A A M J Anveshana Ayurveda Medical Journal

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1 A A M J Anveshana Ayurveda Medical Journal ISSN: Review Article Interpretation of Āśayāpakarśa Siddhānta in Menopausal Syndrome Mona Bajpai 1 K.Venkat Shivudu 2 P. Suneela 3 A b s t r a c t Menopause is defined as the time at which menstruation ceases, whereas climacteric is the phase of waning ovarian activity and may start two or three years before the menopause and continue for two or five years after it. The climacteric is thus a phase of adjustment between active and inactive ovarian function and may occupy several years of a woman s life. [i] The age of menopause ranges between years, average being 50 years, [ii] but it strikes Indian women as young as years. So, menopausal health demands even higher priority in Indian scenario. [iii] The Menopausal Syndrome means cessation of menstruation. A woman is usually considered to be menopausal if she has not had a menstrual period for six month and there is no other underlying cause. [iv] The main clinical features of Menopausal Syndrome are hot flushes[head, chest and arms becomes red and feet hot, lasting from a couple of minutes to as long as an hour] followed by profuse sweating, burning sensation in vagina etc. and other systemic features like osteoporosis etc. This shows a considerable effect on the quality of life of menopausal women. Ayurveda with its holistic approach and time tested theories has a greater role to play in dealing with Menopausal Syndrome. The clinical features explained in Menopausal Syndrome shows the dominance of pitta dośa, though vāta is the predominant Dośa according to age. This phenomenon refers to Āśayāpakarśa Siddhānta where normal Pitta Dośa is displaced from its natural habitat by Vāta Dośa and there by producing the signs and symptoms of Pitta Dośa. This approach will helps in the better understanding of concepts of Menopausal Syndrome and the full details are explained in the main paper. Key words: Menopause, Āśayāpakarśa Siddhānta, Ayurveda 1 PG Scholar, 2 Assistant Professor, 3 Associate Professor, Department of PG Studies in Ayurveda Samhitha & Siddhantha, S.V. Ayurvedic College, Tirupati, Andra Pradesh. CORRESPONDING AUTHOR Dr. MONA BAJPAI PG Scholar, Department of Ayurveda Samhitha & Siddhantha, S.V. Ayurvedic College, Tirupati, Andra Pradesh. drmonabajpai1@gmail.com AAMJ / Vol. 2 / Issue 4 / July August 2016

2 INTRODUCTION The term Menopause denotes the complete cessation of menstruation, either as a normal part of ageing or as the result of surgical removal of both ovaries. It is an event rather than a period of time. The term Menopause is made up of two Greek words [v] viz. 'Meno' and 'pause'. Meno = month = Related to menses Pause = Pausis = Stopping, Cessation. Thus the word Menopause refers to permanent cessation of menstruation. Menopause is defined as the permanent cessation of menstruation at the end of reproductive life resulting from the loss of ovarian follicular activity. The clinical diagnosis is confirmed following stoppage of menstruation for six (or twelve) consecutive months, for which, there is no other obvious pathological or physiological cause. As such, a woman is declared to have attained Menopause only retrospectively. [vi] Menopause is a natural biological process, which is experienced individually by every woman. In a broader sense, as the term is commonly used, it denotes a 1- to 3-year period during which a woman adjusts to a diminishing and then absent menstrual flow and the physiologic changes that may be associated- hot flushes, night sweats, and vaginal dryness. The average age at menopause in western societies today is 51 years. Premature menopause is defined as ovarian failure and menstrual cessation, before age 40; this often has a genetic or autoimmune basis. Surgical menopause due to bilateral oophorectomy is common and can cause more severe symptoms owing to the sudden rapid drop in sex hormone levels. There is no objective evidence that cessation of ovarian function is associated with severe emotional disturbance or personality changes. However, mood changes toward depression and anxiety can occur at this time. [vii] Rajonivritti: In Ayurvedic classics, Rajonivritti is not described separately as a pathological condition or severe health problem the ancient Acharyas termed it as normal physiology. Rajonivrittikala is mentioned by almost all Acharyas without any controversy, few direct references are available in Sūtra [viii] and Śārira sthāna [ix] of Sushruta Samhita. Various other references also available in