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ABSTRACT
The menstrual cycle in ayurveda is called rituchakra. It consists of three phases- the ra-
jahsravakaal, the ritukaala and the rtuvyatitkaala. Also it shows a periodicity of one chan-
dramasa(28 days). Its proper onset on time denotes an intact hypothalamo-pituitary-ovarian
axis and a normally functioning reproductive system. On the other hand, deviation from nor-
mal pattern denotes a diseased state which can be cured only when diagnosed properly. Ab-
normal menstruation is the most important and commonest cause of infertility. Also many
gynaecological disorders are related to it, most of which come under aartavadushti,
yonivyapat, bandhyaetc. as mentioned in ayurveda.
Key words: rituchakra, rajahsravakaal, aartavadushti, yonivyapat, menstruation.
INTRODUCTION
Menstruation in gynaecology has struation also starts.3 the first menstruation
been defined as the visible manifestation in life is called menarche which is one of
of cyclic physiologic uterine bleeding due the signs of puberty.4 this has been called
to shedding of the endometrium, following as prathamrajodarshankaala. On the other
invisible interplay of hormones mainly hand menopause means permanent cessa-
through hypothalamo-pituitary-ovarian tion of menstruation at the end of repro-
axis.1The menstrual cycle occurring in ductive life due to loss of ovarian follicular
females has been termed in Ayurveda as activity.5 it has been termed as rajonivrit-
Rituchakra .The word ‘chakra’ signifies tikaala.Acharya Sushrta has mentioned
its regular onset at regular intervals, just that the rituchakra starts from the age of
like a cycle. A single rituchakra covers a 12years and comes to an end at the age of
period of one chandramasa (28 days) and 50years. 6Vagbhat has also given the same
it has been divided into three phases-the opinion.7 Acharya Kashyap has given
Rajahsravakaala, the Ritukaala and the some different view. He has said that the
Rituvyatitakaala.2 menstrual cycle appears at the age of 16.
PrathamaRajodarshankaala (age of At the same time he has also said that this
menarche) and Rajonivrittikaala (age of age of initiation of menses (menarche) gets
menopause) influenced by specific ahara (dietetics)
The rituchakra does not occur in and arogya (health).8 Arundatta has men-
young girls (before menarche) because tioned that the age of appearance of men-
their yoni (reproductive system) is heen ses and the age of menopause can also oc-
(under developed). As they grow elder, all cur before 12yrs and 50yrs, respectively.9
the bodily systems get matured and men-
Sushma Shankar: menstrual Cycle An Ayurvedic Prospective
All these are quite similar to the modern him, the normal menstruation is that which
views where the age of menarche has been has an interval of one month, duration of
considered between 10 and 16 years, the five days, is not associated with pain or
peak time being 13 years. The onset of burning sensation, the expelled blood is
menses denotes an intact hypothalamo-pi- neither very scanty nor excess in amount,
tuitary-ovarian axis, functioning ovaries, and resembles the colours of gunjaphala,
presence of responsive endometrium to the red lotus flower, or of indragopa.14
endogenous ovarian steroids and the pres- Acharya Sushruta has further said that the
ence of a patent uterovaginal canal.The shuddhaartava (non-vitiated menstrual
important controlling factors for onset of blood) is that which is of the colour of
puberty (and hence menarche) are genetic, rabbit’s blood or of laksharas and which
nutrition, body weight, psychologic state, does not stain clothes.15 If the menstrual
exposure to light and others. A girl living blood is not having these features then it
in urban areas with good nutrition, ade- means that it is vitiated by the doshas and
quate body weight and whose mother and is vikrit (diseased).In ayurveda, the specif-
sisters have early menarche, start puberty ic aahar-vihar for the women during men-
early. 10 ses(rajaswalacharya) has also been men-
Also the age at which menopause occurs is tioned.Coitus specially has been contrain-
