Download - Lekhana garbhavyapad-psr
AKNOWLEDGEMENT
Completion of dissertation work is the hallmark in postgraduate studies. At this important junction of
my life my head bows down with great humility in the feet of Almighty, without whose inspiration I would
not have been able to attain these stages in my life and whose affectionate touch was and always will be with
me to triumph all the obstacles.
I would like to thank my parents, Sri Pampanagouda. S. Patil and Smt Lalitha. P. Patil for their
constant love and support, parent-in-laws, Vaidya. Sri Panchaxari. S. Hosmath and Vaidya. Smt Mahadevi.
P. Hosmath for their kindness and encouragement. Thanks to my sisters for valuable help.
Words are not enough to gratitude to my husband Dr. Sanjay. P. Hosmath for helping and
encouraging me throughout the study. Many thanks to my children Siddarth and Ananya who were allowed
me to concentrate on the work without troubling me.
It is indeed my fortune to have carried out this dissertation work at S.D.M. college of Ayurveda,
Udupi. In this regard, I would like to express my heartfelt gratitude to honourable Dr. D. Veerendra Hegde,
Dharmadhikari, Shri kshetra Dharmasthala, and president of S.D.M. Society.
I genuinely feel that any words of gratitude are inadequate to express my humble thanks to Dr.
V.N.K.Usha, Professor & HOD Dept of Prasooti tantra & Streeroga S.D.M.College of Ayurveda & Hospital.
It is my fortune to have her as my guide whose excellent guidance, moral support & kind words for each &
every step during my course of study gave me a way to success for the dissertation & in future career also.
I take this opportunity to thank my Co-guide Dr. Suchetha for all the expert advice & specific
suggestions during the course of my work. Without her, it would not have been what it ought to be.
I express my heartfelt thanks to Dr. Mamatha K.V, Asst. Professor, for feeding me with precious
training & constructive ideas, throughout my study period.
My sincere gratitude & thanks to Dr. Ramadevi, Asst. Professor, Dept of Prasooti tantra &
Streeroga, S.D.M.College of Ayurveda, Kuthpady, for her worthy suggestions.
I also thanks to Dr. Vidya for her suggestions and help.
I render my thanks to Dr. V.N.Prasad, Principal SDMCA, Kuthpady for his invaluable support and
guidance for the completion of the thesis.
My deep sense of gratitude to Dr. Shrikant. U. Dean of P.G. Studies and Dr. Govind raju Co-Dean of
P.G. Stidies for their valuable guidance.
I am thankful to Dr. Y.N.Shetty, Medical Superintendent and Mr. C.S.Hegde, Manager, S.D.M
Ayurvedic Hospital, Udupi, for providing all the facilities in the hospital for my study.
I express my regards to Dr. Krishna bai and Dr. Veena Mayya for their help.
I greatly indebted to Dr. Murulidhar Sharma, Dept of Shalya tantra, for his ablest guidance and
dragging me to the path of success.
I extend my regard to Mr. Harish Bhat, Liabrarian, S.D.M College of Ayurveda, Udupi for his
generous help during the course of my life.
My genuine thanks to all my friends Dr. Shilpa, Dr. Sukanya, Dr. Sujatha, Dr. Shubha, Dr. Kavya
for always being there to my difficulties and render moral support.
I also thanks to Miss. Rashmi and miss.Shruti for their support and encouragement to make myself
feel at home even in hostel.
My deepest gratitude to the staff of Sampark Xerox for perfection of final product of my dissertation.
I thank all those who have directly or indirectly contributed to the successful completion of this work
still, I apologize for errata and shortcomings.
Dr. Vijayalakshmi.S.Hosmath
LIST OF ABBREVIATIONS
Serial No Abbreviation
1 Su. Sa. Sushruta Samhita
2 A.Sa Astanga Sangraha
3 A.Hri. Astanga Hridaya
4 Gr Group
5 P/V Per vaginal
6 USG Ultra sonography
7 & And
8 % Percentage
Dedicated
To
My Family
ABSTRACT
Title: “Clinical evaluation of lekhana procedure in certain conditions of streeroga &
garbha vyapad”.
Background: Lekhana karma is one of the Astavidha shastra karmas described in
classics and it is only one of its kind. It causes pattalikarana. It is better than chedana,
bhedana etc procedures, because of little intervention to the tissues. The main instrument
which is used for Lekhana karma is Mandalagra shastra. The indications such as
mamsonnati, mamsankura, arsha and granthi which are explained by Sushruta can be
interpreted in Streeroga, as in conditions like hyperplasia of endometrium. It is very
efficient therapeutic modality in shesha amagarbha chikitsa because of shodhana effect.
Hence it has both diagnostic and therapeutic efficacy. The endeavor of the study is to
standardize the procedure as per changing era.
Objective:
• Conceptual study of Lekhana vidhi & it’s indications in certain conditions
of Stree roga & Garbha vyapad.
• Analysis of Lekhana vidhi in different conditions of Stree roga & Garbha
srava.
Design and setting: It is a descriptive observational study. Randomly selected 50
patients from OPD and IPD of S.D.M Ayurveda hospital, Kuthpady, Udupi, according
to inclusive criteria were registered for the study.
Methods: According to following groups, patients were diagnosed as
A) Atyartava , i.e. Excessive bleeding during menstruation.
B) Anartava, i.e. Secondary amenorrhoea.
C) Garbha srava, i.e. Inevitable abortion
D) Vandhyatva & other conditions of Stree roga.
After diagnosing the particular condition, the incidence of Lekhana karma in different
indications was assessed on different parameters like time taken for the procedure,
amount of collected endometrial material, complications and Samyak laxanas of the
procedure.
Results :
• The patients who underwent Lekhana karma, were maximum in the Group of
Garbha srava (48%), followed by patients of Atyartava (44%), Vandhyatva (6%)
and Anartava (2%).
• The efficacy of Lekhana karma was studied. The 52% of patients were cured,
followed by 40% of patients were relieved and in 8% of patients no effect was
seen.
Conclusion:
Lekhana karma is mainly recommended in cases of mamsonnati, mamsankura, granthi,
arsha which usually clinically presented with Atyartava and also in cases of shesha
amagarbha. It is difficult to draw any conclusion regarding Anartava and Vandhyatva
groups, because of small sample size.
Key words : Lekhana karma, Atyartava, Anartava, shesha amagarbha, Vandhyatva,
Garbhavyapad, Mandalagra shastra.
CONTENTS
CHAPTER NO. TITLE
PAGE NO
1 Introduction 1-2
2 Objectives 3
REVIEW OF LITERATURE
3.1 Historical review 4-5
3.2 Introduction of Lekhana karma 6-8
3.3 General description of Lekhana karma 9-14
3.4 Description of Lekhana karma in Streeroga & Garbha vyapad 15-20
3
3.5 Modern Review 21-31
CLINICAL STUDY
4.1 Materials and methods 32-34 4 4.2 observations
35-65
5 Discussion
66-74
6 Summary and conclusion 75-77
7 Bibliography
78-90
8 Annexure
91-102
LIST OF TABLES
Sl No Table heading Page No
1 Distribution of patients according to Age 35
2 Distribution of patients according to Religion 36
3 Distribution according to Education 37
4 Distribution of patients according to Socio economic status 38
5 Distribution of patients according to occupation 39
6 Distribution of patients according to Region 40
7 Distribution of patients according to Diet 41
8 Distribution of patients according to sleeping pattern 42
9 Distribution of patients according to previous menstrual history 43
10 Distribution of patients according to Obstetric history 44
11 Distribution of patients according to previous surgical history 45
12 Distribution of patients according to Prakriti 46
13 Distribution of patients according to Samhanana 47
14 Distribution of patients according to Sara 48
15 Distribution of patients according to Satva 49
16 Distribution of patients according to Satmya 50
17 Distribution of patients according to Aharashakti 51
18 Distribution of patients according to Vyayama shakti 52
19 Incidence of Lekhana karma in 50 selected patients 53
20 Incidence of diagnosis of conditions on the basis of clinical features
in selected 50 patients.
54
21 Incidence of total time taken for procedure in 50 patients 55
22 Incidence of requirement of Vardhana karma before the procedure 56
23 Incidence of P/V bleeding immediately after the procedure 57
24 Incidence of pain in abdomen immediately after the procedure 58
25 Incidence of amount of collected endometrial material obtained after
the procedure
59
26 Incidence of injury after the procedure 60
27 Incidence of infection after the procedure 61
28 Incidence of P/V bleeding after 1 hour, after the procedure 62
29 Incidence of pain in abdomen after 1 hour, after the procedure 63
30 Incidence of surgical interventions after Lekhana procedure 64
31 Incidence of final assessment of the procedure 65
LIST OF GRAPHS
Sl No List of Graphs Page No
1 Distribution of patients according to Age 35
2 Distribution of patients according to Religion 36
3 Distribution according to Education 37
4 Distribution of patients according to Socio economic status 38
5 Distribution of patients according to occupation 39
6 Distribution of patients according to Region 40
7 Distribution of patients according to Diet 41
8 Distribution of patients according to sleeping pattern 42
9 Distribution of patients according to previous menstrual history 43
10 Distribution of patients according to Obstetric history 44
11 Distribution of patients according to previous surgical history 45
12 Distribution of patients according to Prakriti 46
13 Distribution of patients according to Samhanana 47
14 Distribution of patients according to Sara 48
15 Distribution of patients according to Satva 49
16 Distribution of patients according to Satmya 50
17 Distribution of patients according to Aharashakti 51
18 Distribution of patients according to Vyayama shakti 52
19 Incidence of Lekhana karma in 50 selected patients 53
20
Incidence of diagnosis of conditions on the basis of clinical features
in selected 50 patients
54
21 Incidence of total time taken for procedure in 50 patients 55
22 Incidence of requirement of Vardhana karma before the procedure 56
23 Incidence of P/V bleeding immediately after the procedure 57
24 Incidence of pain in abdomen immediately after the procedure 58
25 Incidence of amount of collected endometrial material obtained after
the procedure
59
26 Incidence of injury after the procedure 60
27 Incidence of infection after the procedure 61
28 Incidence of P/V bleeding after 1 hour, after the procedure 62
29 Incidence of pain in abdomen after 1 hour, after the procedure 63
30 Incidence of surgical interventions after Lekhana procedure 64
31 Incidence of final assessment of the procedure 65
LIST OF FIGURES
Serial No Figure Page no
1 Vrittamukha mandalagra shastra 10
2 Kshurakara mandalagra shastra 10
3 Karapatra 10
4 Prayatagra Vruddipatra 11
5 Anchitagra Vriddipatra 11
6 Dantalekhana shastra 11
7 Krpasavihitoshnisha shalaka yantra 99
8 Yonivranekshana yantra 99
9 Sarpaphanamukha yantra 100
10 Svastika yantra 100
11 Garbhashaya eshani 101
12 Shalaka yantra 101
13 Dvitala yantra 101
14 Vrittamukha mandalagra shastra 102
15 Kshurakara mandalagra shastra 102
Chapter 1 Introduction
INTRODUCTION
Ayurveda is the system of medicine which serves ailing humanity. It is eternal
because it has no beginning, it deals with such thing as are inherent in nature and such
manifestations are eternal.
“soayamaayurvedah shaashvato nirdishyate, anaaditvaat,
svabhaavasamsiddalakshanatvaat, bhaavasvabhaavanityatvaachcha.” 1
Though the principles of Ayurveda are everlasting, their applications may differ
from time to time. Ayurveda is not only rich in medicine but is enriched in surgical field
also.
Acharya Sushruta is a pioneer of surgery starting from the basic principles of
surgery to the plastic surgery hence known as a Father of surgery. He explained all the
necessary details about instruments that are used till date, but are used in modified form
in present era. Asthavidha shastra karmas which are explained by Acharya Sushruta,
covers basic features of all surgical procedures.
In the course of period due to so many social & political factors, Ayurveda has
fallen from its height of practice & remained as conceptual. Due to these factors the
surgical procedures of Sushruta disappeared from the mainstream of Ayurveda . Surgical
operations such as the Nasa sandhana, couching for cataract, management of
Moodhagarbha, Asthibhagna chikitsa and many other procedures were not done by
traditional Vaidyas, but by illiterate practitioners who passed on their manual skill from
one generation to the next.2 What so ever we are implementing in contemporary surgical
practice already exists in our samhitas.
Lekhana karma is a distinctive technique which is one among the Ashtavidha
shastra karmas & it has its own efficacy. It is one type of shodana therapy which is used
in failure of shamana chikitsa. It does the shodana of Garbhashaya in conditions of
Artavadusti & Yonivyapad. As it is teekshna chikitsa, it can be also implemented in
Garbhasrava chikitsa. It is mainly indicated in vrana, vartmagata rogas etc.
1
Chapter 1 Introduction
Present study explores the incidence of the various gynecological and obstetric
pathologies which are indications of Lekhana karma. These pathological manifestations
have ill effect on the health and hamper reproductive capacity of the woman. If timely
treated with Lekhana karma, early diagnosis of the pathological conditions and avoidance
of surgical intervention like hysterectomy is possible. Hence Lekhana karma helps in
restorative effect of endometrium. Even in case of shesha amagarbha, teekhna upachara is
significant treatment for expulsion of remaining concepts. Hence Lekhana karma can be
considered.
The practical aspects of surgery were little focused in Ayurveda. Hence this study
helps to prove facts and information present in classics.
2
Chapter 2 Objectives
3
OBJECTIVE OF THE STUDY
1. Conceptual study of Lekhana vidhi & it’s indications in certain conditions of
Stree roga & Garbha vyapad.
