|Year : 2019 | Volume
| Issue : 2 | Page : 98-102
Assessment of Rasa dusti lakshanas among patients with polycystic ovarian disease
Rajani Kulkarni1, M Subash Chandra Bose1, DT Usha2
1 Department of PG Studies in Roganidana, JSS Ayurveda Medical College and Hospital, Mysuru, Karnataka, India
2 Department of Prasooti Tantra and Stree Roga, JSS Ayurveda Medical College and Hospital, Mysuru, Karnataka, India
|Date of Web Publication||14-May-2019|
Dr. Rajani Kulkarni
#31/A, Shanti Marga, Siddarth Nagar, Mysuru, Karnataka
Source of Support: None, Conflict of Interest: None
BACKGROUND: Rasadushti doashas can predispose a patient to metabolic disorders such as polycystic ovarian disease (PCOD). Hence, it is important to screen patients of PCOD with Rasa dusti lakshanas in routine clinical checkups. This study conducted to assess the presence of Rasa dusti lakshanas in PCOD.
METHODS: This cross-sectional hospital-based study was conducted among fifty consecutive previously diagnosed patients with PCOD attending JSS Ayurveda Hospital from January to December 2017. After obtaining written informed consent, the data on demographic details, duration of PCOD, prognosis of disease, and rasa dushti lakshanas were collected in a pretested structured questionnaire by interview technique.
RESULTS: Among the fifty patients with PCOD included in the present study, majority belonging to 21–25 years' (44%) age group and majority 15 (30%) were obese Category II. It was observed that, as the Rasa dusti nidana scores increase, there was also increase in the Rasa dusti lakshanas among patients with PCOD. This correlation was found to be strong and statistically significant (r = 0.764, P < 0.05). As the Rasa dusti lakshana scores increase, there was also increase in the clinical signs and symptoms of PCOD among the study patients. This correlation was found to be strong and statistically significant (r = 0.631, P < 0.05).
CONCLUSION: The present study has revealed that Rasa dusti nidana was seen evidently in the manifestation of PCOD.
Keywords: Nidana, polycystic ovarian disease, rasa dusti
|How to cite this article:|
Kulkarni R, Bose M S, Usha D T. Assessment of Rasa dusti lakshanas among patients with polycystic ovarian disease. Int J Health Allied Sci 2019;8:98-102
|How to cite this URL:|
Kulkarni R, Bose M S, Usha D T. Assessment of Rasa dusti lakshanas among patients with polycystic ovarian disease. Int J Health Allied Sci [serial online] 2019 [cited 2020 Jul 14];8:98-102. Available from: http://www.ijhas.in/text.asp?2019/8/2/98/258188
| Introduction|| |
Polycystic ovarian disease (PCOD) is a multisystemic endocrinopathy with ovarian expression with metabolic disturbance, which includes chronic nonovulation, hyperandronism, associated with normal or raised estradiol, raised luteinizing hormone (LH), and low follicle-stimulating hormone (FSH)/LH ratio caused due to change in lifestyle and stress.
About 5%–10% of women in reproductive age group residing in India are reported to have PCOD. Usually, the prevalence of clinical presentations is as increasing obesity (abdominal – 50%), menstrual abnormality (70%), hirsutism and acne (70%), acanthosis nigricans, and so on. With the understanding signs and symptoms of PCOD, it shows the involvement of tridoshas, rasa, rakta, medo dhatus, and artava upadhatu in the pathogenesis of PCOD.
Sushruta has mentioned that the Rasa is formed from the saara bhaga of ahara, composed of pancha mahabhuta, shad rasa, and having ushna or sheeta veerya. The unwholesome ahara will lead to Rasa dusti. According to the definition of PCOD, the altered lifestyle that might be dietary alterations or lifestyle variations are prime cause for the manifestation of the disease. Therefore, the nidana for both rasadusti and PCOD are similar. To the support of nidana, even in Rasa pradosha nidanas, Acharya Charaka mentioned that Chinta is one of the nidana which can be considered as stress.
