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Leucorrhea & FR

International Journal of Ayurveda and Pharma Research- by Vijay Lakshmi^1*,
Ramesh Kumar Gupta²

a) Abstract

b) Introduction

c) Etiopathogenesis

d) Clinical Features

e) Investigations

f) Treatment

g) Discussion

h) Conclusion

i) References

Abstract

Gynecology is the medical practice dealing with the health of the female reproductive system literally means "the science of women". Woman has a unique existence in the universe created by the God. Women’s health is the pivot not only for the healthy and happy status for her family, rather to the whole society or even to the nation at large. All women have experienced some short of vaginal discharge in her life span. White vaginal discharges along with the other symptoms like feeling of weakness, pain in the back and calves, loss of vital fluids, pruritis on and around the vulva, thighs and thigh joints etc., comes under the heading of Leucorrhoea, which is described as Sweta Pradara in Ayurvedic classics. In Samhitas all gynecological disorders comes under the headings of Yonivyapada. No any description of Sweta Pradara has been described by scholars of Brihatrayee. For abnormal white vaginal discharges, the word Sweta Pradara has been described in texts during and after medieval period.

Key words :Pradara, Leucorrhoea, Yonivyapada.

Introduction

Women status was expected to reach new horizons both socially and physically with the coming of new millennium. But some of the physiological things like menstruation, pregnancy, vaginal discharges, recurrent urinary infections and other sexually transmitted disorders trouble women making them slow down. Amongst these problems, abnormal vaginal discharge is the most common factor which creates irritation in women freedom. Normal vaginal discharge may appear clear, cloudy white and without any types of smell. Changes in normal discharge can be caused by many reasons such as menstrual cycle, emotional stress, nutritional status, pregnancy, usage of medications - including birth control pills and sexual arousal. The menstrual cycle affects the vaginal environment i.e. ph of vagina. You may notice increased wetness and clear thick discharge around mid-cycle. The pH balance of the vagina fluctuates during the cycle and is the least acidic on the days just prior to and during menstruation. Infections, therefore, are most common at this time.

Any changes in color, consistency, amount, smell of discharge may be a sign of a vaginal infection. Vaginal infections are very common during reproductive period of women. Ayurveda, an ancient science of life is enriched with the knowledge of gynecological disorders related to vaginal discharges which may be blood stained or pinkish, mucoid, purulent, white-thin, thick, curdy or watery. White vaginal discharges is known as Swetapradara in Ayurvedic classics.

The “word” Sweta pradara has not described in Brihatrayee i.e. Charaka Samhita, Sushruta Samhita, Astanga Hridaya and Astanga Sangraha. For white vaginal discharge, the word Sweta Pradara has described in Sharangadhara Samhita, Bhava Prakash, Yoga Ratnakara and in commentary on Charaka Samhita by Chakrapani. Sweta Pradara (Leucorrhoea) is not a disease, but a symptom of so many diseases. Sometimes this symptom becomes so severe and it overshadows the other symptoms of actual disease and patients come to O.P.D. for the treatment of only this symptom.

Etiopathogenesis

Since Sweta Pradara is a symptom, not a disease, hence etiopathogenesis of principal disease would be etiopathogenesis of Sweta Pradara also. On the basis of clinical features, it seems to be a Kaphaja disorder of female genital organ because Kapha dosha is main causative factor for any discharge. So, it may be said that Kapha aggravated due to its own vitiating factors, produces white and painless vaginal discharges due dominance of its liquid property by vitiating the Rasadhatu of reproductive system in the presence of Sweta Pradara causing factors such as excessive coitus, abortion, improper mode of life and dietetics during menstruation and Ritukala along with non-cleanliness of vagina.

Clinical Features

Wetapradara or Leucorrhoea or white vaginal discharge is a symptom which is found in all Yonivyapads (Gynecological disorders) those are arising due to vitiation of Kapha and Vatakapha (Atyananda, Karnini, Acharana, Aticharana, Sleshmala, Upapluta and Prasramsini Yonivyapada). Swetapradara is a condition characterized by white vaginal discharges not associated with pain, burning sensation and mixed with other colors, thus it seems to be the description of leucorrhoea. The patient feels weak, run down, has pain in the back and calves, loss of vital fluids, itching pruritis on and around vulva, thighs and thigh joints. In mature ladies, inflammation of uterus (following childbirth) or its displacement or some venereal disease (especially gonorrhoea) may also trigger and hasten lucorrhoeal flow. In young females, thread worms may cause onset of this disorder. Chronicity of disorder may lead to cancerous growth; hence it is necessary that actual cause is fully determined and deduced before initiating treatment.

