleeding. It acts as anti-inflammatory, analgesic, anti-microbial, anti-bacterial, hepatoprotective, antioxidant in action. In this case patient had complaint of mild fever and fatigue, it was due to heavy bleeding. Patient started to take Sharapunkha moola churna with Tandulodaka from 5 th day of her menstrual cycle. Day by day significant effect was seen. As soon as bleeding stopped, her fatigue and mild fever get reduced.

CONCLUSION
Today's sedentary lifestyle causes vitiation of Rakta, Pitta and Vata which are the dushya and dosha of Asrigdara respectively. Sharapunkha moola churna with Tandulodaka has significant role in the bleeding disorder like Menorrhagia (Asrigdara) . It acts as haemostatic, anti inflammatory, analgesic, due to its astringent property, Vata shamak and kapha shamak action. Further investigation is required to identify the effect of Sharpunkha moola churna with Tandulodaka in the management of Menorrhagia and also study its mechanism of action in larger sample size.