2. Analysis of Lekhana vidhi in different conditions of Stree roga & Garbha
srava.
Chapter 3.1 Historical Review
4
HISTORICAL REVIEW
Ayurveda has historically made foundational contributions to the development of
the branch of surgery. Surgery in ancient India was quite specialized and highly
developed. There were number of eminent surgeons who performed surgical procedures
with great skill and success and composed of great compendia on surgery recording their
valuable experiences. Sushruta is called as the father of surgery and the first known
surgeon in the world and even wrote a book and his practices reached the middle east and
later to the west.3 Sushrutha was also the first surgeon to advocate the practice of
operations on inanimate objects such as watermelons, clay plots and reeds; thus predating
the modern practice of the surgical workshop by half a millennium.
There is wrong assumption that surgery waned and gradually came to a fall down
due to emphasis on non-violence by Jains and Buddists. On the contrary, Jain monks
carried with them a medicine chest which contained surgical instruments. Jivaka the
contemporary & devotee of Lord Buddha, was eminent surgeon who performed
miraculous cures by his surgical skill. The actual reason hindering the progress of surgery
in those times were want of anesthesia and lack of antiseptics, surgical operation on a
manmade unconscious with wine along with physical pressure could not be expected to
gain popularity and continue for long.4
Change in thinking strategies regarding surgery and lack of facilities probably
made the surgical aspects infamous in India, later on the same concepts have came up in
different countries and surgical practice has got flourished. One of them being curettage.
Vedic period In Vedic period, references about miraculous performance in surgeries by
Ashvini kumaras are available. But there is no direct reference about Lekhana karma.
Samhita kala –
Chapter 3.1 Historical Review
5
References regarding Lekhana karma are available in Bhruhatrayis.
• Acharya Charaka has explained Lekhana karma while explaining vrana chikitsa
in dvivraneeya chikitsa adhyaya.5
• Acharya Sushruta has explained Lekhana karma as it is one the of Astavidha
shastrakarma6 and it is one of the pradhanakarmas of the shasthi upakramas which
are explained in the vrana chikitsa7. He explained indications8 and procedure9 in
detail. He has described the instruments which are used in Lekhana karma with
the dimension of their sharp edges10, correct technique of holding11, method of
using, merits12 and demerits13 etc. In Lekhyaroga pratishedhadhyaya, he
enumerated the lekhana karma in vartma rogas with procedure14, indications15,
samyak laxana16 and asamyak laxanas17.
• Acharya Vagbhata explained the Lekhana karma mainly in netrarogas with
procedure18, samyak laxanas and asamyak laxanas19. He has described detail
description of shastras20 which are used in Lekhana karma.
• In Bhavaprakasha, reference for Lekhana karma is directly not available, but
indirect reference is available in Bhavamishra commentary while explaining
vrana chikitsa.21
• In Bhela Samhita, reference about Lekhana karma is available in vrana chikitsa22.
Modern -
• The procedure, indications and complications of curettage is explained in all text
books of Obstetrics and Gynecology.
Chapter 3.2 Conceptual study
6
INTRODUCTION OF LEKHANA KARMA
Nirukti23 –
• Lekhya – sÉãZrÉÇ, ̧É, (ÍsÉZÉ+LrÉiÉ|) sÉãÎZÉiÉurÉqÉç sÉãZÉlÉÏrÉqÉç |
CÌiÉ ÍsÉZÉkÉÉiÉÉã: MüqqÉïÍhÉ rÉmÉëirÉrÉãlÉ ÌlÉwmɳÉqÉç ||
(vÉoSMüsmÉSìÓqÉ)
The word lekhya is derived from ‘likha’ dhatu & ‘ya’ pratyaya.
• Lekhana –
ÍsÉZÉç + srÉÑOè
The word Lekhana derived from ‘likh’ dhatu and ‘kta’ pratyaya.
Paribhasha24 –
“Lekhanakarmakaree, pattaleekaranah”.
The process of thinning is called as Lekhana karma.
“Shastradigharshanena vranasya tanukaranam”.
Lekhana karma means thinning of vrana by rubbing with instruments.
“Upakramam shaslyatantre shastrena vilekhanam”.
Lekhana is upakrama of shalyatantra.
Related terms of the word Lekhana25 –
ÍsÉZÉç – ÍsÉZÉÌiÉ, sÉãÎZÉiÉç, sÉãÎZÉiÉqÉç, ÍsÉÎZÉiÉqÉç, ÍsÉZrÉ
To scratch, scrape, furrow, tear up(the ground)
ÍsÉÎZÉiÉ – scraped, scratched, scarified, written
Chapter 3.2 Conceptual study
7
sÉãZÉ – a line, stroke, a writing, manuscript
sÉãZrÉ – to be scratched or scraped or scarified, to be written
Introduction –
Lekhana karma is one type shadvidha shastra karmas.26
Lekhana karma is one among the Ashtavidha shastra karmas.27
Lekhana karma is one of the procedure in surgical management of vrana.28
Lekhana karma is one important procedure in sixty upakramas of vrana.29
According to Dalhana, vartma can be considered as vrana vartma or netra
vartma. So all the procedures which are carried on netra vartma, can be
implied on vrana vartma also.30
• Lekhana karma as main procedure –
It is one of the pradhana karma in shasthi upakramas of vrana
chikitsa.31
It is the one type of asthavidha shastrakarmas.
It is unique technique in some conditions like mamsonnati,
mamsakandi etc.32
In vartmavabandi, klistha vartma, bahala vartma, pothaki, shyava
vartma, kardama vartma, kumbhika vartma, vartma sharkara and
utsanga vartma, it is the main procedure.33
.
• Lekhana karma as adjuvant therapy-
In amarmaja apakva granthi Lekhana karma and kshara karma are
as alternate procedures in paachana chikitsa.34
In kumbhika vartma, vartma sharkara and utsanga vartma, lekhana
should be done after bhedana karma.35
In peedaka, bhedana followed by lekhana36
Chapter 3.2 Conceptual study
8
In pilla chikitsa, after lekhana procedure, if not satisfied, the
procedure should be repeated followed by application of jalouka.37
In nasa sandhana, Lekhana procedure following with other
procedures.38
In alaji, bhedana, lekhana followed by dahana.39
In arbuda, chedana followed by lekhana. 40
In case of upanaha, bhedana followed by lekhana.41
In case of surgical treatment of linganasha, Lekhana karma is
indicated with other procedures.42
Chapter 3.3 Conceptual study
9
GENERAL DESCRIPTION OF LEKHANA KARMA
Indications of Lekhana karma –
• General indications – Kilasa43
Kustha44
Mandala45
• Indications related with shalakya tantra –
4 types of rohini46
Upajihvika47
Dantavaidarbhya48
Vartma rogas49
Adhijihvika 50
Nasika sandhana51
Upanaha52
Linganasha 53
Dantasharkara54
• Indications related with shalya tantra and streeroga –
Granthi55
Arsha 56
Mamsa kandi (alpa mamsankuras)57
Mansonnati 58
Vrana vartma59
Instruments used in lekhana karma –
Mandalagra60
Karapatra61
Vruddipatra62
Dantalekhana shastra63
Chapter 3.3 Conceptual study
10
Description of shastras –
Mandalagra shastra –
According to Acharya Sushruta, it is a round tipped instrument & six angula in length.
According to Acharya Vagbhat, it has its edge in the shape of nail of index finger.
Types - Acharya Dalhana explained 2 types of Mandalagra shastra as follows -
1. Vrittamukha – having circular tip.
Fig No. 1
2. Kshurakaara – it resembles with shape of sickle.
Fig No. 2
Karapatra –
According to Acharya Dalhana, it looks like leaves of Kara which has rough edge. It is
shape of fingers in hand. There are some differences among Acharyas regarding the
length of this shastra. Acharya Sushruta has given its length as six angula while
according to Dalhana its length as twelve angula.
Fig No.3
Chapter 3.3 Conceptual study
11
Vruddipatra –
It resembles the barber’s knife in shape tapering to a sharp point at its tip for use in
unnata and gambheera. Other one is opposite to this, it is having backward bend and a sharp
edge outside.
Prayatagra -
Fig No. 4
Anchitagra -
Fig No. 5
Dantalekhana shastra –
It has four faces, each connected firmly with a band and one sharp edge, and is meant for
scrapping the tarter on the teeth.
Fig No. 6
Chapter 3.3 Conceptual study
12
Shastra dhara in lekhana procedure64 –
• sÉãZÉlÉÉlÉÉqÉkÉïqÉÉxÉÔUÏ
The dhara of shastras which are used for Lekhana karma should be size of half lentil.
Method of holding shastra in lekhana procedure –
• Vruddipatra & Mandalagra should be held by the hand slightly raised up for the purpose
of Lekhana karma & the procedure should be repeatedly.65
• For Lekhana karma, the shastra should be held carefully in between vrintaphala & the
edge with index & middle fingers and the thumb.66
Procedure-
• According to Acharya Sushruta, in management of vrana shopha67 –
Poorva karma-
“Langhanadi virekaantam purvakarma vranasya cha”
From langhana to virechana are considered to be poorvakarma of vrana chikitsa.
Pradhana karma –
‘Paatanam ropanam chaiva pradhaanam karma tat smritam.’
From paatana to ropana are called as pradhaana karma.
Pashchat karma-
“Balavarnaagnikaaryam tu paschatkarma samaadishet”
Impovement of bala, varna, agni to be considered in paschaat karma.
• According to Acharya Sushruta as in Lekhya rogadhyaya68 –
Poorva karma- snehana, vamana, virechana
Chapter 3.3 Conceptual study
13
Pradhana karma – Patient should lie down in supine position devoid of wind & sunrays.
He should be held firmly. The vartma lifted with the left thumb & index finger. It should
be everted & fomented carefully with a cloth dipped in warm water. The vartma should
be cleaned with a swab & lekhana should be done with shastra or patra. Later on
fomentation should be done after cessation of bleeding.
Paschat karma – Apply the kalka of fine powder of manashila, kasisa, trikatu, rasanjana,
saidhava mixed with madhu. Then sprinkle ghee after washing with the lepa with warm
water & further managed like vrana. After 3days swedana, pidana should be done.
• According to Astanga hridaya, in vartma roga chikitsa69 –
Poorva karma – shodhana therapy
Pradhana karma – The patient is made to lie in supine position in a place which is
devoid of air. Svedana should be given to the vartma with warm water. The vartma held
by the thumb & fingers of the left hand in such a way that it neither slips away nor makes
any movement. Then with the Mandalagra shastra, an incision should be made
horizontally, lekhana done by its own edge or leaves. The bleeding should be cleaned
with phena or pichu.
Paschat karma – after bleeding stops powder of saindava mixed with honey should be
applied. After some time it should be washed with warm water, then applied ghee, a
bolus of flour of yava mixed with honey & ghee should be applied. The vartma should be
bandaged, above &below the ears. On the second day the bandage should be removed &
parisheka should be given as described earlier. On the fourth day nasya should be done.
On the fifth day the bandage should be removed.
Chapter 3.3 Conceptual study
14
Samyak lekhya vartma laxanas70-
Asrugaasraavarahita (stoppage of bleeding), kandushopha vivarjitam (not associated with
itching and inflammation), samam (the lesion should be even), nakhanibham (like colour
of nail)
Durlikhita vartma laxanas 71–
Raktasraava , raga, shopha, parisraava, timira, the vartma becomes shyaava in colour,
guru, sthabhdha , and associated with kandu, paaka
Chapter 3.4 Conceptual study
15
DESCRIPTION OF LEKHANA KARMA IN STREEROGA &
GARBHA VYAPAD Chikitsa –
“yaakriyaa vyadhiharanee saa chikitsa nigadhate” 72
The measures or efforts, which destroys the disease is called as chikitsa.
Shastra karma as a variety of shodana karma –
“Samyak shodhayateeti samshodhanam; tadvidham –
bahiraashrayamabhyantaraashrayam cha.
Tatra bahiraashrayam shastrakshaaraagnipralepaadayah: abhyantaraashrayam
chatushprakaaram – vamana, virechanam, asthaapanam, shonitamokshanam cha:
anye tu shonitamokshanamityatra shirovirechanam manyate.”73
The procedure which does the shodhana is called as samshodhana. Samshodhana chikitsa
is divided in to two types – bahiraashraya and abhyantaraashraya.
Bahiraashraya is the application of shastra, kshaara, agni, pralepa etc.
Abhyantaraashraya is again divided into 4 types – vamana, virechana, asthapana,
raktamokshana. According to some other opinion that, instead of raktamokshana,
shirovirechana can be considered.
Any clinical condition if not treated by shamana (medical treatment) chikitsa,
shodhana (surgery) chikitsa indicated after analysis of dosha, dhatu, rogibala and
rogabala. So in such conditions minor surgical procedures like Lekhana karma can be
indicated in female genital tract.
Indications – Indications in Streeroga -
Atyartava – In this condition Lekhana karma can be implemented as Shodhana
therapy.
• Raktayoni –
“……raktayonyaakhyaa srugati sruteh”74
Excessive bleeding per vagina is a main character of Raktayoni.
Chapter 3.4 Conceptual study
16
• Kunapa gandhi artava dusthi – “Kunapagandhyanalpam cha raktena”75
Kunapa gandhi artava dusthi is caused by vitiation of rakta. There is excessive
amount of menstrual blood.
“chakaaraachchonitavarnam pittavedanam cha, kunapam shavastasyeva
gandho asyoti kunapaganghihi”
According to Dalhana Acharya In this condition the bleeding resembles with fresh
blood. It is associated with features of pitta and smell of dead body.