Investigations

The following investigations should be done to confirm the diagnosis and for proper treatment to cure the disease.
1. Cytological examination (Pap smear)
2. Cervical Punch Biopsy
3. Cervical culture
4. Haematological investigation: Hb%, TLC, DLC, ESR etc.
5. Serological investigations: VDRL, HIV
6. Urine examination: Routine & microscopic

Treatment

The principle of Ayurvedic treatment of Sweta Pradara is mostly based on its etiopathogenesis. As Kapha is main causative factor for vaginal discharge. Restoration of Agni (digestive fire) in order to cleanse the accumulated toxins and bring kapha dosha back towards equilibrium and tone up the muscles of reproductive organs with the help of rejuvenating herbs are considered main principle of treatment through Ayurveda.

Treatment consists of two headings
1.General treatment (line of treatment)
2.Specific treatment

General treatment
a. Treatment prescribed for Yonisrava under Yonivyapada chapter.
b. Symptomatic treatment of Yonisrava and Yonipachhilya.
c. Nidana parivarjan
d. Kaphanasak treatment
e. Uses of Drugs having Katu and Kashaya rasa
f. Balya chikitsa (use of Rasayana drugs)

Specific treatment

(1). Oral medicines

a. Pestled root of Rohataka (Tecoma undulata) should be taken with water^[1,2].
b. Use of Darvyadi (Barberis aristata etc.) decoction cures Swetapradara^[3].
c. Paste or powder of Amalaki or seed of Amalaki (Emblica officinalis Gaertn.) should be taken with honey and sugar^[1].
d. Paste of Lodhra (Symplocos racemosa Roxb.) should be taken with decoction of stem bark of Nyagrodh (Ficus bengalensis L.) ^[1].
e. Use of decoction of drugs of Nyagrodha group is beneficial due to its astringent property^[4].
f. Use of Nagakeshar (Mesua ferrea L.) with Takra (buttermilk) followed by diet of only cooked rice and Takra can cure leucorrhoea only within three days^[5,6].
g. Powder of root of Chakramard (Cassia tora L.) should be taken with Tandulodaka (rice-water) in the morning hours^[6].
h. Licking of powdered Shadawasa (a variety of Setaria etallica) mixed with oil of Tila for seven consecutive days cures leucorrhoea^[6].
i. Use of combination of Praval (Coral) Bhasma, Trivang bhasma with rice water relieves the leuorrhoea^[7].
j. Pushyanuga churna should be used with Tandulodaka mixed Madhu^[8].
k. Utpaladi churna should be used with Tandulodaka^[9].
l. Pradarantak lauha, Pradarantak rasa, Pradararipu rasa, Pradarari rasa, Pradarari lauha, Shitakalyanaka ghrita etc. are Rasaushadhi, mentioned in Bhaishajya ratnavali to cure the Sweta pradara^[10].
m. Asava-Arishta: Lakshmanarishta, Ashokarishta, Patrangasava and Lodhrasawa^[11].
n. Ghrita-Tail: Ashoka ghrita, Nyagrodhadi ghrita, Vishwavallabha ghrita and Priyangwadi taila^[12].
o. Kukkutandatwak bhasma 250mg with Madhu (honey) twice in a day^[13].

(2). Drugs for external or local use:

(A) Yoni Prakshalana
(I) Vaginal irrigation with decoction of stem bark of Lodhra (Symplocos racemosa Roxb).^[14]
(II) Vaginal irrigation with decoction of stem bark of Vata (Ficus bengalensis L.).^[14]

(B) Yoni Purana
(i) Use of a bolus of powdered bark of Plaksha (Ficus lacor Buch. Ham.) mixed with honey after oleating vaginal canal^[15].
(ii) Fine powders of Khadira (Acacia catechu (Linn. f.) willd.), Pathya (Terminalia chebula Retz. & Willd.), Jatiphala (Myristica fragrans Houtt.), Nimba (Azadirachta indica) and Puga (Areca catechu Linn.), triturated with soup of Mudga and used in vagina after drying the mixture^[16].

