Key words :Shweta Pradara; Vaginal discharge; Leucorrhoea; Trichomonas; Candida.

In Ayurveda literature Leucorrhoea is not mentioned as a disease entity however white vaginal discharge is quoted as a symptom in multiple gynaecological problems. Sometimes this symptom is so severe that, it over shadows actual disease and women seek for the treatment of only this symptom. In India, vaginal discharge is one of the commonest symptom reported by women.^[1][2][3] Leucorrhoea a white discharge from the vagina may be physiological or pathological. It may also be noticed without any disease. Normally, vaginal discharge happens in regular variations of amount and consistency during the course of the menstrual cycle. A greater than usual amount is normal in pregnancy, and a decrease is to be expected after delivery, during lactation and after menopause.^[4]

Physiological excess of vaginal discharge may not require specific treatment. However pathological conditions involving infections like Candida, Trichomonas, and Gram negative, Gram positive organisms may necessitate its management. Leucorrhoea neither causes mortality nor morbidity in susceptible women, though it is accountable to cause a great extent of mental stress, problem of sexual anxiety and even sometimes fear of carcinoma or failure to conceive, it also causes local inconvenience to the patient. Shweta pradara (leucorrhoea) is a condition characterized with white vaginal discharge not associated with pain, burning sensation and discomfort, thus it seems to be description of leucorrhoea.

In Ayurvedic literature, no separate chapter is allotted concerning Shweta pradara. Commentator Chakrapani has explained the word Pandura - Asrigdara (Pale vaginal discharge) as Shweta pradara (leucorrhoea) in his commentary.^[5] Sushruta has described physiological discharge of women secreted during sexual act.^[6] In the narration of infertility it is quoted that some specific types of infertile women may have varied variety of continuous watery vaginal discharge.^[7] In Kamasutra, types of women are specified as per the physical constitution moreover stated that as per their body types, these women have various physiological vaginal discharges - five varieties of the discharges per vagina according to the character of women are mentioned, hence as per body types, this discharges should be identified clinically whether physiological and need assurance while become troublesome. Certain organisms can cause injury to the uterus through vagina.^[8] Infective organism produced in the vaginal area causes injury to the uterus.^[9]

While describing about good conducts / treatment regimen it is said that it cures the vaginal disease created by infective organisms. There are references that organisms may reach the uterus, vagina and the foetus.^[10] Several disease entities are found with white discharge as a clinical feature. Some general and systemic disorders produce excessive vaginal discharge. Pale discharge per vagina is incapable for reproduction.^[11][12] Peculiar vaginal discharge is stated which is generally associated with body aches and thirst. The vaginal discharge white or reddish having foul smell also quoted.^[13] All these symptoms may arise due to deficiency disorders like vitamins or calcium deficiency or due to some systemic disorders. In a specific disease named somaroga passage of pure, cold, white clear and excessive fluid is mentioned.^[14] Modern authors have correlated Shweta pradara with leucorrhoea including certain physio-pathological vaginal discharge.

Some classical preparations mentioned for the management of Leucorrhoea.^[15]

1. Seeds, Paste, Powder or Juice of fruit Phyllanthus emblica mixed with Sugar and honey 2. Pushyanuga Churna, Pippali (Piper longum), Haritaki (Terminalia chebula)and Loha Bhasma with equal quantity of honey.
3. Paste of lodhra (Symplocos racemosa Roxb.) mixed with decoction of stem bark of Vata (Ficus bengalensis L.)
4. Darvyadi decoction, Juice of Nimba (Azadirachta indica) / Guduchi (Tinospora cordifolia) / Aphanamixis polystachya / Ficus hispida Linn. / Achyranthes aspera root with honey.
5. Powder of bark Symplocos racemos, Saraca asoca and Berberis extract, with rice water and honey.
6. Juice of the fruit of Ficus racemosa with honey followed by diet of cooked rice, milk and sugar.
7. Paste of Rasanjana and root of Amaranthus tricolor Linn. prepared in rice water with honey, Triphala Ghrita.
8. Drugs for external or local use are vaginal douche, Vaginal suppositories, Tampoons and Dhupana (incense).

Vaginal Douches
Kariradi Kwatha, Triphalarasa (Swarasa / Kwatha) with buttermilk or Sukta or cow urine, Tinospora cordifolia, Triphala and decoction of Baliospermum montanum / Mucuna pruriens / bark of the five milk-yielding trees/plants of Rajvrikshadi Gana / purifying plants with urine of cow and salt.