genetically predetermined. The age of dicated by all the acharyas during this
menopause ranges between 45-55 years, phase of rituchakra.16 This phase accord-
average being 50 years. Cigarette smoking ing to modern concept is the phase of men-
and severe malnutrition may cause early strual flow which represents that the ferti-
menopause.11 lisation did not occur during the secretary
Rajahsravakaala (the menstrual phase) phase, so the superficial two-third of the
The rajahsravakaala or the men- endometrium is shed and a new cycle be-
strual phase comes at an interval of one gins.17
month. The duration of this phase varies Ritukaala
according to different acharyas.In general Ritukaala is that phase of ritu-
the duration is from three to five days.12 chakra which comes after the Ra-
Explaining about the physiology of this jahsravakaala. The duration of this phase
cycle, Acharya Sushruta has said that the is twelve days according to Acharya
dark coloured blood gets collected during Sushruta.18 Acharya Vagbhat considers
the whole month by the artavvimochini- this duration as twelve days or sixteen
dhamani in the garbhashaya and this col- days or it may also be of one month.19
lected blood gets expelled through the yon- Acharya Kashyap has given a different
imukha monthly by the action of vayu (ap- concept depending upon different races of
anavayu). This is the phase of ra- the society.20
jahsrava.13 The character of the blood ex- It is called ritukaala because during this
pelled during this kaal has also been men- phase of a woman’s menstrual cycle, if her
tioned. These characters play a great role garbhashaya receives the seeds (sperms),
in diagnosing various types of ‘striroga’ in there are chances of conception (just like
which the normal features of the menstrual the breeding season). The reason for con-
blood get altered. Acharya Charak has ex- ception during ritukaala has been ex-
plained it very beautifully. According to plained very well as follows-as the lotus
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Sushma Shankar: menstrual Cycle An Ayurvedic Prospective
flower closes itself after sun-set, similarly wasthas of women regarding menstrual
the yoni of women gets constricted after cycle can be assessed. Many strivyadhis
ritukaala and does not accept shukra or the (gynaecological diseases) as mentioned in
entry of beej ( sperms) into its inner com- ayurveda can also be diagnosed and treat-
ponents i.e. uterus, fallopian tubes etc. 21 ed. Some of these diseases and their symp-
Various characteristic features of ritumati toms related with menstrual abnormalities
woman have also been mentioned. The are as follows:
ritumati woman looks charming, her 1. Ashtaartavadushti
mouth and teeth are moist , she looks ex- Vatajaartavadushti- The Artava (men-
cited to hear love stories and wants to strual blood) becomes red, black or dark
have sex , her flanks, eyes and hair are violet in colour, thin in consistency, dry,
lax, she feels quivering or twitching over frothy and scattered (with small clots), and
arms, breasts, pelvis, umbilicus, thighs and the patient has perforating or piercing type
hips and looks very happy and excited. of pain.
Alongwith many other things, the clini- Pittajaartavdushti- the Artava vitiated by
cally impotant Ksharkarma and nasya pitta becomes yellowish or bluish in col-
have also been contraindicated to ritumati our, is free from unctuousness, smells like
stri.22 This ritukaala is the proliferative pus, fungus, blood or has putrid smell, the
phase of the menstrual cycle which repre- excreted blood is hot, associated with
sents restoration of the endometrial epi- burning sensation and there occurs feeling
thelium from the preceding menstrua- of heat at the time of its excretion.
tion.23 Kaphajaartavdushti- The artava vitiated
Rituvyatitakaala by kapha becomes whitish or slightly yel-
This is the phase of Rituchakrajust lowish in colour, appears as if mixed with
after the ritukaalaand it ends with the on- bone marrow, becomes very thick, slippery
set of the rajahsravakaala. This phase has or lubricous, unctuous and settles down if
been mentioned in very short as the phase put in water.
