Treatment - Ayurveda Institute UK



Diploma Ayurvedic Practitioners Course Module 67th – 11th March 2020 Course Materials Yoni Roga & Sukra dosha (Infertility & Gynaecological disorders)Yoni Roga & Sukra dosha (Infertility & Gynaecological disorders) – the allopathic perspectiveThe following italicized passages are taken from the NHS online service which provides information and advice to the public on the causes, symptoms and treatment of these disorders. It is useful to review the allopathic understanding of the disorder and the approach taken to treatment both for comparative purposes and in order to better explain to the patient. Please note that not all information provided is replicated here. Infertility OverviewInfertility is when a couple can't get pregnant (conceive) despite having regular unprotected sex.Around 1 in 7 couples may have difficulty conceiving. This is approximately 3.5 million people?in the UK. About 84% of couples will conceive naturally within a year if they have regular unprotected sex (every 2 or 3 days). For couples who've been trying to conceive for more than 3 years without success, the likelihood of getting pregnant naturally within the next year is 25% or less.Getting helpSome women get pregnant quickly, but for others it can take longer. It's a good idea to see your GP if you haven't conceived after a year of trying.Women aged 36 and over, and anyone who's already aware they may have fertility problems, should see their GP sooner. They can check for common causes of fertility problems and suggest treatments that could help. Infertility is only usually diagnosed when a couple haven't managed to conceive after?a year of trying.There are 2 types of infertility:primary infertility?–?where someone who's never conceived a child in the past has difficulty conceivingsecondary infertility?–?where someone has had 1 or more pregnancies in the past, but is having difficulty conceiving againTreating infertilityFertility treatments include:medical treatment?– for lack of regular ovulationsurgical procedures?– such as treatment?for endometriosis,?repair of the fallopian tubes, or removal of scarring (adhesions) within the womb or abdominal cavity??assisted conception?–?this may be intrauterine insemination (IUI) or in vitro fertilisation (IVF)The treatment offered will depend on what's causing your fertility problems and what's available. Private treatment is also available, but it can be expensive and there's no guarantee it will be successful.It's important to choose a private clinic carefully. You can ask your GP for advice, and should make sure you choose a clinic that's licensed.Some treatments for infertility, such as IVF, can cause?complications.For example:multiple pregnancy?– if more than 1 embryo is placed in the womb as part of IVF treatment, there's an increased chance of having twins; this may not seem like a bad thing, but it significantly increases the risk of complications for you and your babiesectopic pregnancy –?the risk of having an ectopic pregnancy is slightly increased?if you have IVFWhat causes infertility?There are many possible causes of infertility, and fertility problems can affect either the man or the woman. But in?a quarter of cases it isn't possible to identify the cause.In women, common causes of infertility include:lack of regular?ovulation, the monthly release of an eggblocked or damaged fallopian tubesendometriosis - where tissue that behaves like the lining of the womb (the endometrium) is found outside the wombIn men,?the most common cause of infertility is poor-quality?semen.Risk factorsThere are also a number of factors that can affect fertility in both men and women.These include:age?– female fertility and, to a lesser extent, male fertility decline with age; in women, the biggest decrease in fertility begins during the mid-30sweight?– being overweight or obese (having a BMI?of 30 or over) reduces fertility; in women, being overweight or?severely underweight can affect ovulationsexually transmitted infections (STIs)?– several STIs, including chlamydia, can affect fertilitysmoking?– can affect fertility in both sexes: smoking (including passive smoking) affects a woman's chance of conceiving, while in men there's an association between smoking and reduced semen quality alcohol?– for?women planning to get pregnant, the safest approach is not to drink alcohol at all to keep risks to your baby to a minimum; for men, drinking too much alcohol can affect the quality of?sperm (the chief medical officers for the UK recommend men and women should drink?no more than 14 units of alcohol a week, which should be spread evenly over 3 days or more)environmental factors?