Vaginal suppositories
(Varti) Arkadi Varti, Pipalyadi Varti, Palashadi Varti, varti made up from the powder of Ficus benghalensis L. and honey / from fine powder of Symplocos racemosa Roxb., Callicarpa macrophylla, Glycyrrhiza glabra and honey / of fine powder any Astringent drugs and honey, Ajagandhadi Varti, Shodhana Dravya Varti, Varti of Piper longum Linn., Piper nigrum, black gram, Asparagus racemosus, Saussurea lappa and Saindhva.

Tampoons Udumbaradi
Taila, Mushaka Taila, Dashmoola & Shrimada (Mundi) Kwatha, Dhatakyadi Taila, Kakolyadi Taila, Suramanda.

Dhupa (incense)
Pinus roxburghii,Guggulu and barley with Ghee / paste of Curcuma longa and Berberis aristata, Powder of Brihat Phala, Acacia catechu, Myristica fragrans Houtt., Pathya, Pugiphala flowers of green gram / Panchakashaya (Acorus calamus, Adhatoda vasica, Luffa acutangula, Callicarpa macrophylla Vahl. and Azadirachta indica) powder.

Due to excessive indulgence of dietetic and behavioural regimen capable of vitiating Vata, Pitta and Kapha, a woman may suffer from specific gynaecological disorders having vaginal discharge as a symptom along with other symptoms like itching vulva. Due to consumption of congenial and non-congenial tastes together, all the three Doshas situated in reproductive system get vitiated and produce their specific symptoms. Sometimes discharge become profuse, not pure white, but is grey-white, yellow or green, brown or rusty in colour and an itching vulva follows which found in various gynaecological disorders as per ancient classics. Leucorrhoea is mentioned as a complication of gynaecological disorders.^[16] In small cervical polyps or erosion, intermittent scanty bleeding or blood stained discharges are noticed. Due to association of chronic inflammation with erosion, burning sensation etc. features may also be noted. Due to non-cleanliness of vagina the parasites develop and produce itching (in vulva).

Other features of vitiation of Kapha such as unctuousness and itching etc. are also present. When a pregnant woman consumes diet or indulges in mode of life capable of vitiating Kapha and also suppresses desire of vomiting and inspiration, then her agitated or vitiated Vata withholding Kapha produces abnormalities producing yellowish vaginal discharge associated with pricking pain or else white mucoidal discharges,[17] when a woman having predominance of Pitta withholds her natural urge of sneezing and eructation at the time of coitus, the vitiated Pitta, getting mixed with Vata produces abnormalities. She also suffers from pain in lumbosacral and groin region, backache and fever, a condition very similar to the chronic infection of genital tract, as all the features are suggestive of its similarity with Pelvic Inflammatory Disease. In another disease problem having vaginal discharge may suffer from dyspareunia caused by coitus, suggestive of condition of acute inflammatory stage (of gonococcal infection). Due to coitus in an uneven and troublesome bed, vitiated vata causes firmness and dilatation of orifices of uterus and vagina, stiffness of vaginal orifice and displacement and other severe pain, Uterine prolapse is one of the condition in which various type of leucorrhoea - vaginal discharge is found. When woman has coitus with a man having big sized penis, suffers from laxity of vaginal walls, pricking pain due to Vata, burning sensation and heat due to Pitta and unctuousness and itching due to Kapha, due to infection it may be the cause of leucorrhoea. In about 25% of women in the reproductive period, the parasites harbor in the vagina in asymptomatic state, which may correlate with the absence of other clinical features of vitiation of Dosha except itching. So, not directly but it reflects trichomonas vaginalis or other genital tract infections. Chronic infection (Kaphaja), most probably tuberculosis (Parisruta Jataharini),Vaginal discharge due to deficiency disorder like vitamins or calcium deficiency or due to some systemic disorder (Asthisrava),Senile/Atropic vaginitis (Vatala), Acute infection of reproductive organs( Pittala), Trichomonas vaginitis or Monilial vulvovaginitis (Sleshmala) Mixed type of severe genital tract infection (Sannipatiki), Genital tract infection (Achrana, Atyananda) Genital tract infection, Vaginitis due to chronic genital tract infection (Aticharna), Monilial vulvo vaginitis specially in pregnant woman/ pathological Monilial (Upapluta), Acute genital tract infection (Paripluta), Second degree uterine prolapse (Prasramsinee), Prolapse of vaginal wall (Phalinee) Leucorrhoea as a symptom indirectly are Cervical polyp or erosion (Lohitakshara, Karninee), Vaginitis due to estrogen deficiency (Shushka), Third degree uterine prolapse or procidentia (Maha Yoni), Genital tract infection (Vipluta) Urogenital infection (Pittaja artava dushti), Chronic endometritis and/or endocervicitis (Kaphaja artava dushti), Endometrial carcinoma (Kunapagandhi), Malignant changes of reproductive organs infected (Granthibhuta), Severe endometritis leading to pyometra (Putipuyanibha), Severe genital tract infection and malignancy (Mutrapurishagandhi), Maliganant conditions as well as severe infection like pyometra (Sannipataja), Sexually Tansmitted Disease (Upadamsha).

