Introduction

Woman - (The foundation not only of progeny but also of the family life.) Maharashi  Kashyap. Any excessive discharge from vagina is called as Pradar. Reproductive system of Female is very active, cyclical in nature, undergoing constant changes, have tremendous impact on life – physical, Physiological, Psychologies & Social too.  All clinical entities or diseases afflicting the reproductive tract in female are grouped as Yonivyapada.

Etiology  & Pathology

Kapha & Vata are predominant factors in all these disorder -

Kapha & Vata are predominant factors in all these disorder –  Kapha prakopa Occurs at

1. Kapha kalas               a) In hemant and vasanta rutu

                        b) early in morning and early in evening

                        c) Immediately after taking for

                        d) in later lalf of rutukala

                        e) Garbhini awastha

                        f) At time of transformation from bala to Taruni epoch

 ii) Excessive in take of Carbohydrate and fats i.e. obesity.

 iii) Rasa disorders.

Leucorrhoea

An excessive normal vaginal discharge. Normal Vaginal Fluid is watery, white in color, non-odorous with PH around 4.0 Microscopically it contains squamous epithelial  cells & few bacteria. Doderlein bacilli, few gram –ve bacteria & anarobes are present without any white or red blood cells.

Pathophysiology:

The excessive secretion is due to-

1. Physiological excess conditions – estrogen level become high.

                        a) During puberty

                        b) During menstrual cycle

Pregnancy

                        d) During Sexual excitement – Bartholin’s gland secretions

1. Cervical Cause – Cervical ectopy, chronic cervicitis, Mucosal polyp & ectropion
2. Vaginal Cause – Prolapse, Use of Pills, ill health with excessive exfoliation of superficial cells.

Even today the cases of leucorrhea are classified in 4 main categories, according to causation namely Trichomonal, Monolial or fungal, bacterial vaginosis & chronic cervicitis.

Diagnosis :

In all these conditions, darshan, sparshan and prashna are the main diagnostic tools

1. Prashan (History)                -  Menstrual, obstetric, sexual history & Symptoms
2. Sparshan (Physical exam)  - Bimanual exam to cote contour etc.
3. Darshan                                 - Visualization of cervix & vagina with Yonivranekshan Yantra (Cusco’s Speculum)

Types of Discharge -

1. Tanu (Thin)                                                   - Acharna
2. Picchil (Mucoid)                                          - Kaphaja
3. Styana (Thick curdy) Pandu (pale milky) - Upapluta
4. Avil tantul (mucopurulent)                        - Aticharana

Sign & Symptoms :

Clinical Study :

Aims & objects

1. To study efficacy of Triphala lodhara Kashaya yonidhavan & Yastimadhusiddha ghrita pichudharan in swetpradara.
2. To rule our efficacy of this Sthanik Chikitsa which is most effective out of these 4 yonivyapad entities.
3. Time duration effectivity
4. To see adverse effect if any

Selection Criteria :

1. Patients age group selected from 18 yrs till 45 yrs. i.e. Nulliparous  married women. Post childbirth period, parous women during child bearing period.
2. Self made drug ( as easily available drugs) Kashaya & Siddha ghrita is used per vaginum in Rutukal only.
3. Only diagnosed, above four yonivyapad entities are selected. Patients with any allergic vaginal epithelial disorder are excluded.

Material & Method :

Drugs Review

1. Material drugs – a) Triphala lodhra kashaya  b) Yastimadhusiddha ghrita

Yastimadhusiddha ghrita –Mode of action :

Yastimadhusiddhaghrita is made  as per Snehakalpana, Sharagdhar sanhita, Madhyam Khanda Addhyaa no. nine) Yastimadhu has madhura rasa, sheeta virya,madhura vipaka and is vatapitta shamaka, vranashodhan, vranaropaka properties.

Mode of action :

Triphalalodhra decoction Yonidhavan :

            Mode of adminstration – Prathamavarta

            Matra 80 – 100 ml.

            Treatment duration – 8 days in Rutukala

            Time – 1 – 1.5 min.

2)        Yastimadhusiddha ghrita pichudharana:

            Tampoon of Yastimadhusiddha ghrita  is use for 8 days in rutukal - Kaphaghna, pungent,

            Astringent taste

These drugs act as  shodhan, shophaghna, vishada & Vranya, Dahaghna.