– exposure to certain pesticides,?solvents and metals has been shown to affect fertility, particularly in men?stress – can affect your relationship with your partner and cause a loss of sex drive; in severe cases, stress may also affect ovulation and sperm productionThere's no evidence to suggest caffeinated?drinks, such as tea, coffee and colas, are associated with fertility problems.CausesInfertility can be caused by?many different things. For 25% of couples, a cause can't be identified.Infertility in womenInfertility is most commonly caused by problems with ovulation, the monthly release of an egg.Some problems stop an egg being released at all, while others prevent an egg being released during some cycles but not others.Ovulation problems can be a result of:?poly cystic ovary syndrome (PCOS) thyroid problems?–?both an overactive thyroid gland and an underactive thyroid gland?can prevent ovulationpremature ovarian failure?–?where a woman's ovaries stop working before the age of 40Scarring from surgeryPelvic surgery can damage and scar the fallopian tubes, which link the ovaries to the womb.Cervical surgery can also sometimes cause scarring or shorten the neck of the womb (the cervix).Cervical mucus problems?When you're ovulating, mucus in your cervix becomes thinner so sperm can swim through it more easily. If there's a problem with the mucus, it can make it harder to conceive.FibroidsNon-cancerous growths called fibroids?in or around the womb can affect fertility. In some cases, they may prevent a fertilised egg attaching itself to the womb, or they may block a fallopian tube.EndometriosisEndometriosis?is a condition where small pieces of the womb lining (the endometrium) start growing in other places, such as the ovaries.This can damage the ovaries or fallopian tubes and?cause fertility problems.Pelvic inflammatory diseasePelvic inflammatory disease (PID)?is an infection of the upper female genital tract, which includes the womb, fallopian tubes and ovaries. It's often caused by a sexually transmitted infection (STI). PID can damage and scar the fallopian tubes, making it virtually impossible for an egg to travel down into the womb.SterilisationSome women choose to be?sterilised if they don't want to have any more children.Sterilisation?involves blocking the fallopian tubes to make it impossible for an egg to travel to the womb. It's rarely reversible?–?if you do have a sterilisation reversed, you won't necessarily become fertile again.Medicines and drugs?The side effects of some types of medicines and drugs can affect your fertility.These include:non-steroidal anti-inflammatory drugs (NSAIDs)?– long-term use or a high dosage of NSAIDs, such as ibuprofen?or aspirin, can make it more difficult to conceivechemotherapy?– medicines used for chemotherapy can sometimes cause ovarian failure, which means your ovaries will no longer be able to function properlyneuroleptic medicines?– antipsychotic medicines often used to treat psychosis; they can sometimes cause missed periods?or infertilityspironolactone?– a?type of medicine used to treat fluid retention(oedema); fertility should recover around 2 months after you stop taking spironolactoneIllegal drugs, such as marijuana and cocaine, can seriously affect fertility and make ovulation more difficult.Infertility in menSemen and spermThe most common cause of infertility in men is?poor-quality semen,?the fluid containing sperm that's ejaculated during sex.Possible reasons for abnormal semen include:a lack of?sperm?– you may have a very low sperm count?or no sperm at allsperm that aren't moving properly?– this will make it harder for sperm to swim to the eggabnormal?sperm?– sperm can sometimes be an abnormal shape, making it harder for them to move and fertilise an eggMany cases of abnormal semen are unexplained.There's a link between increased temperature of the scrotum and reduced semen quality, but it's uncertain whether wearing loose-fitting underwear improves fertility.?TesticlesThe testicles produce and store sperm. If they're damaged, it can seriously affect the quality of your semen.This can happen as?a result of:an infection of your testiclestesticular cancer?testicular surgerya problem with your testicles you were born with (a congenital defect)when one or both testicles hasn't descended into the scrotum,?the loose sac of skin that contains your testicles (undescended testicles) injury to your testiclesSterilisationSome men choose to have a vasectomy?if they don't want