A Conceptual Co-Relation of Endometriosis with Udavarta Yonivyapad

Endometriosis is one of the most mysterious benign gynecological disorder defined by implantation of functioning endometrial tissue outside the uterine cavity. The worldwide prevalence is about 10%. Women with endometriosis are usually confronted with one or more major problems like pain and infertility. Pain includes dysmenorrhea, dysperunia and chronic pelvic pain. It can be co-relate as it is one of the condition which consider under Udavarta yonivypad on the basis of dysmenorrhea and relief in pain just after the menstruation. As in Udavarta Yonivyapad vitiation of Apana and Vyana Vayu occurs. Further it causes alteration in Karma of Apana Yayu resulting retrograde menstruation with dysmenorrhea. Syndrome complex of Udavarta Yonivyapad resembles with Endometriosis. We can state that if pathology of Udavarta yonivypada continues for longer time, further it results into a condition of endometriosis. In Udavarta Yonivyapad Retrograde menstruation with painful menstruation occurs, as this continues for longer time due to vitiation of Apana and Vyana vayu, Strotovaigunya, Vimargagamana, Doshasanghat and Siragranthi type of Srotodusthi occurs accordingly. Also, we can relate this to the complication of untreated Udavarta due to which adhesion in uterus and pelvis takes place, thereafter formation of Chocolate cyst which can relate to


INTRODUCTION
Onset of Artava marks the starting of reproductive life of women and it should be devoid of Shoola, Daha, Paichhilya and should not be excessive or scanty in matra is considered as Shuddha Artava i .Abnormalities of Artava leads to many diseases like Yonivyapad, Artavavyapad, which may result in complications like infertility.Udavarta Yonivyapad is one such amongst the 20 Yonivyapad which are mentioned in Bruhatrayi as well as in Madhav Nidan and Yogaratnakar.According to Acharya Vagbhata, Prakruta Apana Vayu is responsible for excretion of Shukra, Artava, Mala, Mutra, Garbha ii .If natural urges are supressed, Vayu takes upwards course in the genital tract due to which the women suffer painful discharges of the menstrual blood with difficulty because of its upward tendency.After discharge of the menstrual blood, there will be relief instantly.Because of the upward course of menstrual blood, it is known by the wise as Udavartini iii .In nut shell, the Vimargagamana in Artavavaha Srotas accounting to the Vaigunya in Apana Vayu results in displacement of Raja from its original place in altered form (Gunatah and Dravyatah), which corelates the condition of endometriosis.वे गोदावर्त नाद्योननमु दावर्त यर्े ऽननलः| सारुगार्ात रजः कृ च्छ् रे णोदावृ त्तं नवमु ञ्चनर्|| आर्त वे सा नवमु क्त े र्ु र्त्क् षणं लभर्े सु खम् | रजसो गमनाद ू र्ध् वं ज्ञे योदावनर्त नी बु ध ः|| (cha.chi.30/25-26)According to the contemporary science, the syndrome complex of Endometriosis can be resemble with Udavarta yonivyapad and can be consider under Udavarta Yonivyapad.It means presence of endometrial tissue (gland and stroma) outside the uterus.Endometriosis presents in three different entities, which are frequently found together: peritoneal lesions, deep endometriosis and ovarian endometriotic cyst (endometriomas).Ovarian endometrioma is a benign oestrogen dependent cystic mass from ectopic endometrial tissue within the ovary.It contains thick, brown, tar like fluid which may referred as chocolate cyst.The pathogenesis of endometriomas remains contentious, with a variety of theories proffered, including invagination and subsequent collection of menstrual debris from endometriotic implants, which are located on the ovarian surface and adherent peritoneum.Endometriosis is perceived as a chronic disease should be suspected with, Dysmenorrhea, Dyspareunia, subfertility, chronic pelvic pain and menstrual irregularity.Endometriosis can be associated with significant gastrointestinal symptoms (pain, nausea, vomiting, early satiety, bloating and distention, altered bowel habits iv .Endometriosis is one of the most benign gynaecological conditions that affects 1 out of every 10 women of reproductive age and second to uterine fibroid needing major gynaecological surgery.Endometriosis prevalence ranged from 15.4% to 71.4% v , study has been taken to diagnose the disease in early stage, understanding the condition and corelating endometriosis with Udavarta yonivyapad to avoid further complications.

MATERIALS AND METHODS
For the study the literary materials which include the reference of Udavarta Yonivyapad through the available ayurvedic text and for endometriosis, available modern texts and articles has been collected.