In all these gynaecological disorders vaginal discharge is present or may be present along with other symptoms. But it doesn’t means that all these symptoms should present in Leucorrhoea. Hence, all these conditions are not leucorrhoea but may be one of the causative factors of Leucorrhoea. The management of leucorrhoea can be done in three ways. Nidana Parivarjana and the management of disease in which leucorrhoea is found management of leucorrhoea itself. Nidana Parivarjana is the base of the management of all disease. In Shweta pradara the causative factors should be avoided in order to get permanent relief. Management of leucorrhoea depends upon the causative factor, Prakriti of the patient’s, involvement of Doshas etc. Usually leucorrhoea is a curable disease, but recurrence is common due to causative factors like coitus etc. Kapha can be considered as main causative Dosha in Shweta pradara vitiation of Vata occurs chiefly by its Chala & Sheeta Guna Most of the Shweta pradara are the consequence of urogenital infections and thus, vitiation of Pitta should also be given due attention. Researches reveal that the people who are in active reproductive age group, who fall under low economic status, who observe poor sanitation, and individuals with poor nutrition, inadequate, irregular diets are more prone to this disease. Psychologic disturbances are the main exacerbating factors.

The oral administration of Kukkutanda twak bhasma gives effective results in this pathologic manifestation.[19] Udumbaradi tail has shown marked improvement in relieving all the symptoms of cervical erosion and was seen more effective in decreasing the vaginal discharge.[20] Panchavalkala ointment is found to be effective against Trichomonas vaginalis & E. faecalis in vulvo vaginitis during pregnancy.^[21] Another study reveal that Panchavalkala kwatha is kapha shamaka, stambhaka and having the properties like astringent, antiseptic (kashaya rasa) and wound healing (vrana ropana). Because of these properties it helps in increasing local cell immunity and prevent recurrence of symptoms in patients.^[22] Kushthadi Varti has found to be effective in white discharge caused due to cervical erosion.^[23] Amalaki beeja choorna along with pathya ahara and vihara showed effectiveness in alleviating symptoms of Shweta pradara.^[24] Patrangasava revealed better curative effect than Amalaki beeja Churna in another study.^[25] Capsules prepared out of whole plant of Kakajangha (Peristrophe bicalyculata Nees.) with tandulodakam internally thrice daily after food for a period of 15 days observed that subjective symptoms like kandu, srava and objective symptoms like evidence of itching, vaginal discharge were reduced significantly after the treatment.[26

1. Trollope Kumar K. Cultural and biomedical meanings of the complaint of leucorrhoea in South Asian women. Tropical Medicine and International Health 2001; 6:260-266.

2. Bhatia J, Cleland J. Self-reported symptoms of gynaecological morbidity and their treatment in South India. Studies in Family Planning 1995; 26:203-216.

3. Pachauri S, Gittelsohn J. Summary of Research Studies and Implications for Health Policy and Programmes. In Gittlesohn J, Bentley ME, Pelto PJ, Nag M, Pachauri S, Harrison AD, Landman LT, editors. Listening to Women Talk about Their Health Issues and Evidence from India. New Delhi: Ford Foundation and Har-Anand Publications; 1994.

4. Fox KK, Behets FM. Vaginal discharge. How to pinpoint the cause. Postgraduate Medicine 1995; 98: 87-90, 93- 96, 101.

5. Charaka. Charak Samhita (Vidyotini Hindi Commentary), Vol. 2. Shastri KN, Pandey GS, editors. 1st ed. Varanasi: Chaukhambha Bharati Academy; 2006. Chikitsa Sthana, 30 /116. p.768.