of the rituchakrawhen there occurs the Kunapagandhiartavadushti- The kunapa-
closure or constriction of the yoni.24 Be- gandhi(smell of a dead body) artavadushti
cause of this closure, entry of sperms is not is caused by rakta. In this vikriti, the blood
allowed so no conception in this phase. discharged during menses is increased in
The rituvyatitkaala is the secretory phase amount and red like fresh blood. It is also
of the menstrual cycle which represents associated with heat and burning sensation
preparationof the uterus for implantation etc. features of pitta.
of the fertilized ovum.25 Granthibhutaartavadushti- The gran-
Importance of Rituchakra thibhuta(clotted appearance) artavadushti
Rituchakra or menstrual cycle is is caused by vitiation of vata with kapha
one of the most important physiological and is associated with features of both the
events in female’s life. A healthy men- doshas (pain due to vata and unctuousness
strual cycle is a must for reproduction and due to kapha etc.).
continuation of the progeny. It is very im- Putipuyanibhartavdushti- Putipuyanibh
portant to know about the normal physiol- (putrid and purulent) artavadushti is
ogy of Rituchakra because only after caused by pitta with kaphadoshas ac-
knowing about this , prakrit and vikrita- cording to Sushruta and Vagbhat1 and due
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Sushma Shankar: menstrual Cycle An Ayurvedic Prospective
to rakta with pitta by Vagbhat 2.It is char- produces severe pain in sacral, groin and
acterised with features of pitta and kapha. cardiac region, flanks, back and pelvis.
Ksheenartavdushti- Ksheen (scanty) ar- Pittaja Asrigdara- The menstrual blood is
tavadushti is caused by pitta with bluish, yellowish or blackish in colour,
vata.Inthis condition, menstruation is de- hot, comes in profuse amount, repeatedly
layed, and menstrual bood is scanty and is and with pain. It is associated with burning
associated with pain in vagina. sensation, redness, thirst, mental confu-
Mutrapurishagandhiartavadushti- sion, fever and giddiness.
Mutrapurishagandhi(smell of urine and Kaphaja Asrigdara- The menstrual blood
faeces) artavadushti is caused due to vitia- is slimy, pale, heavy, unctuous, and cold,
tion of all the three doshas and has features mixed with mucus and thick and is dis-
of all of them.26 charged with mild pain. Other symptoms
2. Artavakshaya- In this condition, the like vomiting, anorexia, nausea, dyspnoea
menstruation does not appear in appro- and cough etc. are also present.
priate time or is delayed (prolonged in- Sannipataja Asrigdara- Here the clinical
termenstrual period), is scanty and features of all the three doshas are pre-
there is pain in vagina.27 sent.32
3. Nashtartava- In this condition,the 6. Vataja yonivyapat- Along with other
doshas obstruct the passage or orifices features, the menses appears with
of artavavaha srotas, thus the ar- sound, pain, is frothy and dry (absence
tava(menses) does not appear monthly of mucous).33
or is destroyed. The obstructing 7. Pittajayonivyapat- The menstrual
doshasare vata and kapha, because pit- blood is blue, yellow, or black in col-
ta increases rakta and thus produces our, excess in amount, hot and smells
excessive bleeding.28 like a dead body.34
4. Artavaativriddhi- The patient suffering 8. Kaphaja yonivyapat- The menstrual
with artava-ativriddhi has generalised blood discharged is yellowish and unc-
bodyache, excessive bleeding during tuous.35
menses and foul smell in menstrual 9. Tridoshaja yonivyapat- The menstrual
blood.29 discharge is whitish pale and unctu-
5. Asrigdara or Pradara- Due to pra- ous.36
deerana(excessive excretion) of raja 10. Asrija or apraja /Raktayoni
(menstrual blood), it is called pradara /Lohitakshara yonivyapat-
and since there is deerana (excessive Even after conception, there is excessive
excretion) of asrik (menstrual blood) , bleeding per vaginum. Due to this exces-
it is called asrigdara.30 This disease sive bleeding, it is also known as Rak-
appears to be analogous to menorrha- tayoni. According to Sushruta, lohit-
