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SECTION B - Short Answer Questions

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Q1. Stree Vishishta Marma and Clinical Signs of Injury (Viddha Lakshana)

Definition of Marma

Stree Vishishta Marma (Female-Specific Vital Points)

Viddha Lakshana (Signs of Injury to Stree Vishishta Marma)

• Repeated pregnancy loss (Garbhasrava, Garbhapata)
• Infertility (Vandhyatva)
• Uterine hemorrhage
• Severe dysmenorrhea
• Garbhadosha - fetal abnormality

• Excessive bleeding per vaginum
• Dyspareunia
• Urinary dysfunction
• Loss of sensation in the region

• Difficulty in childbirth
• Prolonged labor (Mudhagarbha)
• Post-partum hemorrhage
• Cervical incompetence

• Lactation failure (Stanya Kshaya)
• Breast abscess, mastitis
• Stanya vitiation

• Sadya Pranahara (immediate death) - if Sadya Pranahara Marma
• Kalantara Pranahara (delayed death)
• Vishalyaghna (death on removal of the foreign body)
• Vaikalyakara (permanent disability)
• Rujkara (severe pain only)

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Q2. Garbhashayantara Garbha Sthiti - Ayurvedic Concept of Fetus-in-Utero

(A) Lie (Garbha Sthiti / Garbha Avastthana)

• Sutika Sthiti (Normal): Head-down, spine parallel to maternal spine - corresponds to longitudinal lie
• Tiryak Garbha: Fetus lying transverse - transverse lie
• Urdhva Garbha: Head upward - corresponds to breech

(B) Attitude (Garbha Mudra)

• Natural curled posture of the fetus (like a coiled creature)
• Sushruta describes the fetus sitting with head between knees, arms folded, spine curved
• Corresponds to the universal attitude of flexion

(C) Presentation (Garbha Mukha / Avamukha)

(D) Presenting Part & Denominator

• In Shiro Garbha - the presenting part is the vertex (Shira)
• Denominator in Ayurveda corresponds to the reference bony landmark - for vertex it is the Shiratala (occiput)
• For breech it is the Nitamba (sacrum)
• For face it is the Hanugra (mentum)

(E) Position

• Dakshina (right) or Vama (left) position
• Corresponds to modern LOA, ROA, LOP, ROP etc.

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Q3. Define Garbha and Describe Garbhadhana (Conception) According to Ayurveda

Definition of Garbha

"Shukra-shonita-jeevatmabhih samsrushta garbha iti uchyate"

1. Shukra - paternal seed (sperm/semen)
2. Shonita - maternal seed (ovum/menstrual blood)
3. Jeeva/Atma - the living soul/consciousness
4. Satva - mind/psyche
5. Tridosha (Vata, Pitta, Kapha) - in balanced form
6. Panchamahabhuta - five basic elements

Garbhadhana - The Process of Conception

1. Riitu - Fertile period (Ritukala = days 4-16 of cycle)
2. Kshetra - Healthy uterus (Garbhashaya shuddha)
3. Ambu - Adequate nourishment/fluids (Aahar rasa)
4. Beeja - Healthy seeds (Shukra + Shonita)

• Begins from day 4 after onset of menstruation
• Lasts 12 days (days 4-16)
• Odd nights (5th, 7th, 9th...) favor male progeny
• Even nights (4th, 6th, 8th...) favor female progeny
• Days 4-6 are inauspicious for conception

1. Pumsavana Samskara precedes conception rituals
2. Sexual union during Ritukala
3. Shukra (sperm) travels upward through Apatyapatha (birth canal) via Sira and reaches Garbhashaya
4. Shukra unites with Shonita (ovum) in the uterus
5. Atma (soul) descends and enters the union due to Karma (past actions)
6. Garbha is thus formed - Avyakta (invisible, undifferentiated) at first

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Q4. Clinical Diagnosis of Pregnancy - Signs and Symptoms in First Trimester

Presumptive (Sambhavita) Signs - Subjective

1. Amenorrhea - Absence of expected menses (most common first sign)
2. Nausea and vomiting - "Morning sickness"; begins week 4-6, peaks week 8-10
3. Breast changes - Fullness, tingling, tenderness; darkening of areola
4. Urinary frequency - Due to pressure on bladder + increased GFR
5. Fatigue and lassitude
6. Food cravings/aversions (Dauhrida) - Also described in Ayurveda as Dauhrida (desire of two hearts - mother + fetus)
7. Quickening - Fetal movements (usually weeks 16-20; not first trimester)