6. Sushruta. Sushruta Samhita (Hindi Commentary). Shastri KA, editor. 10th ed. Varansi: Chaukhambha Bharti Academy; 1996, Sharira Sthana, 2/39. p.16.

7. Sharma RJ. Vandhya kalpadruma. 2nd ed. Mumbai: Shri Venkateshwar Press; 1987. 4/46-50. p.112.

8. Max Muller F, editor. Rig-Veda. 4th ed. Varanasi: Chaukhmbha Sanskrita Samsthan; 1999. Ru. 10/97/13.

9. Sharma PV. Ayurveda Ka Vaigyanika Itihas. 2nd ed. Varansi: Chukhamba Orientalia; 1981. p.18.

10. Gaud RS. Atharva Veda Samhita (Hindi), Vol.3. 1st ed. Varanasi: Chaukhambha Vidya bhawan; 2007. p.1-26.

11. Vagbhatta. Ashtanga Samgraha (Hindi), Vol. 2. Gupta AK, Sharma NK, editors. 2nd ed. Varanasi: Chaukhambha Sanskrit Series, 2005. Uttara Sthana, 39/73. p.339.

12. Vagbhatta. Ashtanga Samgraha (Hindi), Vol. 2. Gupta AK, Sharma NK, editors. 2nd ed. Varanasi: Chaukhambha Sanskrit Series, 2005. Shareera Sthana, 1/72. p. 271.

13. Vasavraja. Vasavarajiyam (Aandhratatpariya sahita). Bhishja Vidheya Shree Govardhana Changani, editor. Nagpur: Gorakkshan Press; 1987. Ch.16. p. 248.

14. Bhavamisra. Bhavaprakasa (Hindi). Mishra BS, Pandit BR, editors. 5th ed. Varanasi: Chaukhambha orientalia; 1993. Chikitsa Sthana, 69/3-6. p.763.

15. Charaka. Charaka Samhita (Vidyotini Hindi Commentary), Vol. 2. Shastri KN, Pandey GS, editors. 1st ed. Varanasi: Chaukhambha Bharati Academy; 2006. Chikitsa Sthana,30 /116. p.770-772.

16. Charaka. Charaka Samhita (Vidyotini Hindi Commentary), Vol. 2. Shastri KN, Pandey GS, editors. 1st ed. Varanasi: Chaukhambha Bharati Academy; 2006.Chikitsa Sthana, 30 /37. p.139.

17. Charaka. Charaka Samhita (Vidyotini Hindi Commentary), Vol. 2. Shastri KN, Pandey GS, editors. 1st ed. Varanasi: Chaukhambha Bharati Academy; 2006. Chikitsa Sthana, 30 /21. p.767.

18. Charaka. Charaka Samhita (Vidyotini Hindi Commentary), Vol. 2. Shastri KN, Pandey GS, editors. 1st ed. Varanasi: Chaukhambha Bharati Academy; 2006. Sutra Sthana, 1/59. p.27.

19. Panda G, Mahapatra KB. Clinical effect of Kukkutanda twaka Bhasma in the management of Shweta Pradara. AYU 2011; 32: 370-374.

20. Chaurasia, Ranju Kumari, Bhati, Kuldeep Singh. Role of Udumbaradi Taila in the management of Vaginal Discharge due to cervical erosion - A Case Report. IJRAP 2013;4(4):631-633.

21. Neelam, Deepshikha Joshi, Neeraj Kumar. An Ayurvedic Management of Vulvovaginitis during pregnancy. AYU 2007;28(1):5-10.

22. Bhattar P. A Clinical Study on effect of Yoni Prakshalana with Panchavalkala kwatha in the management of Kaphaja Yoni Vyapada w.s.r. to Candida albicans. Ancient Science of Life 2013;32(2):32-36.

23. Umesh S. Efficacy of Kushthadi Varti in Cervical Erosion – A Clinical Study.

24. Nazima Begum. A Study on Etiopathogenesis of Shweta Pradara w.s.r. to the role of Amalaki Beeja Churna as a means of Samprapti Vighatana.

25. Rekha GN. Clinical evaluation of Patrangasava & amalaki beeja churna in Shweta Pradara w.s.r. to Leucorrhoea.

26. Joly Jose. Pharmacotherapeutic evaluation of kakajangha (Peristrophe bicalyculata Nees.) in swetapradara w.s.r to vaginitis.