gia. Depending upon the involvement akshara is the condition when there is
of doshas, it is of four types - vataja, trickling or oozing of blood per vaginum
pittaja, kaphaja and sannipataja.31 associated with burning sensation.37
Vataja Asrigdara - The menstrual blood is
frothy, thin, rough, blackish or reddish re- 11. Arajaska/Lohitakshaya- Here, raktais
sembling washings of flowers of palash in vitiated by pitta and so the woman be-
colour, comes with or without pain. Vayu comes extremely emaciated and dis-
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Sushma Shankar: menstrual Cycle An Ayurvedic Prospective
coloured, and there is no menses i.e. we are able to explain these things in terms
extremely weakcondition along with of hormones and other physiological pro-
amenorrhoea. cesses. But the concepts given by our an-
In lohitkshaya, due to vitiation of vata and cient acharyas can never be ignored.There
pitta, the raja is decreased and the lady are so many diseases in women which are
suffers from burning sensation, emaciation associated with abnormal menstrua-
and discolouration.38 tion.Most of them are curable if diagnosed
12. Udavartini yonivyapat- Due to the properly.Problems related with menstrual
movement of flatus etc. natural urges disturbances are one of the most common
in reverse direction, the aggravated ap- problems amongst females. Today, every-
anavayu moving in reverse direction one’s life has become so fast and stressful
fills yoni (uterus). This yoni seized that we don’t have time to take care of
with pain, initially throws or pushes ourselves properly. There is no fixed
the raja (menstrual blood) upwards, schedule for daily activities. People don’t
then discharges it with great difficulty. have time for proper aahara and vihara.
The lady feels immediate relief fol- Especially women who have to take care
lowing discharge of the menstrual of household and work outside also, are
blood. Since here the raja moves up- facing a lot of health related problems. All
wards or in reverse direction, it is these changes in lifestyle are disturbing the
termed udavartini.39 bodily physiological activities and result-
13. Karnini yonivyapaat- In a pregnant ing in serious disorders and diseases.The
woman, due to straining during labour age of onset (menarche)and the age of ces-
in absence of labour pains, the vata ob- sation (menopause)of the rituchakra, regu-
structed by foetus, withholding kapha larity and periodicity of the rituchakra, the
and getting mixed with rakta produces amount of the rajahsrava(blood dis-
karnika in yoni, which obstructs the charged), the density of rajahsrava ,the
passage of raja (menstrual blood).40 unctuousness of the rajahsrava ,the colour
14. Shandi yonivyapat—The woman suf- of the rajahsrava and any foul smell if
fering from shandiyoni does not have present,plus its association with pain, etc.
artava(menses) and breasts, though she are the points which should be considered
is capable of coitus, however her vagi- while making the diagnosis. Some men-
nal canal feels very rough.41 strual disorders like shandi yonivyapat are
15. Bandhya yonivyapat- Here the artava because of some genetic or chromosomal
(menses) is destroyed.42 abnormalities and cannot be cured.
DISCUSSION REFERENCES
Thus we see that menstruation has 1. D.C.Dutta, Textbook of Gynecology,
been very well explained in ayurveda. The fourth edition, page no.74.
2. TiwariPremwati (Ed.), AyurvediyaPra-
complete physiology of menstruation, age
sutiTantraevumStriRo-
of onset, age of withdrawal, duration and ga,Chaukhambha Orientalia Vara-
amount of blood discharged, colour, smell, nasi,2nd
unctuousness, etc. of the menstrual blood edition ,2003, Part 1,Page 62 .
in a normal condition have all been ex- 3. KashyapSamhita by VriddhJeevaka
plained in very detail. Today with the de- revised by Vaatsya with Sanskrit intro-
velopment of modern tools and techniques, duction by PanditHemaraj Sharma
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Sushma Shankar: menstrual Cycle An Ayurvedic Prospective