Probable (Sambhava) Signs - Objective but not definitive

1. Uterine enlargement - Detectable per abdomen by 12 weeks
2. Hegar's sign - Softening of the isthmus (week 6-10); bimanual; lower uterine segment soft, body firm, cervix firm - "three-part" sign
3. Goodell's sign - Softening of the cervix (from 4th week)
4. Chadwick's sign - Bluish-purple discoloration of the vagina and cervix due to engorgement
5. Osiander's sign - Pulsations felt in the lateral vaginal fornices
6. Ballottement - Internal ballottement (bimanual) at 16-20 weeks; external at 20 weeks
7. Jacquemier's / Kluge's sign - Blue discoloration of vaginal walls
8. Braxton-Hicks contractions - Painless irregular uterine contractions from 6th week
9. Positive pregnancy test (urine/serum hCG)

Positive (Nishchita) Signs

1. Fetal heart sounds - Doppler from week 10-12; stethoscope from week 20
2. Fetal movements felt by examiner (not first trimester)
3. Ultrasonography - Gestational sac from 4-5 weeks; fetal pole and cardiac activity from 6 weeks

Ayurvedic Signs of Pregnancy (Garbha Lakshana):

• Prasad (happiness, contentment)
• Manda pravrutti (sluggishness)
• Syava stana (nipple darkening)
• Aruchi (anorexia) or Abhilasha (cravings)
• Urdhva nabhivriddhi (elevation of umbilicus)

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Q5. Precocious and Delayed Puberty - Differences, Etiological Factors, and Management

Normal Puberty (Reference)

• Girls: Begins 8-13 years; thelarche first, then pubarche, menarche
• Boys: Begins 9-14 years; testicular enlargement first

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Precocious Puberty

• Idiopathic (most common, especially in girls)
• CNS tumors: hypothalamic hamartoma (most common organic cause), astrocytoma, ependymoma
• CNS infections, trauma, irradiation
• Hydrocephalus
• Neurofibromatosis type 1
• Tuberous sclerosis

• McCune-Albright Syndrome (fibrous dysplasia + cafe-au-lait spots + precocious puberty)
• Congenital adrenal hyperplasia (CAH)
• Adrenal/gonadal tumors (estrogen or androgen-secreting)
• Exogenous sex steroid exposure
• Primary hypothyroidism (Van Wyk-Grumbach syndrome)

• Early breast development, pubic/axillary hair
• Menstruation before age 8
• Accelerated growth velocity initially, but premature epiphyseal fusion leads to short final adult height
• Advanced bone age on X-ray

1. GnRH agonists (leuprolide, histrelin) - suppress HPG axis; treatment of choice for central precocious puberty
2. Aromatase inhibitors (for peripheral, estrogen-dependent)
3. Treat underlying cause (tumor, CAH, hypothyroidism)
4. Monitor bone age, growth velocity, and pubertal staging every 6 months
5. Psychological support

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Delayed Puberty

• FSH, LH (high = primary gonadal failure; low = hypogonadotropic)
• Karyotype (for Turner/Klinefelter)
• Bone age X-ray
• MRI brain (if CNS pathology suspected)
• Prolactin, thyroid function tests

1. Constitutional delay: Reassurance; short course of low-dose sex steroids if psychosocial distress
2. Hypogonadotropic hypogonadism: GnRH pulsatile therapy or gonadotropin therapy (for fertility); hormone replacement therapy (HRT) for secondary sexual development
3. Hypergonadotropic: HRT (estrogen + progesterone) for feminization and bone protection
4. Turner syndrome: GH therapy for height, then estrogen HRT
5. Anatomic causes: Surgical correction

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Q6. Clinical Indications, Diagnostic Uses, and Contraindications

I. Cusco's Speculum (Bivalve Speculum)

1. Visualization of vaginal walls and cervix
2. Inspection of cervix for:
   • Erosion, ectropion
   • Cervicitis, polyp
   • Carcinoma cervix
3. Collection of Pap smear (cervical cytology)
4. Colposcopy - directed biopsy
5. Obtaining high vaginal swab (HVS) and endocervical swab
6. IUCD insertion and removal
7. Cervical cauterization, cryotherapy
8. Assessment of vaginal discharge, foreign body
9. Assessment of cervical dilatation in labor
10. Application of cervical suture (Shirodkar/McDonald)
11. Culdocentesis (posterior fornix aspiration)
12. Ring pessary insertion/removal