children or any more children.?It involves cutting and sealing off the?tubes that carry sperm out of your testicles (the?vas deferens) so your semen will no longer contain any sperm.A vasectomy can be reversed, but reversals aren't usually successful.Ejaculation disordersSome men experience ejaculation problems?that can make it difficult for them to release semen during sex (ejaculate).HypogonadismHypogonadism is an abnormally low level of testosterone, the male sex hormone involved in making sperm. It could be caused by a tumour, taking illegal drugs, or Klinefelter syndrome, a rare syndrome where a man is born with an extra female chromosome.Medicines and drugsCertain types of medicines can sometimes cause infertility problems.These medicines are listed below:sulfasalazine?–?an anti-inflammatory medicine used to treat conditions such as?Chron’s disease?and rheumatoid arthritis; sulfasalazine can decrease the number of sperm, but its effects are temporary and your sperm count should return to normal when you stop taking itanabolic steroids?–?are often used illegally to build muscle and improve athletic performance; long-term abuse of anabolic steriods?can reduce?sperm count and sperm mobilitychemotherapy?– medicines used in chemotherapy can sometimes severely reduce sperm productionherbal remedies?– some herbal remedies, such as root extracts of the Chinese herb Tripterygium wilfordii, can affect the production of sperm or reduce the size of your testicles. Illegal drugs, such as marijuana and cocaine, can also affect semen quality.Unexplained infertilityIn the UK, unexplained infertility accounts for around 25% of cases of infertility. This is where no cause can be identified in either the woman or man. The National Institute for Health and Care Excellence (NICE) recommends that women with unexplained infertility who haven't conceived after 2 years of having regular unprotected sex should be offered IVF treatment.DiagnosisMore than?80% of couples where the woman is under 40 will conceive naturally within a year of having regular unprotected sex.Regular unprotected sex means having sex every 2 to 3 days without using contraception.When to get medical helpSee?your GP if you haven't conceived after a year of trying.You should see your GP sooner if you:are a woman aged 36 or over?– the decline in fertility speeds up when a woman reaches her mid-30shave any reason to be concerned about your fertility?–?for example, if you've had treatment for cancer?or you think you might have had a sexually transmitted infection (STI). Fertility tests can take time and female fertility decreases with age, so it's best to make an appointment early on.Fertility tests for womenTests to find out the cause of infertility in women include:Blood testsA?sample of your blood can be tested for a hormone called progesterone to check whether you're ovulating. The timing of the test is based on how regular your periods?are. If you have irregular periods, you'll be offered a test to measure hormones called gonadotrophins, which stimulate the ovaries to produce eggs.Chlamydia testChlamydia?is an STI that can affect fertility.?A swab?– similar to a cotton bud, but smaller, soft and rounded?– is used to collect some cells from your cervix to test for chlamydia. Alternatively, a urine test may be used. You'll be prescribed antibiotics?if you have chlamydia.Ultrasound scanAn ultrasound scan can be used to check your ovaries, womb and fallopian tubes. Certain conditions that can affect the womb, such as endometriosis and fibroids, can prevent pregnancy.?A?scan can also be used to look for signs that your fallopian tubes?–?the tubes that connect the ovaries and the womb?–?may be blocked, which may be stopping eggs travelling along the tubes and into the womb.?If the ultrasound suggests a possible blockage, your doctor will refer you to a specialist to discuss further checks, such as a laparoscopy. During a transvaginal ultrasound scan, a small ultrasound probe is placed in your vagina. The scan can be used to check the health of your womb and ovaries and for any blockages in your fallopian tubes. A hysterosalpingo-contrast-ultrasonography is a special type of ultrasound scan sometimes used to check the fallopian tubes. A small amount of fluid is injected into your womb through a tube put into the neck of your womb (the cervix).?Ultrasound is used to look at the fluid as it passes through the fallopian tubes to check for any blockages or abnormalities. Again, if the test suggests a possible blockage, your doctor will refer you to a specialist to discuss further checks, such as laparoscopy.X-rayA hysterosalpingogram is an X-ray?of your womb and fallopian tubes after a special dye has been injected. It can be used to detect blockages in your?fallopian tubes,?which may be stopping eggs travelling along the tubes and into your womb.LaparoscopyLaparascopy?