• Asrigdara-
“Tadevaatiprasangena pravruttamanrutaavapi
Asrugdhsram vijaaneeyaadatoanyadraktalakshanaat
Asrugdharo bhavet sarvah saangamardah savedanah.”76
According to Sushrutacharya, artava which is excessive in amount and is
for prolonged period, occurs during intermenstrual period and is different from
shudda artava lakshanas, is called as Asrigdara. Generalized body ache is a
symptom of Asrigdara.
“Rajah pradeeryate yasmaat pradarastena sa smrutah”77
According to Charakacharya, excessive excretion of menstrual blood is called as
pradara.
Types of Asrigdhara –
Vataja asrigdhara78 – The artava which is vitiated by vata dosha is
phenila, aruna, Krishna or shyava varnayukta, parusha, tanu, flows
quickly, does not clot is called as vataja asrigdhara.
Pittaja asrigdhara79 – In this condition the artava is neela, pita, harita or
shyava in colour, visra, katu in taste is not liked by pipilika and makshika.
Kaphaja asrigdhara80 – In this condition the artava is like gairikodaka,
snigdha, bahala, pichchila, chirasravi and gets clotted like muscle.
Sannipataja asrigdhara81 – In this condition the features of all doshas
present and the artava resembles kanji in colour and is foul in smell.
Chapter 3.4 Conceptual study
17
Dwidoshaja asrigdhara82 – In this condition the features of both involved
doshas are present.
Anartava – In this condition Lekhana karma can be indicated as Shodhana
chikitsa.
• Arajaska83 –
“Yonigarbhaashayastham chet pittam sandushayedasruk
Saaarajaskaa mataa kaarshyavaivarnya jananeebhrusham”
The pitta which is situated in yoni and garbhashaya, vitiates rakta, then the woman
becomes more emaciated and discolored, is called as Arajaska.
“Arajasketi anaartavaa”
According to Chakrapani, anartava is a symptom of Arajaska.
• Lohita kshaya – “........vaatapittaabhyaam ksheeyate rajah
Sa daahakaarshyavaivarnya yasyaa saa lohitakshayaa”84
According to Astanga sangraha, when raja vitiated by vaata and pitta, the amount
of raja becomes decreased. This condition is associated with daha(burning
sensation), karshya(emaciation) and vaivarnya(discolouration).
“ksheeyate raktamiti atipravrutyaa raktasya kshayah”85
In Madhukosha commentary excessive bleeding is the cause for raja kshaya.
• Shushkaa –
“Vegarodhaadrutou vaayurdushto vinmutrasangraham
Karoti yoneh shosham cha shushkaakhyaa saativedanaa”86
According to Vagbhatacharya, when vaayu gets vitiated due to suppression of
vegas during rutukala, produces retention of urine and feces, dryness in vagina.
“Shushkaa nashtaartavaa kathitaa”87
According to Adhamalla, amenorrhoea is only symptom of Shushka yonivyapad.
Chapter 3.4 Conceptual study
18
Vandhyatva & other conditions – In all these conditions Lekhana karma
explores the Garbhakostha for detection of Kshetra dusti and favors collection of
artava to detect artava dusti.
• Saprajaa –
“saprajaa apeeti avandhyaa api satee katham chirena garbha vindati”88
Failure to get conception even after having previous uneventful pregnancy is
termed as Saprajaa.
• Aprajaa –
“Yasyam labdheapi garbhe asrugatipravartate, saa taadrusharaktasrutyaa
aprajaa bhavati, iyam cha raktayoniruchyate iti raktaatisrutyaiva
labhyate….”89
Unable to conceive due to excessive bleeding (menstrual irregularities) is called
as Aprajaa. It is also called as Raktayoni.
Indications in Garbhavyaapad -
Garbhasrava -
If pregnancy fails in the 1st trimester due to embryonic or fetal death or in
incomplete spontaneous abortion or inevitable abortion or characterized by the
absence of an embryo in the gestational sac, then these conditions have been
managed with Lekhana karma.
In all these conditions Lekhana karma explores and cleanses the Garbhashaya
kostha.
• Shesha amagarbha –
“Aamagarbhasheshena hi punah punah shulamashajyet
Tasmaateekshnairanavasheshayannupaacharet”90
The amagarbha which is expelled incompletely, it troubles the woman repeatedly.
Hence this condition should be managed by teekshna upachara, till its complete
expulsion.
Chapter 3.4 Conceptual study
19
• Asrujaa –
“Raktapittakarairnaaryaa raktam pittena dushitam
Atipravartate yonyaam labdhe garbhe api saasrujaa”91
Due to excessive consumption of ahara and vihara which aggravates the rakta and
pitta, the rakta which is situated in reproductive organs, vitiated by dushita pitta,
causes excessive bleeding per vagina. This bleeding may be present even after
conception also.
• Vaamini yonivyapad –
“savaatamudigaredbeejam vaaminee rajasaa yutam”92
In this condition yoni excretes beeja with raja and vaata.
“Beejam shukram
Udgiret vamet
Rajasaa yutam artavamishram”
Beeja means shukra. The yoni which vomits shukra with artava.
Procedure – Poorvakarma –
• Preoperative assessment of the patient
According to Acharya Sushruta, if patient is not assessed properly, not
examined accurately and not elicited the clinical signs properly, all leads
to improper treatment.93
• Position –
Lekhana karma in Garbhashaya and Uttarabasti being the different
modalities, involving in same organ “the uterus ( Garbhashaya)”. The
procedure and principles described in Uttarabasti can be attributed to
Lekhana karma as
“Uttaanaayaah shayanaayaah samyak sankochya sakthinee”94
The woman should be in supine position with flexed thighs and elevated
knees.
Chapter 3.4 Conceptual study
20
• Cleaning the parts was described in Lekhana karma of Vartma rogas, same
can be employed
“Tatah pramrujya plotena vartma shastrapadankitam”95
• Exposing the yonimukha with the help of Yoni vikshana yantra.96
• Stabilization of the garbhashaya mukha97
• Vardhana of the garbhashaya mukha, if it is constricted.
“samvrutaam vardhayet punah”98
Pradhana karma –
• Lekhana karma should be samam likhet (uniformly), sulikhita (the lesions
should be scraped well), niravasheshavat (completely) and vartmanaam tu
pramaanena (with appropriate measure).
“Samam likhet sulikhitam likhenniravasheshatah
Vartmaanaam tu pramaanena samam shastrena nirlikhet”99
• The procedure should be according to the different conditions such as
Samalekhanam avagaadhalekhanam -‘ sama lekhana’ means deep
scraping
Sulekhanam mridulekhanam - ‘sulekhana’ means mild scraping
Niravasheshalekhanam nirlekhanam niravasheshalekhanamiti -
niravashesha lekhana’ means complete scraping 100
Paschat karma –
Improvement of bala, varna, agni101
Chapter 3.5 Conceptual study
21
MODERN REVIEW
Indications of curettage102 –
Diagnostic – Infertility
DUB
Pathologic amenorrhoea
Endometrial tuberculosis
Endometrial carcinoma
Postmenopausal bleeding
Therapeutic - DUB
Endometrial polyp
Removal of IUCD
Incomplete abortion
Combined - DUB
Endometrial polyp
Dysfunctional uterine bleeding103 –
It covers all forms of abnormal bleeding for which an organic cause cannot be
found. This type of bleeding usually occurs at the extremes of reproductive age. It
can be classified into two groups according to whether it is ovulatory or
anovulatory.
1. Ovulatory bleeding –
It is mainly due to defect of corpus luteum which present in the following way-
Irregular ripening of endometrium – It leads to inadequate bed for
implantation. So patients present with DUB or infertility.
Chapter 3.5 Conceptual study
22
Causes – Failure of corpus luteum to develop, rapid regression of corpus luteum
after development, failure of endometrium to respond due to decrease sensitivity
to progesterone and hyperestrinism with normal corpus luteum.
Histology – This condition is known as endometrium with irregular hormonal
response. On microscopic examination, mixture of proliferative secretory
endometrial glands or proliferative stroma & secretory glands are seen. Corpus
luteum is normal.
Irregular shedding of the endometrium –
• Menstrual bleeding is prolonged, delayed & excessive
• Stromal granulocytes of the endometrium fail to release their relaxin content &
consequently the reticulum fibers supporting the stroma are not destroyed.
• Shedding of endometrium is late & it occurs in large chunks causing membranous
dysmenorrhoea.
• Histology – Late secretory endometrium mixed with menstrual blood & early
proliferative endometrium. Glands are frequently shrunken, stellate shaped &
degenerated. They may show secretory activity or may regress. Stroma contains
many stromal granulocytes & occasional neutrophils.
Retarded luteal phase – Histology of endometrium lags behind dates by history.
The criteria for diagnosis are that the delay should be at least by 3 days or more.
In these cases corpus luteum is defective.
Chapter 3.5 Conceptual study
23
Pre & post- menstrual bleeding –This may be seen in ovulatory cycles due to
disorderly corpus luteum regression or irregular follicular response, respectively.
Here bleeding is self limiting & requires no therapy.
2. Anovulatory bleeding –
The endometrium remains fragile due to inadequate structural stromal support
due to absence of progesterone. Thus with the withdrawal of estrogen, due to
negative feedback action of FSH, the endometrial shedding continues for a longer
time because of lack of compactness.
Usually this condition is associated with endometrial hyperplasia.
Endometrial hyperplasia104 –
It is a hormone related, estradiol mediated condition and does not present in the
absence of female gonads or without estrogen therapy. The endometrial
hyperplasias are a heterogeneous group of proliferative disorders.
• Classification –
Endometrial hyperplasia – Simple
Complex (adenomatous)
Atypical endometrial hyperplasia – Simple
Complex (adenomatous)
• Etiology –
o Obesity, diabetes and other metabolic disorders may enhance the extra
gonadal estrogen production and the presence of high estrogen levels,
especially of estradiol, as a result of the binding of the hormone to
receptor sites in the nuclei of endometrial cells.
Chapter 3.5 Conceptual study
24
o Estrogen unopposed by progestin
o Tamoxifen therapy
• Macroscopic features –
- Uterus may be enlarged
- Opening it often shows an irregularly thickened pale tan
endometrium, that may be polypoid
- The increased thickness of the endometrium may be demonstrated
by ultrasound.
• Microscopic features –
Histological features of simple hyperplasia –
General – Diffuse changes throughout endometrium
Increased gland: stroma ratio (greater than 1:1)
Glands –
Architectural features – Variation in size and shape
Small to large and cystically dilated
Minimal & focal crowding
Minimal branching with infoldings & outpouchings
No complex angularity
Cellular features – Abundant & cellular epithelium
Ciliated cell change common
Pseudostratification
Nuclear features – Oval & elongated
No significant variation in size or shape
Evenly dispersed chromatin
Small, inconspicuous nucleoli
Variable mitotic activity
Stroma – Abundant & cellular
Small, oval cells with scanty cytoplasm
Chapter 3.5 Conceptual study
25
Mitotic activity in stroma
Prominent superficial venules
Inconspicuous spiral arterioles
Histological features of complex hyperplasia –
General – Focal to extensive
Greatly increased gland: stroma ratio (greater than 3:1)
Glands –
Architectural features – Marked variation in size & shape
Marked crowding
Branching with papillary infoldings & outpouchings
Complex angularity
Cellular features – Abundant & cellular epithelium
Ciliated cell change (less than in simple hyperplasia)
Squamous change
Pseudostratification
Nuclear features – Oval & elongated
No significant variation in size or shape
Evenly dispersed chromatin
Small, inconspicuous nucleoli
Variable mitotic activity
Stroma – Scanty & inconspicuous
Dense & cellular
Atypical hyperplasia –
Histological features of simple atypical hyperplasia –
General – architectural changes diffuse throughout endometrium
Cellular changes focal to diffuse
Increased gland: stroma ratio (greater than 1:1)
Glands –
Architectural features – Variation in size & shape
Chapter 3.5 Conceptual study
26
Small to large & cystically dilated
Minimal & focal crowding
Minimal branching with infoldings & outpouchings
No complex angularity
Cellular features – Abundant & cellular epithelium
Ciliated cell change common
Pseudo stratification
Dense eosinophilia
Nuclear features – Elliptical to round
Variation in size & shape
Hyperchromasia
Nucleoli prominent, enlarged & irregular
Coarse clumping of chromatin
Variable mitotic activity
Stroma – Abundant & cellular
Small, oval cells with scanty cytoplasm
Mitotic activity in stroma
Prominent superficial venules
Inconspicuous spiral arterioles
Histological features of complex atypical hyperplasia –
General – Focal to extensive
Greatly increased gland: stroma ratio ( greater than 3:1)
Glands –
Architectural features – Marked variation in size & shape
Marked crowding
Branching with papillary infoldings & outpouchings
Complex angularity
Cellular features – Abundant & cellular epithelium
Ciliated cell change (less than simple hyperplasia)
Squamous change
Pseudostrtification
Chapter 3.5 Conceptual study
27
Dense eosinophilia
Nuclear features – Elliptical to round
Variation in size & shape
Hyperchromasia
Nucleoli prominent
Coarse clumping of chromatin
Vesicular nucleus – hypochromasia
Variable mitotic activity
Stroma – Scanty & inconspicuous
Dense & cellular
Endometrial carcinoma105 –
Endometrial adenocarcinoma is common type of neoplasma of endometrium.