(C) Yoni-Varti
       (I) After oleating vaginal canal, suppository made with powdered Lodhra (Symplocos        racemosa Roxb), Priyangu (Callicarpa macrophylla Vahl) and Madhuka (Madhuca               indica J.F.Gmel.) mixed with honey or all drugs with Kashaya rasa prominence should        be used^[17].
       (II) A flaxen cloth impregnated with decoction of stem bark of Nyagrodha (Ficus               bengalensis L.) should be used^[17].
       (III) A flaxen cloth impregnated with decoction of stem bark of Lodhra (Symplocos               racemosa Roxb) and Vata (Ficus bengalensis L.). should be used^[17].

(D) Yoni-Dhupana
(I) Dhupana (Fumigation) with Sarala, Guggulu (Commiphora wightii (Arn.) Bhand) and Yava (Hordeum vulgare Linn) mixed with Ghrita should be done after oleating vaginal canal ^[18].
(II) Fumigation with Katu matsyaka (a type of fish) along with oil should be done after oleating vaginal canal ^[18].

Advised: Garlic, meat soup, all dairy products and rice water.

Forbidden: Sweet and sour fruits, nuts, and excess of salt.

Preventive Measures [19, 20]
Be healthy; eat well, get enough sleep, drink enough fluids.
Patients should wear condoms during sexual intercourse with new partners
Keep vaginal area clean and dry to prevent fungal infection.
Wear cotton undergarments.
Wipe from front to back after urination or bowel movement.
Avoid using deodorant pads or tampons.
Don't use petroleum jelly or other oils for lubricants.
Don't douche.
Use medication as long as directed.
Avoid sexual intercourse until treatment is completed and you are symptom free.
Don't scratch infected or inflamed areas; it can cause further irritation.
During an infection, use pads rather than tampons if menstruation occurs.
Avoid vulvo/vaginal irritants, including perfumed or deodorant soaps/body washes.
If symptoms persist after completing the treatment, an examination is indicated. Call for an appointment, and please use nothing in the vagina for 48 hours prior to your pelvic examination.

Discussion

A woman during her life span may have different types of discharges per vagina. The vagina serves as a passageway between the outside of the body and the inner reproductive organs. The pH balance of the vagina is acidic, which discourages infections from occurring. This acidic environment is created by naturally occurring bacteria. A healthy vagina produces secretions to cleanse and regulate itself, similar to how saliva cleanses and regulates the environment of the mouth. These vaginal secretions are normal vaginal discharge. Any interference with the delicate balance of vaginal secretions sets up an environment conductive to infection. Most common causes of leucorrhoea in modern are cervicitis, vaginitis, cervical erosion and bacterial vaginosis etc. White vaginal discharges is known as Swetapradara in Ayurvedic classics. In Ayurvedic classics, all gynaecological disorders including Swetapradara (leucorrhoea) come under Yonivyapada. Therefore, Yonivyapadas which are caused by Kapha or Vatakaphaja doshas are main causative factors of Swetapradara. Treatment of Swetapradara is mainly based on the use of drugs which are having predominance of Kashaya rasa and Kapha-shamaka property. Therefore, the drugs of Kashaya rasa dominance are mainly used locally and internally.

Conclusion

Sweta Pradara can be put parallel to Leucorrhoea in modern medicine on the basis of different symptoms. By improving the general health of women and increasing personal hygiene, we can prevent the incidence of Sweta-Pradara. Treatment of Swetapradara is mainly based on the use of drugs which are having predominance of Kashaya rasa and Kapha-shamak property. Balya chikitsa also play important role to prevent the incidence and to treat the present disease.

References

1. Achaya Charaka, Charak Samhita (Uttarardha), Hindi Translation by Pandit Kashinath Nath Shastri and Dr Gorakh Nath Chaturvedi, Reprint, Varanasi, Chaukhambha Sanskrit Series, 2002 p. 858.