Astanga Samgraha [x], Astānga Hridaya [xi] and Bhāva Prakāsh [xii], 50 years is mentioned as the age of Rajonivritti, when the body is fully in grip of senility. Acharya Arunadatta opines that the age mentioned above is a probable age and not a fixed one. There may be some variations in this regard. [xiii] A demonstrated truth established after several examinations and reasoning is known as Siddhānta. [xiv] In this study the Āśayāpakarśa Siddhānta is taken and correlated with the symptoms associated with Rajonivritti. Acharya Charaka has described this principle in seventeenth chapter of Sūtra Sthāna [xv] but didn t name it as Āśayāpakarśa. Early work carried out: Several studies were conducted on Menopausal Syndrome and its treatment but no where its interpretation with Āśayāpakarśa Siddhānta was discussed. This study mainly deals with the detailed discussion on interpretation of Āśayāpakarśa Siddhānta in Menopausal Syndrome. METHODOLOGY Classical Ayurvedic texts, commentaries and Modern text were thoroughly studied to evaluate the Āśayāpakarśa Siddhānta in Menopausal Syndrome and only nectar part is presented and discussed in the present article. Āśayāpakarśa Siddhānta: In Madhukosha Tika of Madhava Nidana, the commentator has very well explained the Āśayāpakarśa principle while describing the various types of Nidana. He said that disease can be manifested in the following way, Each Dośa has main habitat in our body (vātapakvādhāna, [xvi] pitta-nābhi, [xvii] kapha-uraha [xviii] ). When vitiated Vāta Dośa displaces the normal other two Dośas from their natural habitat to any other part of our body, then it is called Āśayāpakarśa and such Dośas which are displaced are called Āśayāpakriśta. [xix] Even Acharya Charaka has described this principle in seventeenth chapter of Sūtra Sthāna but didn t name it as Āśayāpakarśa. While describing the various features of Vriddhi and Kśaya of Dośa, he mentioned that when vitiated Vāta Dośa displace the normal Pitta Dośa or Kapha Dośa from its main habitat to distinct body parts then various signs and symptoms of displaced Dośas are produced in those sites where they are displaced. Though the displaced Dośas are not aggravated to in quantity, the clinical features of displaced Dośas are seen as if they are aggravated. This is only because of their anya sthāna vrittitva and their association with local Dośa. [xx] AAMJ / Vol. 2 / Issue 4 / July August

3 Acharya Bhattara Harichandra said that while treating, such type of diseases, the main aim of the physician should be to pacify the Vāta Dośa which is responsible for displacement of other Dośas and to bring back the displaced Dośa to its main habitat. He said that the physician should not be confused by seeing the various features of displaced Dośas and effort to pacify only that Dośa which has displaced the remaining Dośas is to be given, because root cause of the disease is vitiated Vāta which is responsible for displacement of Dośa. So along with treatment of mainly Vāta Dośa and symptomatically treatment of displaced Dośas should be the aim of the physician. So it is very important that physician should have the knowledge of Āśayāpakarśa, so that one can make correct diagnosis of such diseases and can treat easily such type of diseases. [xxi] Other Acharyas had also given their views on the commentary of Bhattara Harichandra on Āśayāpakarśa. By putting an example they said that inspite of main habitat of Pitta Dośa it is present in whole body and mainly divided into five types in that one type i.e. Bhrājaka Pitta which resides in Twak can be vitiated by this pathogenesis. When vitiated Vāta brings the normal Pitta from its main habitat to Twak where Bhrājaka Pitta resides then it produce various signs and symptoms of Pitta Dośa there. Acharyas said that it is not possible to produce signs and symptoms without aggravation of Pitta Dośa. So when vitiated Vāta brings the normal Pitta to Twak or any other site then it combines with Bhrajaka or any other Pitta of that place and get aggravated and hence produce the signs and symptoms of the Pitta Dośa. [xxii] Interpretation: As the pathogenesis of Rajonivritti as such is not elaborately described in Ayurvedic text, so by the help of Yukti Jnāna, the Rajonivritti condition can be correlated with Āśayāpakarśa Siddhānta. Acharya Charaka has used the term Yukti in a wide reference and has described that the knowledge that can be perceived by different outcomes of combination of causative factors (actually it is combination of different causative factors) and is valid for past, present and future is known as Yukti (reasoning). This helps in the fulfilment of the human life ie, Dharma(virtue), Artha(wealth) and Karma (desire). [xxiii] Yukti can be defined as application of the theory in the unknown factors which were already understood by seeing the cause and action series by known factors. [xxiv] So Yukti Jnana has extreme importance in Roganirnaya (diagnosis) and Chikitsa (treatment). Even though the pathogenesis of Menopausal syndrome is not directly described in Ayurvedic text, few points can be drawn out into consideration (by the nidānas which are already described previously) by using yukti jnāna. All classics have quoted the age around 50 years as the probable age for Rajonivritti. (i) At the age about 50 years, the decline process starts in female body due to Jarāvastha as a natural process. (ii) This age limit is dominated by "Vāta Dośa" and obviously it easily gets vitiated during this time. [xxv] This dominant Vāta Dośa will have effect all over the female body including all anatomical as well as physiological factors by virtue of its characters like "Laghuta" and "Rūkśata". After describing the clinical features of Menopausal Syndrome, it is very important to understand the probable pathogenesis behind these symptoms. So, here an attempt has been made on the basis of few basic principles to know the pathogenesis of every symptom under the following heading Vāta Vriddhi- The factors, which are present in the female body at the time of Rajonivritti, should be considered as the base for the whole etiopathogenesis. So, these factors like Vāta Vriddhi Avastha, Jarā Avastha, generalised Raukśya, śośa and Kśaya of various body tissues elements will be manifested as generalised Vāta Dośa Vriddhi. So that the Laghu, Rūkśa, Khara, Chala etc. Guna also aggravated, which will lead to various Vāta Dośa related symptoms like karśya, karśnya, gātra sphurana, gātra kampa, nidrānāśa, alpabalatva, gādavarcha etc. [xxvi] Kapha Kśaya- Kapha is normally maintained by the gunas like snigdha, mridu, slakśna etc. [xxiv] when the gunas like rūkśata etc. increase in the body Kapha Kśaya takes place. Rasa Dhātu is directly proportionate to Kapha, [xxvii] whenever Rasa Kśaya occurs, Kapha also decreases. During Vriddhāvastha, āhāra rasa cannot be completely converted into Rasa due to Paripakwa Sarira. Because of this, Rasa Kśaya occurs which indirectly leads to Kapha Kśaya. During Vriddhāvastha, gradual decline of all Dhātus occur which lead to Ojas Kśaya, which ultimately results in Kapha Kśaya, as Ojas is directly proportionate AAMJ / Vol. 2 / Issue 4 / July August

4 to kapha. [xxviii] Ojas Kśaya indicates that Uttorottara Dhātu Pośana is not occuring properly. have to be considered and can be grouped under following Ayurvedic parameters: Ojas decrease due to Abhighāta (injury), DhātuKśaya, Kopa (anger), Śoka (grief), worry, exertion, hunger etc. [xxix] In the Vriddhāvastha, Kśaya of Ojas is there. Clinical feature- Acharya Charaka explains the signs and symptoms of the diminution of Ojas is the fear complex, Dourbalya (constant weakness), worry (Chinta), discomfort in sense organs, loss of complexion, Rūkśata(roughness), unstable mind etc. [xxx] Rūkśādi guns enhance vāta which indirectly decrease kapha. In the Rasa Dhātu, the predominant Dośa is Kapha. Concentrating on Rasa Dhātu Kśaya due to the affected metabolism its Upa Dhātu Rajah will also deteriorate quantitatively and qualitatively. Clinical features of Ojas Kśaya indicate that Uttorottar Dhātu Poshana is not taking place properly. All of the above indirectly infer that Kapha Kśaya present in the Vriddhavastha. Sama sthiti of Pitta- In the Vriddhavastha, the predominant Dośa is Vāta. [xxxi] The other Dośas are present but they don t have predominance in the body. In this Avastha, the Agni does not remain in tīkshnāvastha. Acharya Sushruta says, as Agni and Pitta are directly proportionate to each other, [xxxii] so the chance for Pitta s aggrevation is very limited. By the above, it is clear that the possibility for Pitta s aggrevation is very less, though the clinical features related to enhanced Pitta are seen in Menopausal Syndrome. But that does not mean that Pitta does not increase in its quantity, it may enhance when Pitta precipitating factors are taken in the form of Ahara and Vihara. For eg. Due to Pitta Prakopaka Nidana, diseases like, Kamala and Pandu (in which Pitta is increased) occur. By the above factors followed by menopause, the probability of Dośas isvāta Vriddha, Kapha Kśaya and Samapitta. So, the probable pathogenesis of Menopausal Syndrome can be understood by applying the Āśayāpakarśa