Along with this, according to the upadhatu concept, Rasa have two Upadhatus, Stanya and Artava. According to Acharya Charaka, Acharya Sushruta, and Acharya Vagbhata, Rasa dhatu is responsible for the formation of Artava. Here, the artava is as that of shukra dhatu formed from rasa dhatu. We have to consider artava as beeja not as raja.
In Bhava prakasha, it has been mentioned that the rasa flows as menstrual fluid (raja) in women for 3 days every month. Rasa Dhatu has Stanya (breast milk) and Raja (menstrual flow) as Updhatus, and the quality, quantity, and excellence of upadhatu depend on metabolic and functional status of Rasa Dhatu.
It is found that, from the nidana to the lakshana, the rasa dusti and PCOD have similarities. Hence, it might have direct or indirect involvement in the pathogenesis of PCOD. As we go through the literature, there are many diseases explained, such as Anartava, Pushpagni, and jataharini, which have the similarities with PCOD. As PCOD is a set of disease, here, in our science, signs and symptoms come in vyadi sankara. Hence, the involvement of Rasa Dhatu, its dusti in disease process, is studied and expressed through this study.
| Methods|| |
This cross-sectional, single-center, hospital-based study was conducted by collecting data from study participants from January to December 2017. Approval from the Institutional Human Ethics Committee was obtained before the start of the study.
Fifty patients diagnosed with PCOD were selected for the study. A structured pro forma was prepared for the collection of data on details of history and general and systemic physical examination of patients. Socioeconomic status was calculated by B.G. Prasad Classification modified based on AICPI for January 2017. Body mass index classification done according to Asia Pacific classification and questionnaire to know the Rasa dusti nidana and its lakshanas prepared based on literature search was administered for the assessment of Rasa.
- Diagnosed patients of PCOD on the basis of Rotterdam criteria
- Patients aged between 15 and 40 years and
- Patients consenting to participate in the study.
- Patients within 2 years of menarche
- Patients with hyper- and hypo-thyroidism
- Patients with other systemic disorders and surgical conditions.
Rotterdam diagnostic criteria
Presence of any two of the following three criteria:
- Oligo and/or anovulation
- The second criteria is hyperandrogenism (clinical and/or biochemical)
- The third is polycystic ovaries.
| Results|| |
Among the fifty subjects included in the study, majority of the nidanas were prevalent. Based on prevalence, major nidanas were Atimatra in 48 (96%) followed by Atisnigdha in 47 (94%), Madhura ahara in (86%), Samashana in 41 (82%), Abhishyandi in 40 (80%) Amla sevana in 8 (16%) and Lavana sevana in 5 (10%) [Graph 1].
Out of the fifty patients, 82% of Ashradhdha, 82% of Aruchi, 36% of Asyavairasya, 96% of Arasamjnata, 50% of Hrullasa, 80% of Gourava, 88% of Tandra, 86% of Angamarda, 42% of Jwara, 28% of Tama, 78% of Pandutwa, 90% of Srotavarodha, 20% of Klaibya, 48% of Sada, and 96% of Valaya Palita were seen [Graph 2].
[Table 1] summarizes the relationship between the Rasa dusti nidana and Rasa dusti lakshana.
|Table 1: Distribution of the study patients based on the prevalence of Rasa dusti lakshanas|
Click here to view
[Graph 3] and [Graph 4] show the positive relationship between the Rasa dusti nidana and Rasa dusti lakshanas and also Rasa dusti lakshanas and signs and symptoms of PCOD. Here, when variables such as etiology scores and Lakshana were analyzed, r valuewas found to be 0.764 with P = 0.001. From the values, it was observed that, as the Rasa dusti nidana scores increase, there is also increase in the Rasa dusti lakshanas among patients with PCOD. This correlation was found to be strong and statistically significant (r = 0.764, P < 0.05).
Relationship between Rasa dusti lakshana and clinical presentation of signs and symptoms of PCOD was analyzed with r = 0.631 and P = 0.004. From these values, it was observed that, as the Rasa dusti lakshana scores increase, there is also increase in the PCOD signs and symptoms among the study patients. This correlation was found to be strong and statistically significant (r = 0.631, P < 0.05) [Graph 3] and [Graph 4].
| Discussion|| |
Discussion on nidanas of rasa dusti
As we go through the Nidanas of Rasa dusti and etiology of PCOD resembles the same. Rasa dusti nidanas such as Ati snigdha and Madhura ahara are same as that of high-calorie food; in the same way, Ati matra and Guru ahara were considered as excessive dietary intake and Samashana as Junk and fast-food consumption and Chinta as type of stress. Genetic cause can be considered under matruja and rasaja bhava janya roga because of strong familial presentation and autosomal dominant inheritance, respectively.