Histologically, it arising from the endometrial glands, the glandular components of the
tumor are somehow reminiscent of the normal proliferative endometrium. In moderately
differentiated endometrial adenocarcinomas the glandular pattern is present in 50-90% of
the specimen with solid nest & sheets of tumor cells replacing the glands. These tumors
showing pleomorphic nuclei with intranuclear clearing, coarse clumps of chromatin &
multiple irregular nucleoli. Mitoses are numerous & atypical. Most cells have a high
nucleus-cytoplasm ratio with very scanty basophilic cytoplasm. Anaplastic carcinomas of
the endometrium show no glandular differentiation & a very marked degree of cellular
anaplasia with the resemblance to endometrial tissue being difficult to ascertain.
Endometrial polyps106 –
Endometrial polyps are overgrowths of endometrial glands and stroma with blood
vessels, sometimes also containing smooth muscle, which protrude into the
uterine cavity.
• Pathogenesis – A part of the thick endometrium projects into the cavity and
attains a pedicle. It arises from the basal endometrium surrounded by the
Chapter 3.5 Conceptual study
28
functional zone. Multiple polyps are usually present in endometrial hyperplasia
and are excluded from such a discrete polyp.
• Naked eye appearance – A small polyp size of about 1-2 cm, looks reddish and
feels soft.
• Microscopically – the core contains stromal cells, glands and large thick walled
vascular channels. The surface is lined by endometrium. The pedicle contains thin
fibrous tissue with thin blood vessels.
Chronic endometritis107 –
Every case of acute endometritis might go on to chronic endometritis. It is a rare
condition between the menarche and the menopause, because the regrowth of new
surface endometrium during each menstrual cycle prevents the persistence of any
infection which is not deep seated.
Causes –
Foreign bodies within the uterus
Malignant disease of the uterus
Infected polyps
Retained products of conception
With inflammatory cells including altered macrophages known as ‘foam
cells’
After menopause
Microscopic examination – As a diagnosis of chronic endometritis depends upon
the presence of plasma cells with maximum accuracy.
Tubercular endometritis108 –
• Incidence – 60% endometrium involved
Chapter 3.5 Conceptual study
29
• Pathogenesis –
The causative organism is Mycobacterium tuberculosis of human type
It is almost always secondary to primary infection.
• Pathology –
The infection starts from the tubes either by lymphatic or by direct
spread through continuity.
Corneal ends are commonly affected due to their rich blood supply
and their anatomical proximity to the tubes.
The tubercle is situated in the basal layer of the endometrium only
to come to the surface premenstrually. After the endometrium shed
at each menstruation, reinfection occurs from the lesions in the
basal layer or from the tubes.
Endometrial ulceration may lead to adhesion or synechiae
formation (Asherman’s syndrome )
Rarely infection spreads to the myometrium (2.5%)
Microscopic examination – The principal histological feature of tubercular
endometritis is the epitheloid cell granuloma. The epitheloid cell granuloma of
tubercular endometritis contains a central collection of epitheloid cells with both
Langhans & foreign body type gaint cells. There is usually a peripheral collar of
lymphocytes. The gland may be functionally unaffected in tubercular
endometrium. But they may show a poor response to ovarian hormones, as with
non-specific endometritis. It is possible that this factor contributes to the
infertility.
Inevitable abortion109 –
It is a clinical condition of abortion where continuation of pregnancy is impossible.
Clinical features –
Chapter 3.5 Conceptual study
30
• Symptoms and signs of pregnancy coincide with its duration.
• Vaginal bleeding is excessive and may be accompanied with clots.
• Colicky pain felt in suprapubic region radiating to the back.
• The internal os of the cervix is dilated and products of conception may be felt
through it.
Incomplete abortion –
Retention of a part of the products of conception inside the uterus is called as incomplete
abortion.
Clinical features –
• History of expulsion of a fleshy mass per vagina
• Continuation of pain in abdomen and vaginal bleeding
• On examination, the uterus is less than the period of amenorrhoea. The cervix is
opened and retained contents may be felt through it.
• USG shows the retained contents.
Missed abortion -
When the fetus is dead and retained inside the uterus for a variable period, is called as
missed abortion. Carneous mole is a special variety of missed abortion in which the dead
ovum in early pregnancy is surrounded by clotted blood.
Clinical features –
• Symptoms of threatened abortion may or may not be developed.
• Regression of pregnancy symptoms
• A dark brown vaginal discharge may occur
• The uterus is smaller in size
• Cervix feels firm
Chapter 3.5 Conceptual study
31
Findings in curettage in failed pregnancy110 –
• There are 3 basic criteria which are reporting product of conception from
abortions.
1) Confirmation of the pregnancy
2) Location of the pregnancy
3) To identify or exclude a serious disease process especially gestational
trophoblastic disease.
• In the majority of cases of 1st trimester abortions chronic villi are the only tissues
of fetal origin identified.
• The finding of a placental site trophoblastic reaction is important as it excludes
that the pregnancy was ectopic in the fallopian tube & after aborting washed in to
the uterus.
• The gross appearance of the intrauterine contents from products as follows -
The highest incidence of karyotypic abnormalities occurs in 9.4 wks of mean
gestational age.
Macroscopic features - Gelationous sacs that may be empty or contain a
disorganized embryo or umbilical cord stump.
Microscopic features - The villi are edematous. Some may show fibrosis &
vascular obliteration.
• Frequently the placenta is the only tissue available when examining the early
concepts.
Chapter 3.5 Conceptual study
32
Procedure of curettage111 – The patient should empty the bladder prior to operation. The procedure is
done under general anesthesia or Diazepam sedation. The patient is placed in
lithotomy position. Local antiseptic cleaning & draping done. Bimanual
examination is performed. Posterior vaginal speculum is introduced inside the
vagina. The anterior lip of the exposed cervix is grasped by multiple toothed
vulsellum & pulled down near the vaginal introits. The uterine sound is
introduced to confirm the position & to note the length of the uterine cavity.
Cervical canal is then gradually dilated by the graduated metal cervical dilators.
After the desired dilatation, the uterine cavity is curetted by an uterine curette
either in clockwise or anticlockwise direction starting from the fundus down to
internal os. The completion of the procedure should be confirmed by grating
sound. Vulsellum & the speculum are removed. The curetted material is preserved
in 10 per cent formal-saline (normal saline in suspected tubercular endometritis)
labeled properly & sent for histological examination.
Complications112 – Immediate complications are injury to the cervix, uterine
perforation, injury to the gut, infection. Remote complications are cervical
incompetence and uterine synechiae.
Chapter 4.1 Materials And Methods
MATERIALS AND METHODS
Source of data:
About 50 patients under inclusive criteria of Lekhana karma were selected from
IPD & OPD of S. D. M Ayurveda Hospital Kuthpady, Udupi, were selected for the study.
Method of collection of data:
It is a descriptive study on different indications where the method of collecting
the data was by participant observation method.
A minimum of 50 patients, diagnosed under inclusive criteria were taken for the
study. The Lekhana vidhi was observed with results and the utility of Lekhana vidhi was
evaluated.
A detailed proforma was prepared with all history taking, physical examination
which is explained in our classics & allied science to confirm the diagnosis.
Inclusion criteria:
• Patients between the ages of 18-50 years.
• Patients who are married,
• Patients who are diagnosed having,
A) Atyartava , ie Excessive bleeding during menstruation.
B) Anartava, ie Secondary amenorrhoea.
C) Garbha srava, ie Inevitable abortion
D) Vandhyatva & other conditions of Stree roga.
Exclusion criteria:
• Atyartava due to pittala yoni vyapad or tridoshaja yoni vyapad, ie acute
infective state of reproductive system.
• Endometriosis.
• Fibroid uterus.
32
Chapter 4.1 Materials And Methods
• Unmarried.
• Patients with systemic disorder like severe anemia, diabetes, hypertension,
thyroid dysfunction.
Intervention:
After the diagnosis of particular condition of Streeroga & Garbha vyapad, the
Lekhana karma was observed. Later the patients were categorized in to 4 groups by the
procedure, which they underwent.
Group “A” – The patients of Atyartava.
Group “B” – The patients of Anartava.
Group “C” – The patients of Garbha srava.
Group “D”- The patients of Vandhyatva & any other conditions of Stree roga.
Assessment criteria:
• Incidence of Lekhana vidhi in different conditions of Streeroga & Garbha vyapad
in 50 selected patients was assessed.
• Reasons for implementing Lekhana vidhi in specific conditions of Streeroga &
Garbha vyapad were assessed.
• Effectivety & side effects of procedure in certain conditions of Stree roga &
Garbha vyapad were assessed.
Final assessment:
The reason for Lekhana karma either therapeutic or investigated and the efficacy
of treatment in curing disorders outcome assessed. The patients suffered from any other
complications within 3 days & use of any alternative methods were assessed.
33
Chapter 4.1 Materials And Methods
Investigations:
Blood examination: Hb%
TC
DC
E.S.R
RBS
Urine examination:
Sugar
Albumin
Microscopic
USG (If necessary )
Urine Pregnancy Test (If necessary)
34
Chapter 4.2 OBSERVATIONS
35
OBSERVATIONS
Distribution of patients according to Age: Table No 1 Age group Group A Group B Group C Group D Total %
19-26 yrs 0 0 12 0 12 24
27-34 yrs 2 0 10 2 14 28
35-42 yrs 5 0 2 1 8 16
43-50 yrs 15 1 0 0 16 32
Graph no 1
0
5
10
15
20
25
30
35
Gr A Gr B Gr C Gr D Total %
19-26 yrs 27-34 yrs35-42 yrs43-50 yrs
The study of age shows that maximum no. of patients 32% were found in the age group
of 43-50 years, followed by 28% patients in 27-34 years age group, 24% patients in 19-
26 years age group & 16% patients in 35-42 years age group.
Chapter 4.2 OBSERVATIONS
36
Distribution of patients according to Religion: Table No 2 Religion Group A Group B Group C Group D Total %
Hindu 18 1 17 3 39 78
Muslim 3 0 5 0 8 16
Christian 2 0 1 0 3 6
Graph no 2
0
10
20
30
40
50
60
70
80
Gr A Gr B Gr C Gr D Total %
HinduMuslim Christian
The study of religion shows that maximum no. of patients 78% were Hindus, followed by
16% patients were Muslims & 6% patients belong to Christian.
Chapter 4.2 OBSERVATIONS
37
Distribution according to Education – Table No 3
Education Group A Group B Group C Group D Total %
Uneducated (U.E) 8 0 0 0 8 16
Primary (P) 8 1 7 0 16 32
Secondary (S) 4 0 9 1 14 28
Higher
secondary(HS) 1 0
7
0 8 16
Graduate (G) 1 0 0 2 3 6
Post graduate (PG) 0 0 1 0 1 2
Graph no 3
0
5
10
15
20
25
30
35
Gr A Gr B Gr C Gr D Total %
U.EPSH.SGP.G
The study of education shows that maximum no. of patients 32% were primary educated,
followed by 28% patients were secondary educated, 16% uneducated, 16% higher
secondary educated, 6% patients were graduated and 2% patients were post graduated.
Chapter 4.2 OBSERVATIONS
38
Distribution of patients according to Socio economic status: Table No 4
Socio
economic
status
Group A Group B Group C Group D Total %
Lower (L) 0 0 0 0 0 0
Lower middle
(L.M) 14 1
17 1 33 66
Upper middle
(U.M) 8 0
7 2 17 34
Upper (U) 0 0 0 0 0 0
Graph no 4
0
10
20
30
40
50
60
70
Gr A Gr B Gr C Gr D Total %
LL.MU.MU
The study of socio-economic status shows maximum no. of patients 66% were found in
lower middle class and 34% patients were in upper middle class.
Chapter 4.2 OBSERVATIONS
39
Distribution of patients according to occupation: Table No 5
Occupation Group A Group B Group C Group D Total %
House wife 13 0 22 1 36 72
Working 9 1 2 2 14 28
Graph no 5
01020304050607080
Gr A Gr B Gr C Gr D Total %
house wifeworking
The study shows maximum no. of patients 72% were house wives, and 28% patients were
working.
Chapter 4.2 OBSERVATIONS
40
Distribution of patients according to Region : Table No 6
Region Group A Group B Group C Group D Total %
Urban 9 0 2 1 12 24
Rural 13 1 22 2 38 76
Graph no 6
01020304050607080
Gr A Gr B Gr C Gr D Total %
UrbanRural
The study shows that majority of patients 76% were from rural area and 24% patients
from urban.
Chapter 4.2 OBSERVATIONS
41
Distribution of patients according to Diet: Table No 7
Diet Group A Group B Group C Group D Total %
Vegetarian 5 0 9 2 16 32
Mixed 17 1 15 1 34 68
Graph no 7
0
10
20
30
40
50
60
70
Gr A Gr B Gr C Gr D Total %
VegetarianMixed
The study of diet shows that maximum no. of patients 68% were mixed diet and 32%
patients were vegetarians.
Chapter 4.2 OBSERVATIONS
42
Distribution of patients according to sleeping pattern: Table No 8
Sleeping pattern Group A Group B Group C Group D Total %
Sound 13 0 21 3 37 74
Disturbed 9 1 1 0 11 22
Graph no 8
01020304050607080
Gr A Gr B Gr C Gr D Total %
SoundDisturbed
The study of sleeping pattern shows that maximum no. of patients 74% were having
sound sleep, followed by 22% patients were having disturbed sleep.