Siddhānta. Lakśana of RajonivrittiJanyaVikara- As there is no direct reference available regarding Lakśanas of Rajonivritti in the Ayurvedic classics, the clinical symptoms manifested by the patients of Rajonivritti (A) Vāta Prakopaka Lakśana; Śaririka and Mānasika (B) Apakarśa Pitta Lakśana (C) Śleśma(Kapha) Kśaya Lakśana (A) Vāta Prakopaka Lakśana; Śaririka and Mānasika- Due to increase of Vāta in the body, Acharya Sushruta explains the various symptoms like; Karśya(emaciation), Karśnya (blackishcolouration), Nidrānāsha (lossofsleep), Alpa Bala (decrease in strength), Gādavarcha (hard stool) etc. [xxxiii] Acharya Charaka mention the Ātma Rūpa of Vāta as follows: Khara(coarseness), Parusha(harshness), Viśada, Suśira (porousness), śośa (wasting), śūla(various kinds of pain), Supti(numbness) etc. are the actions that help a competent physician to diagnose the Vātika type diseases. [xxxiv] Acharya Vagbhata says, Rūkśādi qualities of Vāta if associates with śīta properties leads to Vāta Prakopa. [xxxv] Because of the dominant Vāyu and Vriddhavastha; Laghu, Rūkśa, Khara,Chala, Sūkśma etc. Guna also markedly increase in the body and resulting into various anatomical changes like; Rūkśata, Paruśata and Vali observed in Twacha; Śātana & Pālitya of Keśa; Rūkśata and Patana of Nakha; Śośa and Śithilata of Stana; Śaithilyata in Sira and Sauśiryata in Asthi occur. Māmsa reduces (Śośa)and its Lepan Karma will be hampered, so Spik-Gandadi area will become śuśka. Adding to these, Rūkśata and śośa appear at various Āśayas including Garbhāśaya, Yoni etc. [xxxvi] AAMJ / Vol. 2 / Issue 4 / July August

5 According to Acharya Sushruta, Vāta is Rūkśa, Śīta, Laghu, Khara, has movement in all directions, is possessed of the two qualities of Śabda and Sparśa and has the Rajoguna in a predominant degree. [xxxvii] So due to the presence of Rajo Guna, after considering the clinically observed features of Rajonivritti through Ayurvedic point of view various Mānasika Lakśana are also present in the subject as Dukhabahulata, Atanśilata, Adhriti, Ahamkara etc. [xxxviii] Due to Vāta Vriddhi,vitiation of Raja Dośa, Krodha, Śoka, Kama etc. takes place. On the other hand, due to Jarāvastha, progressive decline occurs in the various physical and psychological factors, and mainly menifest as Grahana - Dhārana - Sarana Vigyanādi Hāni. (B) Apakarśa Pitta Lakśana- Though in Rajonivritti, the Pitta s in its normal form, but when Pitta is displaced by the Vāta (because Pitta is Pangu) [xxxix], then it expresses its symptoms like that of Pitta Vriddhi, Pītāvabhāsata(yellowish discoloration of the body), Santāpa (increased body temperature), Śītakāmita(desire for cold things), Alpanidrā (disturbed sleep),bala Hāni (loss of strength), Indriya Dourbalya (weakness in sense organs) etc. [xl] Acharya Charaka mentions the Ātma Rūpa of Pitta as Dāha (burning sensation)sweda, Kleda (moistening), Kotha, Kandu (itching), Srāva (discharge), Rāga(redness) etc. [xli] are the actions that help a competent physician to diagnose the Paittika type of diseases. (C) Śleśma (Kapha) Kśaya Lakśana - Acharya Sushruta mentions that various Kapha Kśaya Lakśanas like; Rūkśata (dryness in body), Antardāha (burning sensation inside), Āmaseyatara Śleśma Śūnyata, Sandhi Śaithilya (looseness of joints), Triśna (thirst), Dourbalya (debility), Prajāgarana( loss of sleep in night) etc. [xlii] Previously it is mentioned that, in Rasa Dhātu the predominant Dośa is Kapha, so Rasa Kśaya Lakśana are also seen in the body when Kapha Kśaya occurs. Due to Rasa Kśaya the symptoms appears in the body are, Rūkśata, Śrama (tiredness), Śośa, Glāni, Shabdāsahiśnuta (not able to tolerate high pitched voice) etc. [xliii] CONCLUSION Āśayāpakarśa is a very specific concept of Ayurvedic Science. In this condition, Pitta Dośa is not vitiated, but aggravated Vāta Dośa displaces the Prākrita Pitta Dośa from its Āśayas and manifests the symptoms, which are broadly like of Pittavriddhi or Pitta vitiation, so, Āśayāpakarśa of Pitta by Vāta is mainly responsible for the Lakśanas of Rajonivritti. ΛΛΛΛ AAMJ / Vol. 2 / Issue 4 / July August

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7 xlii. Yadavji Trikamji Sushruta Samhita of Sushruta Varanasi; 15/7.p.68. xliii. Kunte A.M. & Navre K.S. Astang Hridayam of Prakashana; Sutra sthana 11/17.p.185. Mona et.al,. : Interpretation of Āśayāpakarśa Siddhānta in Menopausal Syndrome Source of Support: Nil. Conflict of Interest: None declared How to cite this article: Mona et.al,. : Interpretation of Āśayāpakarśa Siddhānta in Menopausal Syndrome. AAMJ 2016; 4: ΛΛΛΛ AAMJ / Vol. 2 / Issue 4 / July August