Total years in practice: 1

Publish Date
June 28, 2019
Patient
38 Years, Female, Asian
Medical Condition
Women's Health and Pregnancy
Therapies
Ayurveda,Yoga
Medical History

 A female married patient aged 38 years with complaints of increased white discharge accompanied with itching and burning sensation during urination and stomach cramps. She also complained of her flow and Duration of menstruation with clots since 3 years.  On enquiry, she revealed that her increased white vaginal discharges affected her daily routine since 2 months . 

Past history:  

No H/O HTN/Thyroid dysfunction / diabetes etc

No H/O contraceptive use 

No surgical history

Medication History:

 Hormonal treatment since last 3 months 

 Menstrual History

Duration/Interval:  10-15 days / 28-30 days

Amount:  5-6 pads (fully soaked) /day , with clots for initial 5 days followed by 4pads/day

Mild Low back ache with abdomen pain. 

General Examination

Bulit- Normal, Weight- 55kg, BMI- 25 Kg/m2

Tongue- Coated,

Pallor- Absent, Pulse rate- 74 beats/mi, BP- 110/80 mm of Hg 

Temp- Afebrile




Ashta Vidha Pariksha



Nadi -82 beats / min

Mala -Once / day , hard constipated

Mutra-5 -6times/day

Jivha –Lipta , sama

Shabda –Prakruta , clear , no stammering

Sparsha -Anushna Sheeta/afebrile

Druk -Prakruta

Akriti -Madhyama.


Dasha vidha pariksha

Prakriti –Vata pitta

Vikruti –Madhyama

Bala –Madhyama

Sara –Madhyama

Samhanana –Madhyama

Satmya –Madhyama

Satva –Madhyama

Pramana –Madhyama

Ahara shakti &Abhyavarana shakti –Madhyama

Jarana shakti –Madhyama

Vyayama shakti –Avara

Vaya –Madhyama


Systemic examination:

Per Abdomen- On palpation -soft, non-tender, no organomegaly,

CVS- NAD, CNS- Conscious and well oriented, RS- B/L NVBS heard.

Gynaecological examination

1. On Inspection

Vulva- Normal and healthy and on straining. No genital prolapse was observed.

Per speculum Vaginal examination:

· Cervix-appearance- Normal, healthy.

· White discharge - Nil

· Vaginal walls – Normal


2. On Palpation

a) Per Vaginal Digital examination:

· Cervix-firm in consistency, mobile, tenderness absent

· No labial swelling detected

· No abnormality detected on palpation of vaginal walls

b) Bimanual examination:

· Uterus- Anteverted, freely mobile, normal in size, firm in consistency

· Bilateral Fornices –Free, non tender.


Case Management

Detailed examination of patient was done; in which patient was found vata prakruti, vishamagni, krurakhosti. General and systemic examinations along with per abdomen and per vaginal examinations were normal.  After thorough check-up, and going through all investigations of the patient under mentioned treatment was given:



Ayurvedic treatment for white discharge (Leucorrhea)



Shodhan chikitsa (purificatory management )

YONI DHAVAN & YONI PICHU 


Yoni dhavan with panchvalakal kasaya .


Yoni pichu with jatyadi oil 

YOGA BASTI


Sarvanga snehana & swedana was done before each basti.

 Anuvasana basti:- Balataila 60 ml + Saindhavalavana 1g. Niruhabasti:- Gandharvamula –kashaya; Bilva, Musta – kalka;TilaTaila, Madhu, Saindhavalavana.


 1 st and 2nd day: Anuvasana basti after meal.

 3 rd, 5th, and 7th day: Niruhabasti followed by light diet.

 4 th, 6th and 8th day: Anuvasana basti after meal


NABHI BASTI 


Ring of paste of amalaka and gram flour in which on alternate basis ginger juice and bala-ashwagandhadi oil was filled for 20-25 min. 


Done on alternate basis to yoga basti . 


 After completion of basti oral medication was continued and during this course, pathya diet was followed compulsory. 

Shamana Chikitsa (Palliative management) was planned with;

DETOX WATER 


Immerse four to five grams of fenugreek kernels in 200 ml. water.

Boil and diminish it up to 100 ml. Then Filter and drink hot twice or thrice a day.




CHOORA /POWDER FORM 


Pushyanuga churna 

Amalaki churna 

KASAYA 


Panchvalkal kwath for douching

ASAVA/ ARISTA 


Dashmoolarista 

Lodhrasava 


Yoga :

  • Yoga Asanas– Parvatasana, Yastikasana, Dhanurasana, Bhadrasana, Bhujangasana

  • Pranayamas– Bhramari Pranayama reduces stress, anxiety, tension and depression, very helpful in coping with your mood swings.

  • Relaxation– Savasana

  • Meditation every day acts as a natural mood elevator and activates the parasympathetic nervous system inducing a calming effect. Meditation harmonises the mind, body and emotions and helps to manage PCOS Menstrual issues and leucorrhea symptoms better.

Preventive Measures

  • Be healthy, eat well, get enough sleep, drink enough fluids.

  • wear condoms during sexual intercourse with new partners

  • Keep vaginal area clean and dry to prevent fungal infection.

  • Wear cotton undergarments.

  • Maintain hygiene by wiping with tissue from front to back after washing the area after urination or bowel movement.

  • Avoid using tampons or menstrual cups.

  • Follow medication and yoga as long as directed.

  • Avoid sexual intercourse until treatment is completed.