Discussion on the role of Rasa dhatu in disease pathology
The Rasa dusti lakshanas and signs and symptoms of PCOD can be explained on the either hand. The Rasa dusti lakshanas such as Ashraddha, Aruchi, Asyavairasya, Arasamjnata and Agninasha are considered as the expression of metabolic abnormality; Aruna varna (pandutwa) as acanthosis nigricans, and Klaibya as infertility. In the same way, Rasa dusti leads to upadhatu artava dusti which is nothing but irregular menstruation/anovulation, a sign of PCOD. Here, one of the Rasa dhatu functions, i.e., tarpana, gets hampered. Due to Rasa dusti, there will be formation of vitiated stree shukra which leads to smashru and obstructs garbharambha, which is considered as hirsutism and stoulya lakshana are due to medo dhatu dusti caused by rasa dusti are seen in PCOD where these are seen as signs.
If we assess the Rasa dhatu dusti lakshana and signs and symptoms of PCOD, both indicates that they usually fell under Santarpanoththa vikara or due to dhatu kshaya janya. However, majority of the patients (48 [96%]) presented with santarpanotha janya vyadhi because of metabolic activity impairment which makes patients to consume more and more food which leads to further complications, followed by the remaining two (4%) patients who were presented with apatarpanotha PCOD.
When we look into samprapti, altered gonadotropin-releasing hormone (GnRH) – increased pulse and frequency of LH, which led to decreased FSH levels. Here, for hypothalamic–pituitary–ovarian (HPO) axis imbalance which lead to PCOD the Sanga of rasavaha srotas is the cause in disease pathogenesis. However, as through investigation we cannot calculate the GnRH level, LH level is directly proportional to GnRH. As previous studies already proved that dietary restriction has a direct influence on the frequency and pulse of LH, we can consider that the Rasa dhatu which is formed from Anna rasa will maintain hormonal secretion and balance. Furthermore, when we look into the functions of rasa dhatu, both the vardhana and dharana are altered due to its dusti.
The other kind of pathogenesis is the excess androgen secretion. This is caused because of abnormal regulation of the androgen-forming enzyme by ovary. Here, defective aromatization of androgens to estrogen. In addition, adrenal stimulates to produce excess androgens by stress. Here, the defective aromatization and stress may be considered due to sanga of rasavaha srotas. When we look into nidana and lakshana, the Rasavaha srotas got vitiated which will end up with srotodusti, i.e., sanga leads to further pathology.
There is one more presentation of the disease PCOD, where chronic anovulation is seen. The main reason for this is follicular microenvironment is androgenic than estrogenic, hence leading to anovulation. Here, the environment management is maintained by Rasa dhatu as per Ayurvedic concept. Because tarpana, vardhana, dharana, and preerana are all the functions of Rasa dhatu, dusti of the same leads to the dysfunction.
Due to santarpana, the Kapha dosha get vitiated and does dusti of Rasa, Mamsa, and Medo dhatus which leads to further conditions such as obesity and insulin resistance.
In brief, the main pathology is due to anovulation or androgen excess or HPO axis imbalance which are regulated by the Rasa dhatu. Hence, bringing back the rasa dusti to its healthy condition is the main role of samprapti vighatana.