1. Imperforate hymen or very narrow introitus (in virgo intacta)
2. Severe vaginismus (relative)
3. Active vaginal/vulval infections causing extreme pain (relative)
4. Atrophic vaginitis (use lubrication + smaller size)

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II. Vulsellum Forceps (Tenaculum/Volsellum)

1. Grasping the cervix to steady it during:
   • D&C (dilatation and curettage)
   • MTP (medical termination of pregnancy)
   • Cervical biopsy
   • Endometrial biopsy
   • Hysteroscopy
2. IUCD insertion - to straighten the uterocervical angle
3. Cervical polypectomy - to grasp and twist off cervical polyps
4. Trachelorrhaphy (cervical repair surgery)
5. Manchester/Fothergill operation - amputation of cervix in prolapse repair
6. Shirodkar suture - to grasp anterior lip of cervix
7. Colposcopy-directed biopsy - cervical stabilization

• Assessment of cervical mobility and tenderness (PID evaluation)
• Steadying cervix for sound insertion (uterine sounding)
• Obtaining endocervical tissue for biopsy

1. Carcinoma cervix (friable cervix - risk of bleeding and dissemination)
2. Active cervical infection (relative)
3. Uncooperative patient without anesthesia (relative)
4. Pregnancy (except in specific obstetric procedures - use with extreme care)

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Q7. Artava Kshaya - Samprapti, Nidana, Lakshana, and Chikitsa; Correlation with Oligomenorrhea and Hypomenorrhea

Definition

Nidana (Causative Factors)

1. Ahara (dietary): Excessive intake of Ruksha (dry), Laghu (light), Ushna (hot), Katu (pungent) food; inadequate nutrition; fasting
2. Vihara (lifestyle): Excessive exercise, physical strain, Vegadharana (suppression of urges), Ratri Jagarana (night vigil), excessive sexual intercourse
3. Manasika (psychological): Chinta (worry), Shoka (grief), Bhaya (fear) - these vitiate Vata
4. Vyadhi: Rajayakshma (tuberculosis), Pandu (anemia), Shosha (cachexia)
5. Vata-Pitta Dosha predominant vitiation with Rasa-Rakta Kshaya

Samprapti (Pathogenesis)

Nidana Sevana
    ↓
Vata-Pitta Dosha Vridhi + Rasa-Rakta Dhatu Kshaya
    ↓
Artava Utpatti (Artava formed from Rasa Dhatu) impaired
    ↓
Artava Kshaya
    ↓
Alpa Artava Darshana (scanty menses) / Delayed / Absent menses

Lakshana (Clinical Features)

1. Alpata - Scanty menstrual flow (< 20 mL or < 2 days)
2. Krichhra Artava Pravritti - Difficult / painful menstruation
3. Chirakari - Delayed onset of menstruation
4. Shoola - Pelvic pain (due to Vata)
5. Daurbalya - General weakness
6. Shyava/Krishna Varna - Dark-colored menstrual blood
7. Klama, Shrama - Fatigue
8. Vandhyatva - Infertility (if severe)
9. Symptoms of Rasa Kshaya: Pallor, weakness, palpitations

Chikitsa (Treatment)

• Virechana (purgation) to remove excess Pitta and clear Artava Vaha Srotas
• Uttara Basti (intra-uterine/vaginal medicated enema) with Shatapushpa, Eranda, Tila taila - most important treatment

• Pushyanuga Churna - classical formulation for Artava disorders
• Rajapravartini Vati - promotes menstrual flow
• Kumaryasava - tonic for Artava
• Loha Bhasma + Mandura Bhasma - for Pandu/Anemia
• Shatavari Ghrita, Ashoka Ghrita - nourish Rasa-Artava
• Ashwagandha, Shatavari - Rasayana for general strength

• Nourishing diet: milk, ghee, sesame, jaggery
• Avoid excessive exercise and fasting
• Emotional rest

Correlation with Modern Medicine

• Intrauterine adhesions (Asherman's syndrome)
• Endometrial atrophy
• Hormonal - hypothyroidism, hyperprolactinemia
• Post-curettage, post-myomectomy

• PCOS (most common)
• Thyroid disorders
• Hyperprolactinemia
• Hypothalamic amenorrhea (stress, weight loss)
• Perimenopause

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Q8. Rasayana Chikitsa - Therapeutic Role and Mechanism in Managing Rajonivrutti Vikara

Rajonivrutti (Menopause)