(keyhole surgery) involves making a small cut in your lower tummy so a thin tube with a camera at the end (a laparoscope) can be inserted?to examine?your womb, fallopian tubes and ovaries. Dye may be injected into your fallopian tubes through your cervix to highlight any blockages in them. Laparoscopy is usually only used if it's likely that you have a problem – for example, if you've had an episode of PID?in the past, or if your scan suggests a possible blockage of one or both of your tubes.Fertility tests for menTests to find out the cause of infertility in men include:Semen analysisThis is to?check for sperm problems, such as a low sperm count or sperm that aren't moving properly.Chlamydia testA?sample of your urine will be tested to check for chlamydia, as it can affect fertility.TreatmentIf you have?fertility problems, the treatment you're offered will depend on what's causing the problem and what's available.There are 3 main types of fertility treatment:medicinessurgical procedures?assisted conception?– including intrauterine insemination (IUI) and in vitro fertilisation (IVF)?MedicinesFertility medicines are usually prescribed to women as they're mostly used to help with ovulation problems. But,?in some cases, they may also be prescribed to men.?Common fertility medicines?include:clomifene?–?encourages the monthly release of an egg (ovulation) in women who don't ovulate regularly or who can't ovulate at alltamoxifen?– an alternative to clomifene that may be offered to women with ovulation problemsmetformin?– particularly beneficial for women with PCOSgonadotrophins?– can help stimulate ovulation in women, and may also improve fertility in mengonadotrophin-releasing hormone and dopamine agonists?– other types of medication?prescribed to encourage ovulationSome of these medicines may cause side effects, such as nausea, vomiting, headaches and hot flushes.Medication that stimulates the ovaries isn't recommended?for women with unexplained infertility because it hasn't been found to?increase their chances of getting pregnant.Surgical proceduresSurgical procedures that may be used to investigate fertility problems and help with fertility are outlined below.Fallopian tube surgeryIf your fallopian tubes have become blocked or scarred, you may need surgery to repair the tubes. Surgery can be used to break up the scar tissue in your fallopian tubes, making it easier for eggs to pass along them. The success of surgery will depend on the extent of the damage to your fallopian tubes.Possible complications from tubal surgery include an eptopic pregnancy, when the fertilised egg implants outside the womb.Endometriosis, fibroids and PCOSEndometriosis is when parts of the womb lining start growing outside the womb.Laparoscopic surgery is often used for women who have endometriosis?to destroy or remove fluid-filled sacs called?cysts. It may also be used to remove submucosal fiboids, which are?small growths in the womb. In women with PCOS, a minor surgical procedure called laparoscopic ovarian drilling can be used if ovulation medication hasn't worked.This involves using either heat or a laser to destroy part of the ovary.Correcting an epididymal blockage and surgery to retrieve spermThe epididymis is a coil-like structure in the testicles that helps store and transport sperm. Sometimes the epididymis becomes blocked, preventing sperm being ejaculated normally. If this is causing infertility, surgery can be used to correct the blockage.Surgical extraction of sperm may be an option for men:with an obstruction that prevents?the release of spermborn without?the tube that drains the sperm from the testicle (vas deferens)who've had a vasectomy?or a failed vasectomy reversalAssisted conceptionIntrauterine insemination (IUI)IUI, also known as artificial insemination, involves inserting sperm into the womb via a fine plastic tube passed through the cervix. Sperm is first collected and washed in a fluid. The best-quality specimens?– the fastest moving?