CONCEPTUAL REVIEW UDAVARTA YONIVYAPAD
It is one of the Vishmati Yonivyapdas told by all acharyas.Vata is causative dosha of udavarta yonivyapad by all the acharyas.NIRUKTI-The act of going up.In udavarta, Gati of Vayu turns into upward direction.DEFINITION-Udavarta is the Urdhvagamana of Raja due to Vata vitiation.In Madhukosha teeka, Udavarta is defined as the condition where vitiated Vata takes the Raja upward and then discharges painfully.There will be painful menstruation and pain gets relieved immediately following discharge of menstrual blood.NIDANA-It can be classified into two types for convenience i,e Samanya and Vishesha.Samanya nidana-Mithyachara: It includes both mithya ahara and mithya vihara Mithya aahara

Pradushta artava
When the Artava does not possess Shuddha Artava lakshanas, it is pradushta Artava.And is the cause of Ashta Artava Dushti.These Dushti occurs due to the vitiation of Tridosha which affects not only the quantity and quality of the Artava but also causes painful menstruation.According to modern perspective it resembles Hormonal imbalance as hormones are responsible for the normal and abnormal flow of menstrual blood.

Beeja dosha
Beeja dosha refers to abnormalities in Artava and Shukra, which results into abnormal formation of genital tract of the female foetus like Suchimukhi causing Kricchrartava.In modern correlation, congenital anomalies in the women like pin hole Os of cervix, septate uterus, imperforate hymen etc. are the causes of painful menstruation due to difficulty in escaping of menstrual blood.Daiva When the cause is not known, the disease is said to develop due to Adharma done by the women and also due to Purvajanma kruta papa karma.Vishesha nidana-Vegadharana is the vishesha nidana told by Acharya Charaka and Vagbhata vi .

SAMPRAPTI-
tikta, kashaya rasa aahara sevana • Ruksha, laghu, sheeta aahara sevana Mithya Vihara • Excessive coitus, coitus in abnormal body posture.• Vishama sthana shayana • Ratrijagarana • Bhaya, Shoka etc. • Apadravya sevana: Introducing artificial objects into the vagina in an Unhygienic way which leads to local resistance and facilitate the Invasion of the organisms, precipitating infection.These leads to vitiation of Vata specifically Apana Vata which then moves upward instead of moving downwards thereby causing movement of Raja in reverse diversion and fails to expel the Raja.

Table 2 : symptoms of Udavarta yonivyapad Charaka Sushruta Madhava nidana Vagbhata Yogratnakara
It means presence of endometrial tissue [gland and stroma] outside the uterus.Endometriosis present in three different entities, which are frequently found together: peritoneal lesions, deep endometriosis and ovarian endometriotic cyst (endometriomas) viii .It contains thick, brown, tar like fluid which may referred as chocolate cyst ix .The pathogenesis of endometriomas remains continues, with a variety of theories proferred, including invagination and subsequent collection of menstrual debris from endometriotic implants, which are located on the ovarian surface and adherent peritoneum.COMMON CAUSES-Retrograde Menstruation, Coelomic Metaplasia, Direct implantation theory, Lymphatic and vascular theory, Genetic and immunological factors.Pelvic peritoneum, Pouch of Douglas, Uterosacral ligaments, Rectovaginal septum, Appendix, Fallopian tubes.x SYMPTOMS-Leading symptoms are Dysmenorrhea, Dyspareunia, subfertility, chronic pelvic pain, menstrual irregularity.Endometriosis can be associated with significant gastrointestinal symptoms (pain, nausea, vomiting, early satiety, bloating and distention, altered bowel habits).

between Endometriosis and Udavarta Yonivyapad-As there
dysmenorrhea, Chronic pelvic pain and relief in pain just after the menstruation are the common symptom in both.Thus, we can state that if pathology of Udavarta yonivypada continues for longer time, further it results into a condition of endometriosis.In Udavarta Yonivyapad Retrograde menstruation with Painful discharge occurs, as this continues for longer time due to vitiation of Apana and Vyana vayu, Strotovaigunya, Vimargagamana, Doshasanghat and Siragranthi type of Srotodusthi occurs accordingly.Also, we can relate this to the complication of untreated Udavarta due to which adhesion in uterus and pelvis takes place, thereafter formation Chocolate cyst which can relate to Granthi at Ovarian site.In contemporary science, the primary management of this conditions includes NSAIDs, OCPs and hormonal therapy which have long list of side effects and do not provide long lasting relief.Ayurveda can provide a radical treatment of this disease by normalising the function of Apana Vayu, for that proper diagnosis should done to avoid further complications in future.CONCLUSIONSymptoms of both the diseases can be resembles that is why we can Correlate them as endometriosis is one of the conditions which can consider under the Udavarta Yonivyapad.

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