• Natural cessation of menstruation, typically around age 45-55
• Defined as 12 consecutive months of amenorrhea
• Due to depletion of ovarian follicles and decline in estrogen/progesterone

Rajonivrutti Vikara (Menopausal Symptoms)

• Vasomotor: Hot flashes, night sweats (Daha, Svedana)
• Psychological: Irritability, depression, mood swings (Manasika vikara)
• Urogenital atrophy: Vaginal dryness, dyspareunia, urinary incontinence
• Musculoskeletal: Osteoporosis, joint pains (Asthi-Sandhi Shoola)
• Cardiovascular: Increased risk post-menopause
• General: Fatigue, insomnia, memory decline

Rasayana Chikitsa (Rejuvenation Therapy)

"Labhopayo hi shastaanam rasaadinaam rasayanam" - Rasayana is the science of obtaining the best qualities of Rasa (nutritive fluid) and all subsequent Dhatus.

• Dirgha Ayuh (longevity)
• Smriti (memory)
• Medha (intellect)
• Arogya (health)
• Yauvan (youthfulness)
• Prabha (luster)
• Varna (complexion)
• Swara (voice)
• Deha Bala (physical strength)

Mechanism of Action in Rajonivrutti Vikara

1. Dhatvagni stimulation: Rasayanas enhance the Agni (metabolic fire) at the tissue level (Dhatvagni), improving Dhatu formation - especially Rasa, Rakta, Asthi, and Shukra/Artava
2. Srotas Shodhan: Clears micro-channels blocked due to aging and Dosha accumulation, improving nutrient delivery
3. Antioxidant effect (Vaya Sthapana): Herbs like Amalaki have potent antioxidant properties, reducing cellular damage associated with aging and estrogen decline
4. Adaptogenic / Nervine tonic: Ashwagandha modulates the HPA axis, reduces cortisol, improves energy, sleep, and mood - addressing Manasika vikara
5. Phytoestrogen activity: Shatavari, Ashoka, Nagakesara - contain steroidal saponins and phytoestrogens that partially compensate for estrogen decline
6. Osteogenic activity: Guduchi, Ashwagandha support Asthi Dhatu; clinically shown to improve bone mineral density
7. Immunomodulation: Strengthen Ojas (immunity), reducing vulnerability to disease

Specific Rasayana Formulations for Rajonivrutti Vikara

• Abhyanga (oil massage): Reduces Vata, relieves joint pains and dryness
• Shirodhara: Relieves insomnia, anxiety, mood disorders
• Uttara Basti: For urogenital atrophy
• Virechana: For Pitta-dominant symptoms (hot flashes, irritability)

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SECTION C - Long Answer Questions

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Q.III.1. Phases of Menstrual Cycle and Role of Hypothalamo-Pituitary-Ovarian (HPO) Axis

The Normal Menstrual Cycle - Overview

• Normal cycle: 21-35 days (average 28 days)
• Duration of flow: 2-6 days
• Normal blood loss: 20-60 mL
• Two interconnected cycles: the ovarian cycle and the uterine (endometrial) cycle

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THE OVARIAN CYCLE

Phase 1: Follicular Phase (Days 1-14)

• Begins from day 1 of menstruation to ovulation
• Variable in duration (accounts for cycle length variation)

1. FSH rises (due to corpus luteum degeneration of previous cycle)
2. A cohort of antral follicles is recruited from the ovary
3. One dominant follicle is selected (by day 5-7) - secretes increasing estradiol
4. Rising estrogen causes endometrial proliferation
5. Estrogen provides negative feedback on FSH (FSH falls mid-follicular phase)
6. Follicle produces inhibin B - further suppresses FSH
7. LH shows paradoxical biphasic response: first inhibited by estrogen, then dramatically stimulated (positive feedback) as estrogen peaks late in follicular phase

Ovulation (Day 14 in 28-day cycle)

• Triggered by the LH surge (begins ~36 hours before ovulation)
• LH surge causes:
  • Resumption of meiosis I in the oocyte
  • Prostaglandin synthesis - follicular rupture
  • Luteinization of granulosa cells
• Oocyte released; follicle collapses and transforms to corpus luteum

Phase 2: Luteal Phase (Days 14-28)

• Fixed duration: 14 days
• Corpus luteum secretes progesterone, estradiol, and inhibin A
• Progesterone causes secretory transformation of endometrium (prepares for implantation)
• Progesterone + estrogen + inhibin A suppress LH and FSH (negative feedback)
• If no implantation: corpus luteum degenerates (luteolysis) by day 24-26 - progesterone falls - menstruation occurs