Chapter 4.2 OBSERVATIONS
43
Distribution of patients according to previous menstrual history: Table No 9
Menstrual history Group A Group B Group C Group D Total %
regular 6 1 22 2 31 62
Irregular 16 0 2 1 19 38
Graph no 9
0
10
20
30
40
50
60
70
Gr A Gr B Gr C Gr D Total %
RegularIrregular
The study of previous menstrual history shows that maximum no. of patients 62% were
having regular menstrual periods and 38% patients were having irregular menstrual
periods.
Chapter 4.2 OBSERVATIONS
44
Distribution of patients according to Obstetric history: Table No 10
Obstetric history Group A Group B Group C Group D Total %
Nullipara 0 0 0 3 3 6
Primi 0 0 15 0 15 30
Multi 22 1 9 0 32 64
Graph no 10
0
5
10
15
20
25
30
35
Gr A Gr B Gr C Gr D Total %
NulliparaPrimiMulti
The study of obstetric history shows that the maximum no. of patients 64% were multi
gravidae, 30% patients were primi gravidae and 6% patients were nullipara.
Chapter 4.2 OBSERVATIONS
45
Distribution of patients according to previous surgical history: Table No 11
Previous surgical
history Group A Group B
Group C Group D Total %
Curettage 2 0 6 1 9 18
LSCS 0 0 2 0 2 4
Tubectomy 15 0 0 0 15 30
Any other 0 0 0 0 0 0
Nothing specific 5 1 16 2 24 48
Graph no 11
05
101520253035404550
Gr A Gr B Gr C Gr D Total %
CurettageLSCSTubectomyAny otherNothing specific
The present study shows maximum number of patients 48% had no previous surgical
history followed by 30% patients were tubectomized, 18% patients previously underwent
curettage and 4% patients had history of LSCS.
Chapter 4.2 OBSERVATIONS
46
Distribution of patients according to Prakriti :
Table No 12
Prakriti Group A Group B Group C Group D Total %
Vata-kapha 4 0 7 0 11 22
Vata-pitta 8 1 13 3 25 50
Pitta-kapha 10 0 4 0 14 28
Graph no 12
05
101520253035404550
Gr A Gr B Gr C Gr D Total %
Vata-kaphaVata-pittaPitta-kapha
The present study shows that maximum patients 50% were of vata-pitta prakriti, followed
by 28% patients were of pitta-kapha and 22% patients were of vata-kapha prakruti.
Chapter 4.2 OBSERVATIONS
47
Distribution of patients according to Samhanana : Table No 13
Samhanana Group A Group B Group C Group D Total %
Pravara 5 0 1 0 6 12
Madyama 14 0 19 3 36 72
Avara 3 1 4 0 8 16
Graph no 13
01020304050607080
Gr A Gr B Gr C Gr D Total %
PravaraMadyamaAvara
The present study shows maximum number of patients 72% were of madyama
samhanana, followed by 16% patients were of avara samhanana and 12% patients were of
pravara samhanana.
Chapter 4.2 OBSERVATIONS
48
Distribution of patients according to Sara: Table No 14 Sara Group A Group B Group C Group D Total %
Twak 0 0 0 0 0 0
Rakta 0 0 0 0 0 0
Mamsa 6 0 7 1 14 28
meda 10 0 3 2 15 30
asthi 6 1 14 0 21 42
majja 0 0 0 0 0 0
shukra 0 0 0 0 0 0
Satva 0 0 0 0 0 0
Graph no 14
05
1015202530354045
Gr A Gr B Gr C Gr D Total %
TwakRaktaMamsaMedaAsthiMajjaShukraSatva
The incidence of sara shows that maximum number of patients 42% were asthisara,
followed by 30% patients were meda sara and 28% patients were mamsa sara.
Chapter 4.2 OBSERVATIONS
49
Distribution of patients according to Satva : Table No 15 Satva Group A Group B Group C Group D Total %
Pravara 1 0 0 0 1 2
Madyama 19 0 20 3 42 84
Avara 2 1 4 0 7 14
Graph no 15
0102030405060708090
Gr A Gr B Gr C Gr D Total %
PravaraMadyamaAvara
The present study shows that maximum number of patients 84% were of madyama satva,
followed by 14% patients were avara satva and 2% patients were pravara satva.
Chapter 4.2 OBSERVATIONS
50
Distribution of patients according to Satmya : Table No 16 Satmya Group A Group B Group C Group D Total %
Pravara 1 0 0 0 1 2
Madyama 19 0 20 3 42 84
Avara 2 1 4 0 7 14
Graph no 16
0102030405060708090
Gr A Gr B Gr C Gr D Total %
PravaraMadyamaAvara
The present study shows that maximum number of patients 84% were of madyama
satmya, followed by avara satmya 14% and pravara satmya 2%.
Chapter 4.2 OBSERVATIONS
51
Distribution of patients according to Aharashakti : Table No 17 Ahara shakti Group A Group B Group C Group D Total %
Pravara 1 0 1 0 2 4
Madyama 19 0 18 3 40 80
Avara 2 1 5 0 8 16
Graph no 17
01020304050607080
Gr A Gr B Gr C Gr D Total %
PravaraMadyamaAvara
The present study shows that maximum number of patients were of madyama ahara
shakti 80%, followed by avara ahara shakti 16% and pravara ahara shakti 4%.
Chapter 4.2 OBSERVATIONS
52
Distribution of patients according to Vyayama shakti : Table No 18 Vyayama shakti Group A Group B Group C Group D Total %
Pravara 0 0 0 0 0 0
Madyama 19 0 18 3 40 80
Avara 3 1 6 0 10 20
Graph no 18
0
10
20
30
40
50
60
70
80
Gr A Gr B Gr C Gr D Total %
PravaraMadyamaAvara
The present study shows maximum number of patients were of madyama vyayama shakti
80%, followed by avara vyayama shakti 20%.
Chapter 4.2 OBSERVATIONS
53
Incidence of Lekhana karma in 50 selected patients : Table No 19
Indication Total %
Group A 22 44
Group B 1 2
Group C 24 48
Group D 3 6
Graph no 19
Group AAtyartavaa
44%
Group BAnartava
2%
Group CGarbhasrava
48%
Group DVandhyatva
6%
%
In selected 50 patients, in present study maximum number of patients 48% in Group C,
followed by 44% patients in Group A, 6% patients in Group D and 2% patients B.
Chapter 4.2 OBSERVATIONS
54
Incidence of diagnosis of conditions on the basis of clinical features in selected 50 patients: Table No 20
Vyadhi Group A Group B Group C Group D Total %
Vataja asrigdhara 13 0 0 1 14 28
Kaphaja
Asrigdhara 1 0
0 0 1 2
Vata-kaphaja
asrigdhara 8 0
0 0 8 16
raktayoni 0 0 0 2 2 4
shushka 0 1 0 0 1 2
Shesha
amagarbha 0 0
24 0 24 48
Graph no 20
0
10
20
30
40
50
Gr A Gr B Gr C Gr D Total %
Vataja asriddharaKaphaja asrigdharaVata-kaphaja asrigdharaRaktayoniShuskaShesha amagarbha
The present study shows the majority of patients 48% were diagnosed as Shesha
amagarbha, followed by 28% patients were diagnosed as Vataja asrigdhara, 16% were
Vata-kaphaja asrigdhara, 4% were Raktayoni & 2% each in Kaphaja asrigdhara &
shushka yoni vyapad.
Chapter 4.2 OBSERVATIONS
55
Incidence of total time taken for procedure in 50 patients: Table No 21
Time Group A Group B Group C Group D Total %
3-4 mins 6 1 0 0 7 14
5-6 mins 16 0 11 2 29 58
7-8 mins 0 0 9 1 10 20
9-10 mins 0 0 4 0 4 8
Graph no 21
0
10
20
30
40
50
60
Gr A Gr B Gr C Gr D Total %
3-4 mins5-6 mins7-8 mins9-10 mins
The present study shows maximum number of patients 58% completed the procedure
within 5-6 mins, followed by 20% patients within 7-8 mins, 14% patients within 3-4 mins
and 8% patients with in 9-10 mins.
Chapter 4.2 OBSERVATIONS
56
Incidence of requirement of Vardhana karma before the procedure: Table No 22 Procedure Group A Group B Group C Group D Total %
With Vardana 22 1 18 3 44 88
Without Vardana 0 0 6 0 6 12
Graph no 22
0102030405060708090
Gr A Gr B Gr C Gr D Total %
With vardanaWith out vardana
The present study shows maximum number of patients 88% required Vardana karma
before Lekhana karma and 12% patients does not required Vardana karma the procedure.
Chapter 4.2 OBSERVATIONS
57
Incidence of P/V bleeding immediately after the procedure: Table No 23 Bleeding Group A Group B Group C Group D Total %
Absent 22 1 24 3 50 100
Mild 0 0 0 0 0 0
Moderate 0 0 0 0 0 0
Severe 0 0 0 0 0 0
Graph no 23
0102030405060708090
100
Gr A Gr B Gr C Gr D Total %
AbsentMildModerateSevere
The present study shows all patients 100% did not having P/V bleeding immediately after
the procedure.
Chapter 4.2 OBSERVATIONS
58
Incidence of pain in abdomen immediately after the procedure: Table No 24
Pain Group A Group B Group C Group D Total %
No pain 0 0 0 0 0 0
Mild 20 1 21 3 45 90
Moderate 2 0 3 0 5 10
Severe 0 0 0 0 0 0
Graph no 24
0
10203040
50607080
90
Gr A Gr B Gr C Gr D Total %
No painMildModerateSevere
The present study shows maximum number of patients 90% were having mild pain
immediately after the procedure, followed by 10% patients were having moderate pain.
Chapter 4.2 OBSERVATIONS
59
Incidence of amount of collected endometrial material obtained after the procedure: Table No 25 Amount Group A Group B Group C Group D Total %
1-10 ml 18 1 2 3 24 48
11-20 ml 4 0 6 0 10 20
21-30 ml 0 0 10 0 10 20
31-40 ml 0 0 6 0 6 12
Graph no 25
05
101520253035404550
Gr A Gr B Gr C Gr D Total %
1-10 ml11-20 ml21-30 ml31-40 ml41-50 ml
1-10 ml of endometrial bits obtained was maximum in 48% patients, followed by 20%
each in 10-20 ml & 21-30 ml group, 10% patients in 31-40 ml & 2% patients in 41-50 ml.
Chapter 4.2 OBSERVATIONS
60
Incidence of injury after the procedure:
Table No 26
Injury Group A Group B Group C Group D Total %
Present 0 0 0 0 0 0
Absent 22 1 24 3 50 100
Graph no 26
0102030405060708090
100
Gr A Gr B Gr C Gr D Total %
presentAbsent
The present study shows 100% patients had no injury after the procedure.
Chapter 4.2 OBSERVATIONS
61
Incidence of infection after the procedure: Table No 27
Infection Group A Group B Group C Group D Total %
Present 0 0 0 0 0 0
Absent 22 1 24 3 50 100
Graph no 27
0102030405060708090
100
Gr A Gr B Gr C Gr D Total %
presentAbsent
The present study shows 100% of patients had no infection after the procedure.
Chapter 4.2 OBSERVATIONS
62
Incidence of P/V bleeding after 1 hour, after the procedure: Table No 28
Bleeding Group
A
Group
B
Group
C
Group
D Total %
Absent 1 1 3 0 4 8
Spotting 19 0 17 2 38 76
½ pad 2 0 4 1 7 14
More than ½ pad 0 0 0 0 0 0
Graph no 28
0
10
20
30
40
50
60
70
80
Gr A Gr B Gr C Gr D Total %
Absent Spotting1/2 padMore than 1/2 pad
The present study shows maximum number of patients 76% were having P/V spotting
1hour after the procedure, followed by14% patients were having ½ pad soaked and 8%
patients were having no bleeding.
Chapter 4.2 OBSERVATIONS
63
Incidence of pain in abdomen after 1 hour, after the procedure: Table No 29
Pain Group A Group B Group C Group D Total %
Absent 0 0 8 0 8 16
Mild 17 1 16 3 37 74
Moderate 5 0 0 0 5 10
Severe 0 0 0 0 0 0
Graph no 29
0
10
20
30
40
50
60
70
80
Gr A Gr B Gr C Gr D Total %
Absent Mild Moderate Severe
The present study shows maximum number of patients 74% were having mild abdominal
pain 1 hour after the procedure followed by 16% patients were having no pain and 10%
patients having moderate pain.
Chapter 4.2 OBSERVATIONS
64
Incidence of surgical interventions after Lekhana procedure : Table No 30 Surgical
intervention Group A Group B
Group C Group D Total %
Recurettage 0 0 0 0 0 0
Hysterectomy 3 0 0 0 3 6
Others 0 0 0 0 0 0
None 19 1 24 3 47 94
Graph no 30
0102030405060708090
100
Gr A Gr B Gr C Gr D Total %
RecurettageHystotectomyothersnone
The present study shows that maximum number of patients 94% not underwent any
surgical intervention after Lekhna karma, followed by 6% patients had hysterectomy.
Chapter 4.2 OBSERVATIONS
65
Incidence of final assessment of the procedure: Table No 31
Result Group A Group B Group C Group D Total %
Cured 2 0 24 0 26 52
Relieved 17 0 0 3 20 40
No effect 3 1 0 0 4 8
Graph no 31
0
10
20
30
40
50
60
Gr A Gr B Gr C Gr D Total %
curedRelievedNo effect
The study shows majority of patients 52% cured from their complaints after Lekhana
karma followed by 40% of patients relieved and in 8% of patients no effect.
Chapter 5 Discussion
DISCUSSION
Ayurveda is the pioneer in the art of surgery. Judicious application of Ayurvedic
principles of surgical interventions can prevent complications and facilitate speedy
recovery. Surgery is a medical technology consisting of physical intervention of tissues.