– are selected.In vitro fertilisation (IVF)In IVF,?the?egg?is fertilised?outside the body. The woman takes fertility medication to encourage her ovaries to produce more eggs than normal. Eggs are removed from her ovaries and fertilised with sperm in a laboratory. A fertilised egg called an embryo is then returned?to the woman's womb to grow and develop.Egg and sperm donationIf you or your partner has an infertility problem, you may be able to receive eggs or sperm from a donor to help you conceive. Treatment with donor eggs is usually carried out using IVF. Anyone who registered to donate eggs or sperm after April 1?2005 can no longer remain anonymous and has to provide information about their identity.This is because a child born as a result of donated eggs or sperm is legally entitled to find out the identity of the donor when they become an adult (at age 18).Complementary therapyThere's no evidence to suggest complementary therapies for fertility problems are effective. The National Institute for Health and Care Excellence (NICE) states further research is needed before such interventions can be recommended.Yoni Roga & Sukra dosha (Infertility & Gynaecological disorders) – the Ayurvedic perspectiveYoni RogaIn Ayurveda considerable attention and focus is given to gynaecological and womens disorders. ‘Yoni Roga’ means vaginal or reproductive disorders in women. ‘Yoni’ in Sanskrit means the womb or place of birth for every living or non-living being. For example, Hindus believe that the world was created by Maha Brahma Muka or yoni. The Charaka Samhita explains that “sthree yoni” - the woman’s womb or vagina - is the creator of humanity. Hence humans should know how to respect and keep that area free of disorders. “Sthree yoni” is considered to be the beginning and the end of humanity. According to Ayurveda, 20 Yoni Roga are identified: Vata – 5 Pitta – 5Kapha – 5 Tridosha – 5 The vagina and womb are situated in the apana vata area. Hence all Yoni Roga are due to vitiated vata even though the involvement of other dosha is recognised. Nidhana Incompatible foods Intake of excessive alcohol (or different types of alcohol consumed together)Eating before previous meal digested Indigestion Consuming raw food or food that is hard to digest Terminations or abortions Excessive sex Excessive libido / craving for sex all the time Horse or camel riding Cart ridingLong distance walkingExtreme sadness / worrying Excessive fasting Excessive weight loss Weight lifting Accidents / abuse to the area Daytime sleeping All menstrual disorders and Yoni Roga can be caused by these nidhana.Samprapti When there has been association with the above causative factors, women’s Arthavavaha srotas can be contaminated or obstructed (Sroto avarodha). This can lead to apana vata imbalance. The imbalance in apana vata can cause Yoni Roga or gynaecological disorders such as menstrual disorder, infertility and other associated disorders such as endometriosis, fibroids, PCOS (Beeja dosha – ovary / eggs).Vata Yoni Roga Causes Obstruction of vata in the apana vata area which affects vata function. Signs / symptoms Pain and pressurePins and needles SensitivityRough / dryness Loss of sensation (difficult to achieve orgasm) Menstrual blood (thin / frothy / vaginal popping sounds) and painful Pitta Yoni Roga CausesVata + pitta causes (katu, amla, lavana)Signs / symptoms Burning sensation Like fever / flu Excessive sweating Fishy smell / bad odour Vaginal discharge / yellow / slimy Menstrual blood dark red / blackish / clots Kapha Yoni RogaCauses Vata + kapha prominent diet / lifestyle Daytime sleep / oily food Signs / symptoms Phlegm like vaginal secretions A lot of white odourless discharge Mucus in menstrual blood Itchiness Light colour menstrual blood and only a little amountLittle pain or pain lessVataja Yoni Roga – Madhava Nidhana Udavarta – painful / frothy menstruation (dysmenorroea)Vandhya and vipluta – absence of menstruation (amenorrhoea). In vipluta pain is constantly present (vaginismus)Paripluta – severe pain during coitus (dyspareunia) Vatala – vagina is rough and stiff with spasmodic and pricking pain (dryness of vagina - hypoestrogenaemia)Pittaja Yoni Roga – Madhava Nidhana Lohitaksaya – excessive loss of menstrual blood with burning sensation (menorrhagia and metrorrhagia) Vamini – failure to fertilise the ovum (natural killer cells / NK cells). Bija (sperms) and raja (ovum) are expelled with vayu Prasramsini – prolapse of uterus due to straining (raised intra-abdominal pressure) making conception difficult Putraghni – habitual abortion where product of conception repeatedly aborted due to bleeding Pittala – severe burning sensation and formation of pus with fever Kaphaja Yoni Roga – Madhava Nidhana Atyananda – unable to be satisfied with any amount of sexual intercourse (sexual insatiability) Karnini – nodular swelling formed in genital organs