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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 6  |  Issue : 3  |  Page : 127-132

Management of tubal blockage through Ayurvedic interventions: A case study


1 Department of Striroga and Prasuti Tantra, Government Ayurvedic College and Hospital, Balangir, Odisha, India
2 Indira Gandhi Memorial Ayurvedic Medical College and Hospital, BBSR, Odisha, India
3 Department of Rognidan and Vikruti Vigyan, Sri Sri College Ayurvedic Science & Research Hospital, Sri Sri University, Cuttack, Odisha, India
4 Department of Striroga and Prasuti Tantra, All India Institute of Ayurveda, Goa, India

Date of Submission11-Aug-2022
Date of Acceptance03-Oct-2022
Date of Web Publication01-Nov-2022

Correspondence Address:
Dr. Sudha Dansana
Department of Striroga and Prasutitantra, Govt. Ayurvedic College and Hospital, Balangir 767001, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jras.jras_122_22

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  Abstract 

INTRODUCTION: Fallopian tube blockage is among the most notorious factors for female infertility, which is responsible for 25%–30% of total female infertility. Tubal blockages can be correlated to Sanga Srotodushti of Artavavaha Srotasa in Ayurveda, involving Vata and Kapha Doshas. Normalizing the vitiated Vata–Kapha Dosha leads to restoration of tubal function and easy conception. The case report presented here highlights the role of Ayurvedic medicines and therapies in successfully managing tubal blockage. MATERIALS AND METHODS: In the present case report, a 27-year-old married female diagnosed with infertility due to bilateral fallopian tube blockage presented with chief complaints of inability to conceive for 3 years and was treated with Ayurveda medications and therapeutic procedures. Oral medicines such as decoctions, herbal powder, medicated ghee, and tablets were administered along with therapeutic procedures, which included Virechana (therapeutic purgation), Basti (therapeutic enema), and Uttarbasti (intrauterine medication). Pre- and post-assessments were done by hysterosalpingography (HSG). RESULT AND CONCLUSION: At the end of the treatment, there was a normal spillage of dye in both tubes noted in HSG. In this study, a comprehensive therapeutic intervention using Ayurveda medications and therapeutic procedures such as Virechana, Basti, and Uttarbasti was found to effectively clear the blockage of tubes.

Keywords: Artavavaha Srotodushti, infertility, tubal blockage, Uttarbasti, Virechana


How to cite this article:
Dansana S, Hota DK, Panda PK, Kadam S. Management of tubal blockage through Ayurvedic interventions: A case study. J Res Ayurvedic Sci 2022;6:127-32

How to cite this URL:
Dansana S, Hota DK, Panda PK, Kadam S. Management of tubal blockage through Ayurvedic interventions: A case study. J Res Ayurvedic Sci [serial online] 2022 [cited 2022 Dec 7];6:127-32. Available from: http://www.jrasccras.com/text.asp?2022/6/3/127/360156




  Introduction Top


Infertility is a global health issue affecting 10%–15% of couples of reproductive age.[1] Infertility is defined as the failure of a couple to conceive after 1 year of regular unprotected coitus. Estimates suggest that 48 million couples and 186 million individuals live with infertility globally. However, 25%–30% of infertile females are reported to have tubal pathology.[2] Often tubal factor infertility is caused by pelvic infections, such as pelvic inflammatory disease or endometriosis, recurrent reproductive tract infections, scar tissues that form after pelvic surgery, or a history of tuberculosis.[3]

According to Acharya Sushrut-Ritu (ideal period for conception), Kshetra (female reproductive system), Ambu (essential nutrition), and Beeja (ovum and sperm) are considered to be the prime factors for the achievement of pregnancy.[4] Abnormalities present in any of the above factors singly or combined may lead to a couple’s infertility. Infertility is a symptom due to damage to Artavavaha Srotasa,[5] which may be compared to the fallopian tube in the present context. Infertility due to tubal blockage can be understood under Kshetra Vikriti (deformity in female reproductive system) and Sanga Srotodushti (blockage of microchannel) of Artavavaha Srotasa.