Method :

Total 60 no. of patients visiting OPD & IPD of LK Ayurved hospital Yavatmal are studied and they are divided into two groups.

Group A – 30 patients are treated with Triphala Lodhra kwath Yonidhawan & Yastimadhusiddha ghrita pichudharan with conservative treatment.

Group B – 30 patients are treated only with conservative treatment.

Follow up  –  For two months

Conservative treatment – Ashok & Lodhra Churna in Samapraman 5gm twice daily for 8 days for both groups.

Discussion

Observations & Results :

General Observation

1. Sex wise – Shwetpradara is feminine disorder, so all patients in both group were naturally females.
2. Age wise –

Shwetpradara mostly occurs between 20-30 yrs. Age group as it is most fertile period of female.

1. Economy status –

1. Occupation wise –

Leucorrhea occurs mostly in Housewives than the working women.

1. Prakriti wise –

Leucorrhea occurs mostly in Vatakaphaja Prakriti than other dwandaj parakritis.

1. Diet wise–

Shwetapadara occurs mostly in mixed diet group.

1. Yonivyapada wise –

Group Observations:

Here to measure the symptoms severity 4-point scale was used i.e. Severe, moderate, mild, Nil

1. Severity was marked as +++ &  measured by value 3
2. Modern was marked as ++ & measured by value 2
3. Mildness was marked as + & measured by value 1
4. Nil is marked as -- & measured by value  0

To test that Sthanik chikitsa with conservative treatment is shwetpradara is effective than only conservative treatment. We simple take mean in (%) after treatment values of each symptoms grouped together such as -         

Discussion  :

In 20-30 yrs. Age group patients, swetapadara most  common & showed factor improvement as compared to other age group.Poor class patients in study showing little one improvement were more proned to leucorhoea because of unhygienic conditions, and still there were only 11 rich class patients shows mild improvement because of causative factors as lack of exercise, obesity, their lifestyle as compared to poor & middle class group. Housewives are mostly affected than working woman due to above mentioned similar causative factors. Clinical features of leucorrhoea mostly occurred in vatakaphaja Prakriti than other dwandaja prakriti. Varna of lesions & stravamatra showed very fast improvement in trial group A within 7 days. Group A showed more results than Group B patients specially in stravaswarupa, matra, varna, inflammation symptoms. Group A patients, 7 days sthanik chikitsa with conservative treatment does not     show any side effect within 2 month follow up. Disadvantage of this sthanik chikitsa is that  Daily fresh kashaya has to use & Patient has to visit hospital daily for procedure. by above analysis, efficacy of Triphalalodhra kwath & Yastimadhusiddha ghrita pichudharana in shwetpradar is more as compared to the conservative treatment only. As kaphaprakopaka Aahar, Ativyavaya , lack of exercise are causative factors for increasing shwetapradara lakshanas. In present study, vegetarian ladies got more improvement than non-vegetarian patients for shwetaparadara treatment.

Action of Triphalalodhra kwath yonidhawan and Yastimadhusiddha ghrita pichudharana on shwetpradara :

Triphala madur, Kashaya rasa which is kaphapittanasaka decreases kledadhikaya, diminishing kapha & absorbing water, so rasadhatu dusti get suppressed while laghu, ruskha guna of lodhra & triphala is suppressed by snehana karma of yastimadhusiddha ghrita. In shwetpradara, Aapmahabhutadhikya distrubs Rasadusti proportion at female lower reproductive tract i.e. cervix & vagina get normalised due to tridoshnashak triphala & astringent lodhra. So, sthanvaigunya normelises & aapmahabhutadhikya get supressed due to kaphavatashamak, karma of triphala & snigdhtwa & vranropakatwa shophaghna Vishada, varnya karma of Yastimadhusiddha ghrita pichu. As per Ayurvedic and modern view by observation obtained from 60 patients clinical study within my limit.As, in Brihattrayi, there is no reference about the word Pradara/ Shwetpradara.

Conclusion

Sthanik Chikitsa of Triphalalodhra yonidhavan & Yastimadhusiddha ghrita pichudharana in shwetapradara is very effective than conservative treatment. Following auxiliary mode of treatment becomes supportive to improve results. This treatment does not show any adverse effect during two months follow up. This treatment is most effective in Cervical erosion (Aticharana & Karnini Yonivyapada).