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THE UTERINE (ENDOMETRIAL) CYCLE

Phase 1: Menstrual Phase (Days 1-4)

• Progesterone and estrogen fall → withdrawal of hormonal support
• Endometrial spiral arteries spasm → ischemia → endometrial shedding
• Prostaglandins mediate uterine contractions (cause dysmenorrhea)
• Shed endometrium, blood, and tissue pass as menstrual fluid

Phase 2: Proliferative Phase (Days 4-14)

• Driven by rising estrogen from developing follicle
• Endometrium regenerates from the basal layer (stratum basalis)
• Glands become straight, stroma proliferates
• Endometrium grows from ~0.5 mm to 3-5 mm

Phase 3: Secretory Phase (Days 14-28)

• Driven by progesterone (from corpus luteum)
• Endometrial glands become tortuous ("saw-tooth" on histology)
• Glands secrete glycogen-rich fluid - "uterine milk"
• Spiral arteries lengthen
• Endometrium reaches 6-10 mm (maximum)
• If fertilized ovum implants (day 7-10 post-ovulation): hCG is secreted → rescues corpus luteum → progesterone maintained → no menstruation (pregnancy)

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ROLE OF THE HYPOTHALAMO-PITUITARY-OVARIAN (HPO) AXIS

HYPOTHALAMUS
    |  GnRH (pulsatile, from arcuate nucleus)
    ↓
ANTERIOR PITUITARY
    |  FSH + LH (pulsatile)
    ↓
OVARY
    |  Estradiol, Progesterone, Inhibin A/B
    ↓
FEEDBACK to hypothalamus and pituitary

• Slow pulses (1/90 min) → favor FSH secretion
• Fast pulses (1/60 min) → favor LH secretion
• Continuous (non-pulsatile) GnRH → downregulates GnRH receptors → suppresses both FSH and LH (basis of GnRH agonist therapy)

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Q.III.2. Masanumasika Garbhini Paricharya - Month-Wise Antenatal Regimen with Clinical Relevance

Rationale

1. Nourish the growing fetal structures (Poshana)
2. Maintain maternal health (Matru Swasthya)
3. Ensure optimal labor and delivery
4. Prevent pregnancy complications

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Month-Wise Regimen

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Special Practices in Garbhini Paricharya

1. Pumsavana (2nd-3rd month) - ritual for fetal sex/health promotion
2. Simantaonnayana (4th-5th month) - ceremony to honor mother and fetus
3. Manasa Paricharya: Avoid anger, fear, grief; engage in devotion, pleasant activities (Sattvik mental regimen)
4. Vihara (Behavioral rules):
   • Avoid heavy lifting, strenuous exercise
   • Avoid sitting on hard surface
   • Sleep on left lateral position (Vama Parshva Shayan)
   • Avoid Vegadharana
   • Daily gentle walking (Manda Gati)
5. Avoid: Alcohol, smoking, Tikta-Katu food, fasting, excessive travel, sexual intercourse (especially in 1st and 9th months)

Clinical Correlation of Masanumasika Paricharya

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Q.III.3. Asrugdara - Nidana, Samprapti, Lakshana, and Chikitsa; Correlation to AUB

Definition

Nidana (Etiology)

• Excessive intake of Amla (sour), Lavana (salty), Katu (pungent), Ushna (hot), Tikshna foods
• Excessive alcohol (Sura), fermented foods
• Meat of aquatic/marshy animals

• Atiyoga of Maithuna (excessive intercourse)
• Excessive strenuous exercise and jumping
• Pressure injuries, trauma to abdomen

• Krodha (anger), Shoka (grief), Chinta (anxiety) - vitiate Pitta and Rakta

• Pradara in the context of Garbhashaya roga (uterine diseases)
• Raktaj Gulma (blood tumor - possibly fibroid/polyp)

Samprapti (Pathogenesis)

Nidana Sevana (especially Pitta/Rakta aggravating causes)
    ↓
Pitta Dosha vridhi + Rakta Dhatu Dushti
    ↓
Pitta enters Rakta (Pitta-Rakta Sammurchhana)
    ↓
Artava Vaha Srotas Dushti (especially by Atipravrutti type)
    ↓
Teekshna, Ushna, Drava properties of Pitta → Rakta Atipravrutti
    ↓
Asrugdara (Excessive uterine bleeding)