In tubal blockage, the drugs with subtle, sharp, and hot, scraping properties that pacify Vata-Kapha Dosha can be considered for therapy and administered for purgation, enema, and Uttarabasti. Uttarabasti is an effective local therapy for most gynecological diseases, including infertility. The present case study highlights the role of Ayurvedic therapeutic procedures such as Virechana, Basti, and Uttarbasti in treating tubal blockage.

Patient information

A 27-year-old married female reported in outpatient department of Prasutitantra and Striroga department of Govt. Ayurvedic College and Hospital, Balangir on February 16, 2022 with complaints of inability to conceive for 3 years, with the latest hysterosalpingography (HSG) report dated December 6, 2021 showing no free intraperitoneal spill on both fallopian tubes. On detailed history, her menstrual cycle was regular with a duration of 4–5 days and 28–35 days intervals without any associated complaints. Her last menstrual period reported was on February 3, 2022. She had no history of hyroid dysfunction, psychiatric illness, HIV infection, diabetes mellitus, and tuberculosis. The couple reported no other symptoms or illness.

Clinical findings

Physical examination

The patient was afebrile. Pulse rate was 75/min, respiratory rate was 19/min, and blood pressure was 112/80 mm Hg. No abnormality was noted after the detailed systemic examination. Appetite, micturition, bowel habits, and sleep were normal. The patient was of medium body built and belonged to Vata-Kapha Prakriti.

Local examination

On per speculum examination, the cervix was normal without any local lesion. No discharge per vagina was seen. The uterus was anteverted, firm, mobile, and normal size, as observed in the per vaginal examination. Cervix was smooth, and cervical motion tenderness was absent. No abnormality was detected in adnexa palpation.

Timeline

The patient had been married for 3 years. Just after marriage, the couple tried for conception, but they failed. The patient was advised HSG by the family physician, where she was diagnosed with a bilateral tubal blockage in HSG done on December 16, 2021. The patient came for Ayurvedic treatment on February 16, 2022, and the treatment was continued till June 9, 2022. The total duration of the treatment was 4 months.

Diagnostic assessment

HSG was done on December 16, 2021, which showed no free intraperitoneal spill on both fallopian tubes. Hematological findings such as CBC, ESR, lipid profile, and blood glucose level were within normal limits. Hormonal assays were found to be within normal limits. The menstrual cycle was also regular (bleeding: 3–5 days and duration: 28–30 days)

Therapeutic interventions

After thoroughly examining the patient, treatment was planned with Ayurveda Panchakarma (five internal bio-cleansing therapies) and oral interventions. On the first visit, appetizer and digestive medicines were started, followed by oral intake of medicated ghee and whole body massage with steam, and finally, Virechana was done. A total of 26 vegas were observed, and according to that specific diet, a schedule was advised. In the next visit, Yogabasti (a course of eight therapeutic enemas) was administered for 8 days with the combination of Sneha Basti (oil enema) and Kashaya Basti (enema with medicated decoction). After the cessation of each menstruation, Uttarbasti was administered in an aseptic condition consecutively for 03 menstrual cycles. Each Uttarbasti was preceded by vaginal douching with Triphala decoction, followed by vaginal tamponing with Phalasarpi. The therapeutic intervention details are presented in [Table 1].
Table 1: Schedule of the therapies with duration

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Table 2: Oral medicines with dose

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Oral medications

Along with the therapies oral medicines as listed in [Table 1] were also given for the last 3 months of treatment.

Pathyapathya (Do’s and Don’ts)

Pathya (Do’s)

Light, digestible, fresh, and warm food, especially Khichdi, Mudgayusha (juice made of green gram), and a diet rich in fiber like brown rice, Oats, and dalia were advised. Yogasana, like Suryanamaskar, Tadasana, and Vrikshasan, were advised to alleviate stress and anxiety. Trikonasana and Pranayama, such as Bhramari, Anulomvilom, breathing exercises, and “OM” chanting, were recommended daily, morning and evening, for 20 min each.