2. Acharya Vagbhat, Astanga Sangraha, Sanskrita Commentary by Vaidya AnantDamodar Athawale, Pune, Shreemada Atreya Athawale, 1980, p. 838.

3. Acharya Sharandhara, Sharandhara Samhita, Dipika Hindi Commentary by Brahmanand Tripathi, Reprint, Varanasi, Chaukhambha Shubharati Prakashana, 2001, p. 149.

4. Acharya Sharandhara, Sharandhara Samhita, Dipika Hindi Commentary by Brahmanand Tripathi, Reprint, Varanasi, Chaukhambha Shubharati Prakashana, 2001, p 149.

5. Acharya Bhav Mishra, Bhav Prakash Nighantu, Uttarkhanda, Hindi Commentory by Shree Brahma Shankar Mishra, 4th edition, Varanasi, Chaukhambha Vishwabharati, 1988. p. 764.

6. Yoga Ratnakar: Hindi Commentory by Achrya Laxmipati Shastri, Published by chaukhambha Sanskrita Series Office, Varanasi. 2nd Edition, 1973 p. 246.

7. Yoga Ratnakar: Hindi Commentory by Achrya Laxmipati Shastri, Published by chaukhambha Sanskrita Series Office, Varanasi. 2nd Edition, 1973 p. 246.

8. Achaya Charaka, Charak Samhita (Uttarardha), Hindi Traslation by Pandit Kashinath Nath Shastri and Dr Gorakh Nath Chaturvedi, Varanasi, Chaukhambha Sanskrit Series, 1998 p. 853-854.

9. Sri Govindacharya, Bhaisajya Ratnavali with Vidyotini Hindi commentary by Sri Kaviraja Ambikadatta Shastri edited by Acharya Rajeshwaradatta Shastri, 17th edition, Varanasi, Chaukhambha Publications, 2004 p. 853-854.

10. Sri Govindacharya, Bhaisajya Ratnavali with Vidyotini Hindi commentary by Sri Kaviraja Ambikadatta Shastri edited by Acharya Rajeshwaradatta Shastri, 17th edition, Varanasi, Chaukhambha Publications, 2004, p. 79-90.

11. Sri Govindacharya, Bhaisajya Ratnavali with Vidyotini Hindi commentary by Sri Kaviraja Ambikadatta Shastri edited by Acharya Rajeshwaradatta Shastri, 17th edition Varanasi, Chaukhambha Publications, 2004 p. 1038-1039.

12. Sri Govindacharya, Bhaisajya Ratnavali with Vidyotini Hindi commentary by Sri Kaviraja Ambikadatta Shastri edited by Acharya Rajeshwaradatta Shastri, 17th edition Varanasi, Chaukhambha Publications, 2004 p.1036-1037.

13. C.B.Jha, Ayurvediya Rasa Shasta, 2nd edition, Varanasi, Chaukhamba Surabharati, 1998 p. 446.

14. Acharya Vagbhat, Astanga Hridaya, Hindi Translation by Atridev Gupta, 10th edition Varanasi, Chaukhambha Sanskrita Sansthan, 1987 p. 839.

15. Tiwari P.V., Ayurvediya Prasuti tantra & Stri Roga, IInd Part, 2nd edition, Varanasi, Chaukhambha Oriantalia, 2000, reprint 2005, p. 266-268.

16. Tiwari P.V., Ayurvediya Prasuti tantra & Stri Roga, IInd Part, 2nd edition, Varanasi, Chaukhambha Oriantalia, 2000, reprint 2005 p. 266-268.

17. Achaya Charaka, Charak Samhita, (Uttarardha) Hindi Translation by Pandit Kashinath Nath Shastri and Dr Gorakh Nath Chaturvedi, Varanasi, Chaukhambha Sanskrit Series, 1998 p. 858.

18. Achaya Charaka, Charak Samhita (Uttarardha), Hindi Translation by Pandit Kashinath Nath Shastri and Dr Gorakh Nath Chaturvedi, Varanasi, Chaukhambha Sanskrit Series, 1998 p. 858.

19. Dawn C.S., Text Book of Gynaecology, Contraception & Demography, 14th Edition, Kolkata, Dawn Books, 2003. p. 503-505.

Research

Abortion and FR