1. Vataj Asrugdara: Dark/blackish, frothy blood; Severe pain; irregular; thin
2. Pittaj Asrugdara: Bright red, warm blood; burning sensation; continuous flow
3. Kaphaj Asrugdara: Pale/whitish blood; slimy, heavy; mild pain
4. Sannipataj: Mixed features; most serious

Lakshana (Clinical Features)

1. Atyartava - Excessive menstrual flow (> 80 mL)
2. Atidirghakala - Prolonged bleeding (> 7 days)
3. Akala Artava - Bleeding at irregular times (intermenstrual)
4. Daurbalya - General weakness
5. Panduta - Pallor (anemia)
6. Hridrava - Palpitations
7. Bhrama - Dizziness
8. Trishna - Excessive thirst
9. Klama, Shrama - Fatigue
10. Mukha Vaivarnya - Facial discoloration

Chikitsa (Treatment)

• Virechana (purgation) - removes excess Pitta; most important
• Rakta Mokshana (blood-letting) - only in extreme Pitta-Rakta Dushti

1. Pushyanuga Churna - classical first-line for all types of excessive vaginal discharge/bleeding
2. Chandraprabha Vati - reduces uterine inflammation
3. Ashoka Ghrita / Ashoka Arishtam - Ashoka bark is the primary drug (Saraka asoka = Ashoka); hemostatic, uterine tonic
4. Lodhra Churna - astringent, hemostatic
5. Nagakesara - specific for Pittaj Asrugdara (hemostatic + anti-inflammatory)
6. Dhatri Loha / Mandura - for associated Pandu (anemia)
7. Bolbaddha Rasa - for acute hemorrhage

Correlation with AUB (Abnormal Uterine Bleeding)

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Q.III.4. Artava Dushti as Described by Acharya Sushruta - Types, Lakshanas, and Chikitsa Siddhanta

Definition

Types of Artava Dushti According to Sushruta

Primary Classification - Dosha-wise:

• Mixed features of all three
• Most difficult to treat
• Corresponds to complex AUB or mixed infection

• Sushruta specifically mentions Raktaj Pradara separately
• Features: Bright red, hot, coppery smell (Tamra Gandha)
• Due to pure Rakta Dushti (blood vitiation)

Lakshanas (Signs and Symptoms of Artava Dushti)

1. Artava Vaivarnya - change in color of menstrual blood
2. Artava Vaishamya - irregularity in amount and timing
3. Artava Durgandha - foul smell
4. Artava Vikara - abnormal consistency (clots, frothy, slimy)
5. Associated Vedana (pain), Daha, Kandu
6. Systemic symptoms: Pandu, Daurbalya, Bhrama

• Vataj Artava Dushti → Vata-predominant defects in fetus (sensory/motor)
• Pittaj → Jaundice, skin disorders in newborn
• Kaphaj → Sluggish, heavy-built child with Shleshma disorders
• This is clinically relevant: maternal conditions like infection, nutritional deficiency, and hormonal disorders can cause fetal abnormalities

Chikitsa Siddhanta (Treatment Principles - Sushruta's Approach)

• Snehana (oil therapy) - internal and external
• Vata-pacifying diet: milk, ghee, Bala, Ashwagandha
• Anuvasana Basti with medicated oils
• Shatavari Ghrita

• Virechana (purgation) - primary Shodhana
• Pitta-pacifying diet: cool, sweet, bitter foods
• Chandanasava, Usheerasava, Sarivadyasava
• Nagakesara, Lodhra, Praval Pishti

• Langhana (lightening therapy), Ruksha Udavartana
• Kapha-pacifying: light, dry, pungent foods
• Trikatu, Triphala, Guggulu preparations
• Kanchanara Guggulu (for Kapha-type uterine growths)

• Rakta-sthambhana herbs: Lodhra, Nagakesara, Chandana, Mocharasa
• Rakta Shodhana: Sariva (Hemidesmus), Nimba, Patola
• Pushyanuga Churna, Ashoka preparations

• Medicated oil/ghee introduced via vaginal/uterine route
• Directly acts on Artava Vaha Srotas
• Both diagnostic (assesses Yoni type) and therapeutic
• Most cited treatment for all Artava-related disorders

• Avoid spicy, sour, fermented, hot foods
• Avoid excessive exercise, sexual intercourse during treatment
• Mental peace, sattvic lifestyle
• Regular sleep and meal times
• Tila (sesame), Mudga (green gram), Yava (barley) as staple grains

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