In the present study, the observations on Rasa dusti nidanas are Madhura (86%), Amla (16%), Lavana (10%), Ati Snidgha (94%), Ati Matra (96%), Samashana (82%), and Abhishyandi ahara (80%) were also prevalent in patients having PCOD. Rasa dusti lakshana: Out of Rasa dusti lakshanas, Ashradhdha (82%), Aruchi (82%), Asyavairasya (36%), Arasamjnata (96%), Hrullasa (50%), Gourava (80%), Tandra (88%), Angamarda (86%), Jwara (42%), Tama (28%), Pandutwa-Aruna varna (78%), Srotavarodha (90%), Klaibya (20%), Sada (48%), and Valaya Palita (96%) were seen in patients with PCOD, indicating the involvement of Rasa dhatu dusti in disease. As disease progress, the Rasa dhatu dusti will also lead to other dhatu dusti such as Rakta dhatu in three (6%) patients, Mamsa dhatu in five (10%), Medo dhatu in four (8%), and Shukra dhatu in six (12%) patients. This shows the Uttarottara dhatu involvement.
Discussion on results
From the results, it was observed that, there was a positive correlation between Rasa dusti nidana and Rasa dusti lakshanas among patients with PCOD. This correlation was found to be strong and statistically significant. From the results, there was a positive correlation between Rasa dusti lakshana and signs and symptoms of PCOD among the study patients. This correlation was found to be strong and statistically significant.
| Conclusion|| |
From this study, it can be validated that the Rasa dhatu is one of the factors responsible to maintain the healthy internal body environment by maintaining hormonal balance and proper functioning of the same. Hence, this PCOD can be considered under one of the Rasa dusti prakaras, as there is hampering of Tarpana, Vardhana, Dharana, and Preenana which is not maintained. The consumption of Rasa dusti nidana was seen evidently in the manifestation of PCOD.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Padubidri Howkins VG. Bourne Shaw's Textbook of Gynaecology. PCOS or PCOD. 14th
ed. Noida: Elsevier; 2008. p. 331.
Allahbadia GN, Merchant R. Seminars in reproductive medicine. Aesculap academy-Asia, Pacific center for minimally invasive surgery. Train Res Mazgaon 2008.
Shastri KA. Sushruta. Shonitvardaneeya Adhyaya. In: Ayurveda-Tattva Sandeepika. Susruta Samhita, Reprint. Varanasi, India: Chowkhamba Prakahsan; 2010. p. 61.
Vaidya Yadavji Trikamji Acharya, editor. Vimana Sthana. Agnivesha, Charakaa Samhita with Ayurveda Deepika Commentary of Chakrapani Datta, Reprint. Ch. 5/13. Varanasi: Choukamba Prakashana; 2007. p. 251.
Yadavji Trikamji Charaka Samhita of Agnivesha, with Ayurvedadeepika Commentary by Sri Chakrapani Datta. Sloka. Ch. Sa. 15/17. Varanasi: Choukamba Surbharati Prakashan; 2013. p. 514.
Kaviraj Ambikadutta Shastri. Sushruta Samhita of Sushruta, Reprint edition. Varanasi: Choukamba Publications; 2011. p. 64.
Vaidya Yadavaji Trikamji Acharya. Sushruta Samhita Dalhana Tika. SU. Su. 14/15. Varanasi: Choukamba Surbharti Prakashan; 2008. p. 62.
Tewari P. Ayurvediya Prasuti Tantra Evam Striroga: Formation of Raja, Reprint. Part I. 2nd
ed. Varanasi: Choukamba Orientalia; 2007. p. 58.
Purva B, Shilwant AA. The study of co-relation between Rasasarta and Rajapravritti. IAMJ 2015;3:2191-9.
Yadavji Trikamji Charaka Samhita of Agnivesha, with Ayurveda Deepika Commentary by Sri Chakrapani Datta. Ch. Chi. 30/17. Varanasi; Choukamba Surbharati Prakashan; 2013. p. 635.
Narayana Murthy MS, Vijnana R, Vijnana V. Kapha Gunas. 2nd
ed. Varanasi: Choukamba Sanskrit Series Office; 2011. p. 11.
Bhavamishra A. Bhavaprakasha, Poorva Khanda. Pandit Shree B.S. Mishra. 9th
ed. Varanasi: Choukamba Samskruta Samsthana; 2005. p. 18.
Yadavji Trikamji Acharya. Charaka Samhita of Agnivesha, with Ayurvedadeepika Commentary by Sri Chakrapani Datta. Ch. Su. 28/9, 10. Varanasi: Choukamba Surbharati Prakashan; 2013. p. 179.