Asthavidha shastrakarmas are the fundamental procedures to the development of surgery
which includes Lekhana karma.
• Lekhana karma is one of the important techniques in the management vrana. In
classics while explaining the vrana chikitsa, the method of procedure is explained.
In vartmagata rogas also we will get detail description of Lekhana karma with its
indications, procedure, samyak lakshanas, asamyak lakshanas and management of
complications.
• In some procedures it is a main therapy and in some procedures it is an adjuvant
therapy. Here this procedure is a main therapy.
• Lekhana karma is shodhana therapy in bahya ashraya vyadhis like granthi,
mamsankura, mamsonnati, arsha etc. If these conditions are present in yoni,
produces yonivyapads & artava vyapads, asrigdhara etc.
• Though different Acharyas mentions the instruments used for Lekhana karma,
among them Mandalagra shastra is suitable for the purpose of Lekhana procedure
in Garbhashaya. Because of its size and shape, it can be easily inserted in uterine
cavity and avoids injury to the adjacent parts.
• Even though Lekhana karma is described by Acharya Sushruta, in present days
manipulation of endometrium is done by a procedure called uterine curettage
which is widely in practice. As Ayurvedic instruments are not available for
practical usage today, the instruments used in uterine curettage are inevitably
taken for the purpose since same instruments which explained in classics are
modified according to changing era.
66
Chapter 5 Discussion
Procedure –
• Related to present topic, there was no direct reference in the classics.
• The principle of position during Lekhana karma was taken from Uttara basti
procedure as this procedure is comfortable for Lekhana karma.
• The principles of Lekhana karma which was explained in management of general
procedure of vartma rogas like
Cleaning the parts – for purpose of antiseptic precaution
Stabilization of the organ – in order to avoid the injury to adjacent parts
• Vardhana of Garbhashaya mukha – It facilitates easy insertion of the instruments
in uterine cavity.
• The technique of procedure means samam likhet, sulikhitam, niravasheshavat and
vartmanaam tu pramaanena were taken from vrana chikitsa.
• Paschat karma of the procedure taken from management of vrana shopha.
Samyak lekhya lakshana –
‘Asrigsravarahita’ means stoppage of the bleeding and Kandushopha vivarjitam (not
associated with itching and inflammation), it indicates that after Lekhana karma, it should
not associated with any infections which are explained in vartma rogas can be considered.
Utility of Lekhana karma in Streeroga and Garbha vyapad-
• Lekhana karma is said to be superior to shamana chikitsa, if it is done in proper
manner. Because shamana chikitsa takes longer time to act on particular dhatu
(target tissue), where as lekhana karma is done on directly on target tissues.
Shamana chikitsa is not effective in disease which is in bhedavastha, where as
lekhana karma is very effective in that condition.
• Niravasheshavat lekhana – Lekhana is niravasheshavat means without any
remnant. Lekhana is done up to that point, there is no vitiated dhatu is seen. This
can be confirmed by stoppage of bleeding.
67
Chapter 5 Discussion
• Sama lekhana & Sulekhana – which are probably, indicated superficial handling
of pathology where chedana and bhedana cannot be performed.
Eg- endometrium, eyelid
• Lekhana karma is indicated in relation to present study as follows –
Mamsonnati –
It refers to hyperplastic condition of muscular tissue of uterus.
Mamsankura & Arsha –
These are also hyperplasic condition of muscular tissue & can taken as
Endometrial polyps -
Endometrial polyps are overgrowths of endometrial glands and stroma
with blood vessels, sometimes also containing smooth muscle, which
protrude into the uterine cavity.
Granthi –
The definition of Granthi as follows –
“Vigrathitam granthiriti pradishtah”
“Granthi grathanaat smrutah”
Granthi is a type of shotha vikara & is a nodular structure. This condition
can be taken as Cystic glandular hyperplasia (metropathia haemorrhagica).
Shesha amagarbha-
When Amagarbha which is incompletely expelled, for complete expulsion
teekasna upachara is indicated. As shastra karma is teeksna upachara, it
can be indicated in this condition. Lekhana karma is one type of shastra
karma & suitable therapy among the astavidha shastra karmas, it can be
implement in this condition. Because this technique can applied repeatedly
till its complete expulsion.
“Teekshnairanavasheshayannupaacharet”
Out of 8 shastra karmas, Lekhana karma is simple, involving only
scraping of endometrium and not like chedana, bhedana etc. it is suitable
treatment protocol in soft uterus which is engorged in
recent pregnancy.
68
Chapter 5 Discussion
• Ayurvedic physicians depended upon macroscopic structure and nature of Artava
to diagnose the yonovyapads & artavavyapads.
For e.g. –
In Artava dusti –
Kunapa gandhi – depending upon the gandha. Gandha signifiees
putrification which indicates infenction.
Granthi – depending upon the rupa. It indicates nodular appearance.
In Yoni vyapad –
Raktayoni –depending upon laxana i.e.” srugati sruteh” excessive
bleeding. Probably it indicates anovulaton. This pathology also diagnosed
by remnants obtained from Lekhana karma.
Arajaska – depending upon laxana (Anartava)
Apraja – the woman remains without child
But for proper understanding of Artava dusti & Yonivyapads, further lead
to microscopic examination. Lekhana karma facilitates collection of endometrial
material which facilitates to diagnose the exact pathology of diseases available on
contemporary science. Based on available contemporary facilities the pathological
conditions can be further classified under the heading of
1. Infections
2. Inflammation
3. Neoplasia – benign or malignancy
4. Study of hypothalamo-pituitary-ovarian-uterian axis
To get the fresh and uncontaminated tissue right from the origin of
pathological area, Lekhana karma can be implemented as diagnostic procedure.
• As mamsonnati, mamsankura and granthi are main indications of Lekhana karma,
but in these conditions Lekhana karma can be adopted for diagnostic &
therapeutic purpose. On basis of USG when endometrial thickness is more than
normal on the particular day of menstruation, after the procedure the
histopathological reports showed maximum reports were endometrial hyperplasia
and cystic glandular hyperplasia. But no endometrial polyp cases are observed in
50 randomly selected patients.
69
Chapter 5 Discussion
• In case of shesha amagarbha (incomplete abortion) Lekhana karma is effective as
therapeutic procedure.
Discussion on incidence observations –
Age –
Age wise distribution of GroupA, Group B, Group C & Group D showed majority
of patients belonged to age group of 43-50 years. In this age group most patients were
having symptom of atyartava & one patient was having symptom of anartava. Atyartava
is common in this age group because anovulatory cycles lead to endometrial hyperplasia.
In group C majority of patients comes under the age group of 19-26 years & 27-34 years.
It may be due to common reproductive age of women in this area.
Religion –
Incidence of patients belonging to Hindu religion was highest i.e. 78%. This
reflects the geographical distribution of population in this area.
Education –
The study of education shows that maximum no. of patients 32% were primary
educated, followed by 28% patients were secondary educated, 16% uneducated, 16%
higher secondary educated, 6% patients were graduated and 2% patients were post
graduated.
Socioeconomic status –
Maximum number of women came from lower middle class i.e. 66% & 34% from
upper middle class. The S.D.M hospital is a charity hospital & most of the patients
visiting to the hospital are of middle class and poor.
Occupation -
70
Chapter 5 Discussion
Majority number of women were housewives, i.e. 72%. As women coming to this
hospital are from middle class background, non-working class seemed to have more
incidences.
Region –
The majority of patients came from rural area i.e. 76%.
Diet –
The maximum numbers of women was taking mixed diet i.e. 68% and 32%
women were vegetarians. The area where study was conducted is coastal area. Most of
the people are having their main food as fish. This observation gives that most of patients
had mixed type of dietary habit.
Sleeping pattern –
Maximum numbers of patients were having sound sleep i.e. 74% and 22%
patients were having disturbed sleep.
Previous menstrual history –
The study of previous menstrual history shows that maximum no. of patients 62%
were having regular menstrual periods and 38% patients were having irregular menstrual
periods. But maximum number of Group A (Atyartava) patients were having previous
irregular menstrual periods. It may be due to premenstrual age. In Group C, majority of
patients were having regular menstrual periods which are essential for conception.
Obstetric history –
The study of obstetric history shows that the maximum no. of patients 64% were
multi gravidae, 30% patients were primi gravidae and 6% patients were nullipara. In
Group A, all patients were multi para. In Group D all patients were nullipara & they came
with complaint of primary infertility. In Group C, majority of patients were primigravida.
71
Chapter 5 Discussion
Previous surgical history –
In this study the majority of patients who were having the previous surgical
history of curettage come under Group C.
Pareekshya bhavas -
The present study on prakruti shows that maximum patients 50% were of vata-
pitta prakriti, followed by 28% patients were of pitta-kapha and 22% patients were of
vata-kapha prakruti.
Maximum numbers of patients 72% were of madyma samhanana, followed by
16% patients were of avara samhanana and 12% patients were of pravara samhanana.
The incidence of sara shows that maximum number of patients 42% were
asthisara, followed by 30% patients were meda sara and 28% patients were mamsa sara.
The present study shows that maximum number of patients 84% were of
madyama satva, followed by 14% patients were avara satva and 2% patients were pravara
satva.
The study on Satmya shows that maximum number of patients 84% were of
madyama satmya, followed by avara satmya 14% and pravara satmya 2%.
The present study shows that maximum number of patients were of madyama
ahara shakti 80%, followed by avara ahara shakti 16% and pravara ahara shakti 4%.
The present study shows maximum number of patients were of madyama
vyayama shakti 80%, followed by avara vyayama shakti 20%.
72
Chapter 5 Discussion
Observations made for Lekhana karma in different pathological
conditions of Streeroga & Garbhavyapad –
• Incidence of Lekhana karma in different indications –
Majority of patients 48% were in Group C i.e. Garbha srava. As the USG of this
group showed incomplete abortion, missed abortion & nonviable pregnancy.
Group A i.e. Atyartava and Group D i.e. Vandhyatva underwent Lekhana karma for
the purpose of Asrigdhara. Most of the histopathological reports of these groups
showed endometrial hyperplasia.
In Group B i.e. Anartava, there is only one patient.
Diagnosis of conditions on the basis of clinical features in selected 50 patients:
The majority of patients 48% were diagnosed as Shesha amagarbha, followed by
28% patients were diagnosed as Vataja asrigdhara, 16% were Vata-kaphaja asrigdhara,
4% were Raktayoni & 2% each in Kaphaja asrigdhara & shushka yoni vyapad.
Time taken for Lekhana karma –
In present study the majority of patients 58% completed the procedure within 5-6
mins. The duration of the time taken for the procedure varies from person to person. It
may depend on endometrial thickness/ concepts part, co-operation of the patient etc.
Requirement of Vardhana karma before Lekhana karma –
The majority of patients 88% required Vardhana karma before Lekhana karma
because it facilitates the easy insertion of Lekhana shastra in the uterine cavity.
73
Chapter 5 Discussion
Remaining 12% of patients comes under the Group C i.e. Garbhasrava which does not
required Vardhana karma.
P/V bleeding immediately after the procedure:
In present study, P/V bleeding was not seen in any of the patients immediately
after the procedure. It shows Samyak lekhya lakshana of the procedure.
Pain in abdomen immediately after the procedure:
The present study shows maximum number of patients, i.e. 90% were having mild
pain immediately after the procedure. Due to surgical intervention, there is local injury to
the tissues and it leads to pain. The intensity of pain will be differing, because of patient’s
tolerance capacity towards pain.
Amount of collected endometrial material obtained after the procedure:
1-10 ml of endometrial bits obtained was maximum in 48% patients, followed by
20% each in 10-20 ml & 21-30 ml group & 12% patients in 31-40 ml.
Injury after the procedure:
100% patients had no injury after the procedure.
Infection after the procedure:
100% of patients had no infection after the procedure.
P/V bleeding after 1 hour, after the procedure:
Maximum number of patients 76% were having spotting P/V, 1hour after the procedure. So it shows the samyak lekhya lakshana of the procedure.
Pain in abdomen after 1 hour, after the procedure:
Maximum number of patients 74% were having mild abdominal pain, 1 hour after the procedure followed by 16% patients was having no pain and 10% patients having moderate pain.
Surgical interventions after Lekhana procedure:
74
Chapter 5 Discussion
In present study maximum number of patients 94% had no any surgical
intervention after Lekhna karma. It indicates that Lekhana karma is an effective
procedure in all indications of 50 randomly selected patients. Remaining 6% patients had
hysterectomy. These 6% patients comes under the Group A i.e. Atyartava.
Final assessment of the procedure:
Majority of patients 52% cured from their complaints after Lekhana karma
followed by 40% of patients relieved and in 8% of patients no effect.
75
Chapter 6 Summary and Conclusion
SUMMARY AND CONCLUSION
The present dissertation study entitled “Clinical evaluation of lekhana procedure
in certain conditions of streeroga & garbha vyapad” is planned with following aim &
objectives.
1) Conceptual study of Lekhana vidhi & it’s indications in certain conditions
of Stree roga & Garbha vyapad.
2) Analysis of Lekhana vidhi in different conditions of Stree roga & Garbha
srava.
The whole study was elaborated in terms of
• Review of literature
• Methodology
• Discussion
• Conclusion
1. Introduction: This chapter describes the need for the study & aim of under
taking the study.
2. Review of Literature :
2.1. History Review: This chapter deals with the historical aspects of
Lekhana karma.