due to vitiation of slesma and rakta Acarana – inability to retain the male seed due to early discharge of the woman Aticarana – inability to retain the male seed due to desire for longer sexual intercourse Slesmala – vaginal canal is unctuous, itchy and excessively cold (vaginitis) Tridosha Yoni Roga – Madhava Nidhana Sandi – amenorrhoea (absence of menstruation), amazia (absence of mammary glands and vagina feels rough during coitus Andali – disease created by adolescent girl having sexual intercourse with a man with an excessively big penis Mahayoni – big and wide vagina Sucivaktra – vagina is excessively constricted and narrowSannipataja – features due to vitiation of all the doshas are presentChikitsaAll Yoni Roga due to predominantly vata imbalance because yoni, ovary, all associated organs are housed in pelvic area which is governed by apana vata Balancing vata is the main goal of the treatment Secondary focus is pitta or kapha imbalance which may cause obstruction in arthavavaha srotas Thirdly all sexual and gynaecological organs lie on the second chakra in which the water element is prominent (buta). Hence, this area needs frequent rejuvenation and nutrition and water to this area have to be enhanced. Aims of the treatment: Vata = (balancing)Pitta (reducing)Kapha (increasing)Reduce or cut down vata and pitta aggravating diet and lifestyle Introduce moisture and oleation and nourishment to the areaTreatments Sneha Sweda Vasthi Sheeta karma Powders Apana vata balancing:Triphala powder + Dhatri + Pipili choorna and honey Agni deepana to balance pitta: HinguwastakaAmaharaPaaka choorna To reduce pitta: Chandana (sandalwood powder) Nimbadi (neem) Bu nimbha (Andrographis peniculata) Manjistha choorna Pushyanaga choorna Vrnghana Shatawari choorna Ashwagandha choorna Tablets Triphala Ashwagandha Shatawari Pittahara Coriander sheeta kashaya – cold infusionCoriander + coconut water Alepa – application of medicinal pastes Triphala with warm water applied to vaginal area Sandalwood / manjistha applied to vaginal area Mahanarayana oil / pinder oil applied to vaginal area Avagahana – vaginal bath Pancha valkala kashaya Manjistha water Sandalwood red / white decoction Milk + triphala decoction Oil tampon Neelyadee oil Bala sheradhe oil Tonics Dashamoola arista Ashoka arista Shatawari gopakanyadi Ashwagandha arista Nutritive jam Soma jam Surya jam ChayawanaprashSukra dosha (male infertility)Nidhana Excessive exerciseExcessive sexual indulgences Incompatible food / lifestyle Excessive intercourse Asexual (avoiding sex) Excessive consumption of salt / sour / astringent Excessive consumption of hot food / pungent food Being with women with low libido Excessive ejaculation Jara (emaciation) Excessive sadness / worries Excessive exposure to heat Accident to pelvic / genital area Fever / tiredness Excessive anger / suspicion Excessive diarrhoea Suppression of natural urges Samprapti After association with the causative factors, rasa dhatu becomes vitiated. Rasa dhatu is responsible for preenana (satisfaction to the body) and as it the first dhatu, once vitiated all steps below are malnourished as a result (rasa, rakta, mansa, medas, asthi, majja, sukra). Hence there are two ways in which the sukra dhatu can become imbalanced: Inadequate nutrition to the sukra dhatu produces malnourished sukra Preenana (satisfaction) is obstructed even where there are nourished sperms. Without a signal of sensual satisfaction to the brain either sperms are not produced or not released. As a result sukra dosha can appear (psychological factors).Love is explained in different capacities: Sneha = mothers love Kama = sexual love Raga = attachment love Prema = universal love If one has prema, he is capable of the other three naturally and without the need to seek out excessively lust, stimulation, sensuality etc. Chikitsa Avoid:Drinking lots of water Incompatible foods Heavy carbohydrate Heavy food Acidic food Red meat / yoghurt Greed for processed food like blue cheese Treatment Main aims of treatment are: Srotas shodana (Panchakarma is the best treatment) Rejuvenation Oleation (snehana / abyanga) – apply oil and massage pelvic and penis areaMahanarayana oil Ashwagandha oil Bala oil Shodana Purgative (if patient is not emaciated)Vasti (enema) Anuvasana vasti decoction with rejuvenate herbs like Ashwagandha balaAgni deepana Hinguwastaka (aphrodisiac) Rasayana Shatawari choorna Ashwagandha choorna Ashwagandha rasayana Chayawanaprash Arista Dashamoolarista Bala arista Ashwagandha arista ................
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