  • Don't scratch infected or inflamed areas; it can worsen the irritation.


The main aim of the treatment was to minimize the cyclic blood loss with regularization of cycle and to improve the general condition of the patient. So, the treatment and Ayurvedic medicine for white discharge was planned as Shamana Chikitsa with pushyanuga choorna and amalaki churna ,dashmoolarista , lodhrasava . During this period of basti treatment, Agnivridhi, malashudhi, regular calm sleep was seen in the patient. The Palliative treatment was given for two consecutive months with follow up advice after every cycle in a month. Patient was keenly observed for a period of three months with follow up every month. 

 

Leucorrhoea / Shweta pradar - Excessive discharge of a white, sticky, foul-smelling material from the vagina is called Leucorrhoea. This common problem mainly occurs due to unhygienic conditions, infection of the genital tract, or impaired immune function . 

In ayurvedic texts, it is described as in yonivyapada . This symptom occurs as a result of kapha and vata doshadhikya. But amongst them kapha is the main dosha producing leucorrhoea, stated in Charak Samhita. The colour, feel, consistency of leucorrhoea is also similar to gunas of kapha dosha which are very well elucidated in Ashtanga Hridaya Samhita. 

Kapha is Svadu (sweet), Snigdha (unctuous), Mrudu (soft), Shita (cold), Sthira (stable), Slakshna (smooth), Picchila (sticky), Guru (heavy), Sandra (dense), Manda (sluggish) and Shukla (white) by nature, when in the state of avidagdha (proper digestion) it is sweet in taste. In the state of vidagdha (improper digestion), it has saline taste.

 Types of Discharge;

 1. Tanu: Thin watery, kaphaprakopa is accompany with its pittaprakopa of its dravyaguna specially.

 2. Picchila - Slippery, lubricous, kaphaprakopa especially of its picchile and styana guna accompanied with vataprakopa of its chala guna.

 3. Styana - thick, bulky. It denotes kapha prakopa in a stage of samavastha.

 4. Aavil tantula - Sticky and watery - kapha prakopa of samavastha and accompanied with vata prakopa 

5. Durgandhi - pitta - durgandhi offensive, pitta yellowish kaphaprakop with pitta prakop.


 According to modern science it is divided into two groups:

Physiological Normal secretions from vulva, vagina, cervix show an increase under the following

 conditions :


Pathological

 a. General health cause  

b. Genital causes 

  • Some newborn gets leucorrhoea for a week due to maternal oestrogen.

  •  At puberty due to hormone effect, which corrects itself.

  • At about ovulation and early pregnancy .

  •  During sexual excitement. This excess of secretion is usually enough to moisten the vulva and occasionally pours out to stain the under clothing.


General health causes :

  • Ill health and undernutrition

  •  Dysfunctional (endocrinal, marital disharmony and psychosomatic) 

  • Psychological 


Genital causes : 

 Anaemia,  colitis, vaginitis, cervical erosion, genital prolapse and cervical carcinoma.



 Clinically the causative factors can be explained according to phase of woman’s life:

  • Before puberty - vaginitis in children causing mucopurulent discharge, is mostly due to foreign body inside the vagina.

  •  After puberty in young virgin - poor general health, unclean personal hygiene, anemia, colitis, endocrine dysfunction, masturbation and rarely vaginal cervical erosion are the responsible factors.

  •  Nulliparous married women - Trichomonas and candida; vaginitis are common causes.

  •  Post childbirth - This is largely due to puerperal cervical erosion which is considered physiological. 

  •  Parous women during the child bearing period cervical erosion and chronic cervicitis are the commonest causes.

  •   Pre-menopausal women: Uterine polyp, decubitus ulcer in genital prolapse uterine fibroid and uterine carcinoma are the important factors.

  •   Post-menopausal women - Carcinoma of the genital tract, genital prolapse, senile vaginitis and endometritis pyometra are the important factors.

 If all the above causes according the period factors of women’s life are not treated well , mostly develops complication. In Ayurveda, the following yonivyapad have the symptom of shweta pradar (leucorrhoea) ;

  •  Upapluta yonivyapad 

  •  Asamvritamukhi

  •  Karnini yonivyapad 

  •  Kaphaj yonivyapad 

  •  Acharna

 Treatment plan according to the basic principles of Ayurveda include following therapies that are useful for the alleviation of kapha dosha that had been vitiated: 

  •   Administration of emetic and inhalation therapies with sharp drugs

  •   Intake of light and unctuous food

  •   Exercise, smoking, gandusha

  •   Fomentation therapy

  •  Intake of old yava, godhuma, honey and meat of jangala animals.

  •   Old alcoholic drinks 

  •   To avoid day sleep


    Discussion on Leucorrhea:

    Shweta Pradara(Leucorrhoea) is not a disease, but a symptom of so many diseases. Sometimes this symptom becomes so severe and it overshadows the other symptoms of actual disease.  The causative factors like improper food and lifestyle aggravates Kapha Dosha and vitiate rasa dhatu present in the vaginal tract, ultimately leading to the painless discharge of white colored fluid from the vagina. Most common causes being ;

     1. As anatomy of female genitals is more prone for infections 

     2. Poor hygienic conditions  

     3. consuming too much weight gaining foods which cause vitiation of Kapha Dosha and rasa dhatu 

     4. Sedentary lifestyle 

    5. Physiological reasons like menopause and pregnancy & some females experience this during premenstrual symptom also 

     6. Nylon based underwear as it causes more irritation

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