2.2. Introduction of Lekhana karma: The chapter contains Nirukti &
Paribhasha of the words Lekhya & Lekhana, related words of the word
Lekhana.
2.3. General description of Lekhana karma: The chapter contains
general indications of Lekhana karma, indications related with
Shalakya tantra, Shalya tantra & Stree roga, instruments used in
Lekhana karma, procedure, samyak lakshana & asamyak lakshana of
Lekhana karma according to classics are explained.
2.4. Description of Lekhana karma in Streeroga & Garbha vyapad
: The chapter contains Lekhana karma is a variety of shodhana
75
Chapter 6 Summary and Conclusion
chikitsa, indications of Lekhana karma in Streeroga & Garbha vyapad
and the procedure explained on the basis of principle from Lekhana
vidhi of vrana and vartma rogas.
2.5. Modern Review: Indications, procedure and complications of
curettage is described in detail in this chapter.
3. Clinical study :
3.1. Material and Methods : This study consisting of methodology of
the study, including assessment criteria has been discussed
3.2. Observations: Here, the incidence of occurrence of various
criteria has been observed corresponding observations have been
drawn.
4. Discussion: It is based on the observations obtained after the completion of the
study is done here.
5. Conclusion: Here concluding remarks have been made & future scope of study
on this topic is mentioned.
• Based on the present study it is summarized that the Lekhana karma
described by Bruhatrayis, has been one of the effective treatment
modality in conditions of Atyartava and Garbhasrava (Garbha shesha
avastha).
• The incidence of Lekhana karma in 50 patients was 44% of patients in
Group A, 2% of patients in Group B, 48% of patients in Group C and 6%
of patients in Group D.
• The efficacy of Lekhana karma shows majority of patients 52% cured
from their complaints after Lekhana karma followed by 40% of patients
relieved and in 8% of patients no effect seen.
Benefits of Lekhana karma –
76
Chapter 6 Summary and Conclusion
• Lekhana karma is an effective treatment modality in cases of mamsonnati,
granthi, arsha, mamsankura which are present in Garbhashya.
• Lekhana karma can be implemented as only a diagnostic procedure as well as
therapeutic procedure in conditions like mamsonnati, granthi, arsha, mamsankura.
• As Lekhana karma is a teekshna upachara, it is therapeutically effective in shesha
amagarbha chikitsa.
• If Lekhana karma is used in proper way, then it has least complications, minimum
hospital stay and cost effective therapy.
Limitations of Lekhana karma –
• The patients who are having less pain threshold capacity, they may require
anesthesia during Lekhana karma.
• Need of antibiotic therapy whenever anticipated.
77
Chapter 7 Bibliography
78
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86. Vagbhatacharya, Ashtangahridayam with Sarvangasundara commentary of
Arunadatta and Ayurvedarasayana of Hemadri collated by late Dr.Anna
Moreshwara Kunte and Ramachandra Shastri Navare Edited by Bhishagacharya
Harishastri Paradakara Vaidya, Reprint 9th edition 2005, Chaukhambha Orientalia,
Varanasi, Pp 956:896
87. Sarangadharacharya, sharangadhara samhita, with the commentaries Adhamalla’s
Dipika & Kasirama’s Gudhartha-Dipika, Edited by Pt. Parashuram Shastri
Vidyasara, Chaukhamba Surbharati Prakashana, Varanasi, Edition 2006, Pp
398:127.
88. Agnivesha, Charaka samhita with Chakrapani commentary, Edited by Vaidya
Jadavaji Trikamji Acharya, Reprinted edition 2007, Chaukhambha orientalia,
Varanasi. Pp738:302.
89. Agnivesha, Charaka samhita with Chakrapani commentary, Edited by Vaidya
Jadavaji Trikamji Acharya, Reprinted edition 2007, Chaukhambha orientalia,
Varanasi. Pp738:635.
90. Vriddha Vagbhata, Astanga sangrah with the Sasilekha Sanskrit Commentary by
Indu, Edited by Dr. Shivaprasad Sharma, Chowkhamba Sanskrit Series Office,
Varanasi, Pp 965:292.
91. Agnivesha, Charaka samhita with Chakrapani commentary, Edited by Vaidya
Jadavaji Trikamji Acharya, Reprinted edition 2007, Chaukhambha orientalia,
Varanasi. Pp738:635.
92. Sushruta, Sushruta samhita with the Nibandhasangraha Commentary of Sri
Dalhanacharya, Edited by Vaidya Jadavji Trikamji Acharya, Ninth edition:2007,
Chaukhambha Orientalia, Varanasi, Pp 824:669.
Chapter 7 Bibliography
90
93. Sushruta, Sushruta samhita with the Nibandhasangraha Commentary of Sri
Dalhanacharya, Edited by Vaidya Jadavji Trikamji Acharya, Ninth edition:2007,
Chaukhambha Orientalia, Varanasi, Pp 824:44.
94. Vagbhatacharya, Ashtangahridayam with Sarvangasundara commentary of
Arunadatta and Ayurvedarasayana of Hemadri collated by late Dr.Anna
Moreshwara Kunte and Ramachandra Shastri Navare, Edited by Bhishagacharya
Harishastri Paradakara Vaidya, Reprint 9th edition 2005, Chaukhambha Orientalia,
Varanasi, Pp 956:285.
95. Sushruta, Sushruta samhita with the Nibandhasangraha Commentary of Sri
Dalhanacharya, Edited by Vaidya Jadavji Trikamji Acharya, Ninth edition:2007,
Chaukhambha Orientalia, Varanasi, Pp 824:620.
96. Vagbhatacharya, Ashtangahridayam with Sarvangasundara commentary of
Arunadatta and Ayurvedarasayana of Hemadri collated by late Dr.Anna
Moreshwara Kunte and Ramachandra Shastri Navare, Edited by Bhishagacharya
Harishastri Paradakara Vaidya, Reprint 9th edition 2005, Chaukhambha Orientalia,
Varanasi, Pp 956:314.
97. Sushruta, Sushruta samhita with the Nibandhasangraha Commentary of Sri
Dalhanacharya, Edited by Vaidya Jadavji Trikamji Acharya, Ninth edition:2007,
Chaukhambha Orientalia, Varanasi, Pp 824:620.
98. Agnivesha, Charaka samhita with Chakrapani commentary, Edited by Vaidya
Jadavaji Trikamji Acharya, Reprinted edition 2007, Chaukhambha orientalia,
Varanasi. Pp738:636.
99. Sushruta, Sushruta samhita with the Nibandhasangraha Commentary of Sri
Dalhanacharya, Edited by Vaidya Jadavji Trikamji Acharya, Ninth edition:2007,
Chaukhambha Orientalia, Varanasi, Pp 824:400.
100. Sushruta, Sushruta samhita with the Nibandhasangraha Commentary of Sri
Dalhanacharya, Edited by Vaidya Jadavji Trikamji Acharya, Ninth edition:2007,
Chaukhambha Orientalia, Varanasi, Pp 824:400.
Chapter 7 Bibliography
91
101. Sushruta, Sushruta samhita with the Nibandhasangraha Commentary of Sri
Dalhanacharya, Edited by Vaidya Jadavji Trikamji Acharya, Ninth edition:2007,
Chaukhambha Orientalia, Varanasi, Pp 824:19.
102. D.C.Datta, Textbook of Gynaecology including contraception, Edited by Hiralal
Konar, Fifth edition 2008, New Central Book Agency, Kolkata Pp 627:557.
103. Disfunctioning Uterine Bleeding : An Update, Edited by
Chittaranjan.N.Purandare, Jaypee Brothers Medical Publishers, Reprint 2006, Pp
219:19-20.
104. Pathology of the Female Reproductive Tract, Edited by Stanley.J.Robboy,
Malcom.C.Anderson, Peter Russell, Harcourt Publishers Limited, First published
2002, Pp929:305-315.
105. Pathology of the Female Reproductive Tract, Edited by Stanley.J.Robboy,
Malcom.C.Anderson, Peter Russell, Harcourt Publishers Limited, First published
2002, Pp929:334-335
106. Pathology of the Female Reproductive Tract, Edited by Stanley.J.Robboy,
Malcom.C.Anderson, Peter Russell, Harcourt Publishers Limited, First published
2002, Pp 929:298-300.
107. Pathology of the Female Reproductive Tract, Edited by Stanley.J.Robboy,
Malcom.C.Anderson, Peter Russell, Harcourt Publishers Limited, First published
2002, Pp 929:286-287.
108. 108Pathology of the Female Reproductive Tract, Edited by Stanley.J.Robboy,
Malcom.C.Anderson, Peter Russell, Harcourt Publishers Limited, First published
2002, Pp929:290-291.
109. 109102D.C.Datta, Textbook of Obstetrics including Perinatology and
contraception, Edited by Hiralal Konar, Fifth edition 2001, New Central Book
Agency, Kolkata Pp 705:173-176.
Chapter 7 Bibliography
92
110. Pathology of the Female Reproductive Tract, Edited by Stanley.J.Robboy,
Malcom.C.Anderson, Peter Russell, Harcourt Publishers Limited, First published
2002, Pp929:745-747.
111. D.C.Datta, Textbook of Gynaecology including contraception, Edited by Hiralal
Konar, Fifth edition 2008, New Central Book Agency, Kolkata Pp 627:557-558.
112. D.C.Datta, Textbook of Gynaecology including contraception, Edited by Hiralal
Konar, Fifth edition 2008, New Central Book Agency, Kolkata Pp 627:558.
Chapter 8 Annexure
91
CASE PROFORMA
S.D.M. college of Ayurveda –Udupi Department of Prasooti Tantra and Stree Roga
2007 – 2010
“CLINICAL EVALUATION OF LEKHANA PROCEDURE IN CERTAIN CONDITIONS OF STREEROGA & GARBHAVYAPAD”
1) ATURA VIVARA- Atura nama : Serial No: vaya : Antaha kramanka: Jati: H / M / C / others Bahiha kramanka : Education: Pravesha dinanka : Vyavasaya : Nirgamana dinanka : Samajika stithi : Indication : Address : Date : 2)VEDANA SAMUCHRAYAM – PRADHANA VEDANA – Causes indicating Lekhana karma - Group ‘A’ –
Atyartava- a) Duration of illness-
b) Last menstrual period- c) Onset – Gradual/ Sudden d) Duration of blood loss – e) Interval of blood loss – f) Amount of blood loss – No of pads/ clothes per day Staining Clots
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92
g) Character – Colour Consistancy
Staining Odour
Group ‘B’ - Anartava-
Period of amenorrhoea- H/O previous periods- Time of menarche- Group ‘C’-
Garbha srava- Period of amenorrhoea- Last menstrual period-
Vedana – Raktasrava - H/O bija nirgamana - Group ‘D’ -
• Vandhyatwa- Sapraja / Apraja –
• Artava sambandi vyadhi – Anartava – Artava kshaya – Atyartava – Kastartava – Artava dusti –
• Kshetra sambandi – Uterus – Cervix – Vagina –
• Beeja sambandi – History of ovulation – Ovarian pathology – Semen report of husband if any –
• Ambu – Varna –
Samhanana – Doshavabhava sthiti –
Chapter 8 Annexure
93
SAMANYA ITI VRITTANTA - Anya yoni srava sambandi – Vaginal discharge - Pr /Ab Amount – Character – Colour – Consistancy – Odour – Others – Relation with menses – before / during / after ANUBANDHA VEDANA- Angamarda- Dourbalya – Katishula – Brama –
Daha - Atisweda – Vibanda – Osha / Chosha – Gurutva -
POORVA VYADHI VRITTANTA- H/O D.M / HTN / HIV / V.D.R.L / TB / any other Previous surgical history – D&C Encirclage operation – Any other - KULA VRITTANTA- H/O HTN / D.M / HIV / VDRL / TB / any other
H/O Carcinoma / Early menopause / infertility / fetal congenital abnormalities / any other.
VAYAKTIKA VRITTANTA-
Diet – Vegetarian / Nonvegeterian / Mixed Sleep- Sound / Disturbed Bowel – Consistancy- Frequency- Micturation – Frequency –day- night- Any habits –
Chapter 8 Annexure
94
POORVA RAJO VRITTANTA –
Raja kala - days/ days Pramana – No of pads/ clothes per day- 1st day – 2nd day – 3rd day onwards -
Last menstrual period – Associated complaints, if any – Character – Colour Consistency Odor Staining PRAJANANA VRITTANTA – Married life – Gravida /Parity/Live/Abortions/Dead/Last delivery CONTRACEPTIVE HISTORY – Safe period /Contraceptive pills /IUCD/Any other DASHAVIDHA PAREEKSHA –
a) Prakriti – V / P / K / VP / VK / PK / VPK b) Vikriti – c) Sara – d) Samhanana – e) Satmya – f) Satva – g) Pramana – h) Vaya – i) Abhyavarana shakti –
Jarana shakti – j)Vyayama shakti – GENERAL EXAMINATION – Built & nourishment – Wt – Ht – Pallor – Icterus – Edema – Lymphadenopathy – Cyanosis – VITAL SIGNS -
BP – PR – RR – Temp – HR –
Chapter 8 Annexure
95
SYSTEMIC EXAMINATION- Respiratory system- Cardiovascular system- Gastrointestinal system- Any other- STHANIKA PAREEKSHA-
a) Per abdomen- Darshana pareeksha- Sparshana pareeksha- b) Per vaginal- a) Vulva- b) vagina- Darshana pareeksha- Sparshana pareeksha- C) Cervix - Size-
Condition- OS- Colour- d) Uterus- Size- Position- Mobility- Consistancy- e) Fornices-
INVESTIGATIONS- a) Hematological- Hb%- TC- DC- ESR- RBS-
b) Urine- Routine- Albumin- Sugar-
Chapter 8 Annexure
96
Microscopic- Epithelial cells- /hpf Pus cells- /hpf R.B.C.s- /hpf Casts, Crystals, any other-
c)UPT (If necessary d)USG (If necessary)- SAMPRAPTI GHATAKA VICHEDANA - Doshic conditions before procedure – Vata – pain / srava varna Pitta - daha / paka / jwara / srava Kapha – kandu / gurutva /tandra Dushya- Srotas- Srotodusthi- Agni- Ama- Udbhava sthana- Sanchara sthana- Adhisthana- Vyaktasthana- Rogamarga- UPASHAYA ANUPASHAYA- VYADHI- OBSERVATION- Date – Time- Poorva karma- Preparation of the patient- Consent – Prepare the parts -
Chapter 8 Annexure
97
Garbhashaya mukha vistrutikarana – Condition of the cervix -
Duration of the dilatation- Number of the dilators used-
Pradhana karma- Length of the uterus – Position of the uterus – Colour / nature of the evacuation – Amount of obtained endometrial material - Time taken for completion of the procedure -
Paschat karma- Vital signs –
B.P- P.R- R.R- Temp- H.R- Bleeding per vagina-
Immidiately after the procedure – Ab/ Mild/ Moderate/Severe After 1 hr of the procedure – Ab/Spotting/ ½ pad/More than ½ pad
Pain in abdomen – Immediately after the procedure – Ab/mild/moderate/severe 1 hr after the procedure - Ab/mild/moderate/severe
Sending the material for histopathology report- Yes/not Doshic conditions – Vata – vedana / varna / srava / any other Pitta – daha / srava / paka / jwara / any other Kapha – kandu / gurutva / tandra / any other COMPLICATIONS- During procedure- After procedure- Follow up after 15 days -
Chapter 8 Annexure
98
CONCLUSION- Signature of the Guide: Signature of the Co-guide
Dr. V.N.K. Usha, Dr. Suchetha kumari, M. D.(Ayu ) M. S. (Ayu)
Signature of the scholar Dr. Vijayalakshmi. S. Hosmath B.A.M.S
xuÉoÉÑ®rÉÉ cÉÉÌmÉ ÌuÉpÉeÉãSè rÉl§ÉMüqÉÉïÍhÉ oÉÑ̬qÉÉlÉç AxÉÇZrÉãrÉÌuÉMüsmÉiuÉÉcNûsrÉÉlÉÉÍqÉÌiÉ ÌlɶÉrÉÈ | xÉÑ.xÉÔ.
Yantras & Shastras For D&C ----An Ayurvedic Purview
Chapter 8 Annexure
99
An Attempt By,
Dept of Prasuti Tantra & Stree Roga S.D.M.College of Ayurveda,Udupi
Instruments used in D&C –
• Sponge holding - MüÉmÉÉïxÉM×üiÉÉãwhÉÏ
• Sims Speculum - rÉÉãÌlÉ uÉëhÉã¤ÉhÉ rÉl§É
• Anterior vaginal wall retractor - LMü iÉÉsÉ rÉl§É
• Vulsellum - ÍxÉÇWûqÉÑZÉ xuÉÎxiÉMü rÉl§É
• Uterine sound – aÉpÉÉïvÉrÉ LwÉhÉÏ
• Dilators - aÉlQÒûmÉS qÉÑZÉ vÉsÉÉMüÉ rÉl§É
• Ovum forceps - ̲iÉÉsÉ rÉl§É
• Curette - sÉãZÉlÉ vÉx§É
Sponge holding –
• Fig No.7
iÉ§É xuÉÎxiÉMürÉl§ÉÉÍhÉ:A¹ÉSvÉÉÇaÉÑsÉmÉëqÉÉhÉÉÌlÉ,ÍxÉÇWûurÉÉbÉëuÉ×MüiÉU¤uÉѤɲÏÌmÉqÉÉeÉÉïU. xÉÑ.xÉÔ. 7/10 .MüÉmÉÉïxÉÌuÉÌWûiÉÉãwhÉÏwÉÉ: vÉsÉÉMüÉ: wÉOè mÉëqÉÉeÉïlÉã| A WØû xÉÔ 25/34 OûÏMüÉ Éë ÉÉ ÉïlÉã ÉÉ ÉlÉã ÉÉUY ÉãSÉSã
• Speculum
lÉÉQûÏrÉl§ÉÉÍhÉ – AlÉåMümÉëMüÉUÉÍhÉ, AlÉåMümÉërÉÉåeÉlÉÉÌlÉ, LMüiÉÉåqÉÑZÉÉlrÉÑpÉrÉiÉÉåqÉÑZÉÉÌlÉ cÉ, iÉÉÌlÉ xÉëÉåiÉÉåaÉiÉvÉsrÉÉå®UhÉÉjÉïÇ ,UÉåaÉSvÉïlÉÉjÉïqÉç,----- xÉÑ.xÉÔ.7/13 rÉÉåÌlÉuÉëhÉå¤ÉhÉÇ qÉkrÉå xÉÑÌwÉUÇ wÉÉåQûvÉÉXûaÉÑsÉqÉç | qÉÑSìÉoÉ®Ç cÉiÉÑÍpÉï¨ÉqÉqpÉÉåeÉqÉÑMÑüsÉÉlÉlÉqÉç || cÉiÉÑÈvÉsÉÉMüqÉÉ¢üÉliÉÇ qÉÔsÉå iÉ̲MüxÉålqÉÑZÉå || A.WØû.xÉÔ.25/22,23 ÉÉåÌlÉ ÉëhÉ ÉÏ ÉiÉåÅlÉålÉåÌiÉ iÉiÉ ÉÉåÌlÉ ÉëhÉå ÉhÉÇ
Chapter 8 Annexure
100
Fig No. 8
• Retractor
Fig No. 9
vÉsÉÉMüÉrÉl§ÉÉhrÉÌmÉ lÉÉlÉÉmÉëMüÉUÉÍhÉ, lÉÉlÉÉmÉërÉÉãeÉlÉÉÌlÉ, rÉjÉÉrÉÉãaÉmÉËUhÉÉWûSÏbÉÉïÍhÉ cÉ, iÉãwÉÉÇ aÉÇQÕûmÉS xÉmÉïTühÉ vÉUmÉÑÇZÉ oÉQûÏwÉqÉÑZɲã²ã, LãwÉhÉ urÉÔWûlÉ cÉÉsÉlÉ............ xÉÑ xÉÔ 7/14 OûÏMüÉ: xÉmÉïTühÉqÉÑZÉã ²ã, CÌiÉ LMüÇ
wÉÉãQûvÉÉÇaÉÑsÉqÉmÉUÇ ²ÉSvÉÉÇaÉÑsÉÍqÉÌiÉ pÉãSãlÉ xÉmÉïTühÉqÉÑZÉxrÉ ²æÌuÉkrÉÇ ¥ÉãrÉÇ||
LãwÉhÉÇ aÉqpÉÏUmÉÉMüÉSÉæ mÉÔrÉɱluÉãwÉhÉÇ | urÉÔWûlÉÇ FkuÉÏïçMüUhÉÇ ÍNû¨uÉÉã¨ÉÑÎlQûiÉxrÉÉã®UhÉÉjÉïÇ, uÉÉUÇaÉãhÉÉlÉÑxÉUhÉÍqÉirÉãMãü CÌiÉ QûsWûhÉÈ |
urÉÔWûlÉÇ iÉÑ cÉÔÍhÉïiÉÉvqÉrÉÉïSÏlÉÉÇ xÉÇaÉëWûhÉÇ CÌiÉ WûÉUhÉcÉlSì:
AÉ U urÉÔWûlÉÇ mÉëxÉ×iÉqÉÉÇxÉÉSÏlÉÉÇ
Swastika Yantra
• Simhamuhka Yantra
iÉ§É xuÉÎxiÉMürÉl§ÉÉÍhÉ:A¹ÉSvÉÉÇaÉÑsÉmÉëqÉÉhÉÉÌlÉ,ÍxÉÇWûurÉÉbÉëuÉ×MüiÉU¤uÉפɲÏÌmÉqÉÉeÉÉïU ´ÉÑaÉÉsÉqÉ×aÉæuÉÉïÃMüMüÉMüMüÇMÑüUUcÉÉxÉpÉÉxÉvÉvÉbÉÉirÉÔsÉÔçMüÍcÉÎssÉ.......... AÎxjÉÌuÉS¹vÉsrÉÉã®UhÉÉjÉïqÉÑmÉÌSvrÉliÉã|| xÉÑ xÉÔ 7/10 A¹ÉSvÉÉÇaÉÑsÉÉrÉÉqÉÉlrÉÉrÉxÉÉÌlÉ cÉ
Chapter 8 Annexure
101
Fig No.10
Uterine sound Fig No.11
iÉãwÉÉqÉãwÉMüqÉïhÉÏ || EqÉã aÉhQÕûmÉSqÉÑZÉã ||{A.¾û.xÉÑ 25\29} iÉãwÉÉÇ aÉèhQÕûmÉSxÉmÉïTühÉvÉUmÉÑÇZÉoÉÌQûvÉqÉÑZÉ㠲㠲ã ||LwÉhÉurÉÔWlÉcÉÉsÉlÉÉWûUhÉÉjÉïqÉÑmÉÌSvrÉãiÉã || {xÉÑ.xÉÔ 7/14}
LwÉhÉÏ Dilators Fig No. 12
vÉsÉÉMüÉrÉl§ÉÉhrÉÌmÉlÉÉlÉÉmÉëMüÉUÉÍhÉ,lÉÉlÉÉmÉërÉÉãeÉlÉÉÌlÉ,rÉjÉÉrÉÉãaÉmÉËUhÉÉWû SÏbÉÉïÍhÉ cÉ; iÉãwÉÉÇ aÉÇQÕûmÉS xÉmÉïTühÉ vÉUmÉÑÇZÉ oÉQûÏwÉqÉÑZɲã²ã, LãwÉhÉ,urÉÔWûlÉ, cÉÉsÉlÉ............xÉÑ xÉÔ 7/14 ÌOûMüÉ-vÉsÉMüÉrÉl§ÉÉhrÉmÉÏirÉÉÌS rÉjÉÉ rÉÉãaÉmÉËUhÉÉWûSÏbÉÉïÍhÉÌiÉ mÉËUhÉÉWûÉã uÉiÉÑïsÉiÉÉ | iÉãwÉÉÇ vÉsÉÉMüÉrÉl§ÉÉhÉÉÇ qÉkrÉã|
Ovum forceps
iÉÉsÉrÉl§É -iÉÉsÉrÉl§Éã - ²ÉSvÉÉXçaÉÑsÉã qÉixrÉiÉÉsÉuÉSãMüiÉÉsÉ̲iÉÉsÉMãü, MühÉïlÉÉxÉÉlÉÉQûÏvÉsrÉÉlÉÉqÉÉWûUhÉÉjÉïqÉç || xÉÑ. xÉÔ. 7/12 ²ã ²ÉSvÉÉXçaÉÑsÉã qÉixrÉiÉÉsÉuÉiÉç ½ãMüiÉÉsÉMãü | iÉÉsÉrÉl§Éã xqÉ×iÉã MühÉïlÉÉQûÏû vÉsrÉÉmûÉWûÉûËUhÉÏ || A.¾û.xÉÑ. 25/10 xÉ0 - ²ã iÉÉsÉrÉl§Éã pÉuÉiÉ: |
Chapter 8 Annexure
102
Fig No. 13
• Curette sÉåZÉlÉ vÉx§É F Fig No. 14 Fig No.15
• Excerpted from SOUSHRUTHI-PRASUTI, 2008 July.
qÉlQûsÉÉaÉë vÉx§É - qÉlQûsÉÉaÉëÍqÉÌiÉ qÉlQûsÉÍqÉuÉÉaÉëÇ rÉxrÉ iÉlqÉhçQûsÉÉaÉëÇ, iÉccÉ Ì²ÌuÉkÉÇ | iÉjÉÉÌWû, “rÉSåaÉëå qÉlQûsÉÇ uÉë¨ÉÇ ¤ÉÑUxÉÇxjÉÉlÉqÉåuÉ cÉ | qÉhçQûsÉÉaÉëxrÉ eÉÉlÉÏrÉÉiÉç mÉëqÉÉhÉÇ iÉÑ wÉQûXÒûsÉqÉç CÌiÉ” ||̲kÉÉ qÉlQûsÉÉaÉëçÇ wÉQûXÒûsÉmÉëqÉhÉqÉåMüÇ uÉëѨÉqÉÑZÉÇ, ̲iÉÏrÉÇ ¤ÉÑUÉMüÉUÇ | xÉÑ.xÉÔ.8/3 qÉlQûsÉÉaÉëÇ TüsÉå iÉåwÉÉÇ iÉeÉïlrÉliÉlÉïZÉÉM×üÌiÉ | sÉåZÉlÉå NåûSlÉå rÉÉåerÉÇ mÉÉåjÉMüÐvÉÑÎhQûMüÉÌSwÉÑ ||
• Concept – Dr. V.N.K.Usha • Work done by
Dr. Mahejabeen, Dr. Shilpa, Dr. Seemanthini , Dr. Gayan, Dr.Girija, Dr.Shivani M.D. batch 2004
• Scientific advisors – Dr. Muralidhara Sharma Dr. K.R.Rama Chandra
• Executive advisors – Dr. U.N.Prasad Dr. Prasanna N. Rao