Apathya (Don’ts)

During the whole treatment, the patient was advised not to take white rice, curd, bakery products, black gram dal, sour, spicy, non-vegetarian food, or food rich in starch, carbohydrate, and preservative. She was advised not to take day sleep and maintain abstinence.

Follow-up and outcome

HSG was done after the completion of 4 months of treatment. HSG findings dated July 13, 2022 showed normal spill from both fallopian tubes [Figure 1] and [Figure 2]. There was no adverse or unanticipated event seen during whole regime.
Figure 1: Hysterosalpingography findings before and after treatment

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Figure 2: Hysterosalpingography report before and after treatment

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  Discussion Top


In some cases, infertility due to tubal blockage is a significant yet rectifiable etiology. This condition is not described in Ayurvedic classics, as the fallopian tube itself is not mentioned directly. But infertility is described as a symptom due to damage to Artavavaha Srotasa as described by Acharya Sushruta.[5]Vata and Kapha are the leading Doshas that can result in stenosis and obstruct the lumen of the fallopian tube. Hence the drugs that possess Vata-Kapha pacifying properties, Tikshna (sharp), and Ushna (hot) properties are considered effective for clearing the blockage. Local administration of any drugs which are having Sukshma (light), Vyavayi (fast diffusing) properties, and Katu Vipaka (pungent) have an effective role in removing the blockage and restoring the normal function of tubes.

Appetizers and digestive medicines optimize metabolic activities that help easily eliminate morbid factors from the body and reduce Ama formation which is a major cause of the blockage of microchannels in the body. Varunadighrita,[6] taken for oral intake before purgation, has Varuna (Crataevanurvala) as a key ingredient. Crataeva nurvala contains an active ingredient Lupeol,[7] and due to its anti-inflammatory, chemoprotective, antimicrobial, and immune-modulatory action. It effectively clears the blockage in micro-channel. Trivrita Avaleha was used for Virechana due to its subtle, hot, and sharp quality. Virechana is the mechanism to remove the Pitta Pradhana Dosha through the anal route.[8]Trivrita has anti-inflammatory, antioxidant, and immunomodulatory activities and helps eliminate toxins from the body.[9]

According to Acharya Kashyap, infertility, being a Vataja disorder,[10] therapeutic enema has been considered the first treatment line.[11] Drugs given through the rectal route are absorbed through the mucosal layer of the rectum and enter into systemic circulation faster than oral.[12] So in the present case study, decoction enema prepared from the decoction of Dashmoola and oil enema of Sahacharadi Taila[13]is intended to normalize the function of Apana Vayu as it may further correct the menstruation and ovulation and functioning of Aartvavaha Srotasa.

Uttarbasti is a local procedure where medicated oil or ghee is administered directly into the uterus. In the current case study, Apamargakshara[14] oil used for intrauterine instillation contains Kshara has properties of mainly excision, incision, and scraping.[15] The Apamarga Kshara is strongly alkaline in reaction (pH of 5%w/v solution in water 10.44) and hygroscopic.[16] Its strong alkaline nature might be responsible for the removal of fibrotic tissue present inside the lumen of fallopian tubes. The water-soluble alkaloid achyranthine found in Achyranthes aspera is screened for its anti-inflammatory action.[17] The aqueous and ethanol extracts of leaves may promote wound healing process inside the tubes, as it contains tannins, flavonoids, glycosides, and alkaloids..[18]

Phalasarpi helps achieve conception and is proclaimed best for curing all female reproductive tract disorders, as per Ayurveda classical texts. The Vata Dosha pacifying property helps remove the tubal blockage and improves ciliary motility.[19]Shatapushpa Churna acts on vitiated Kapha and Vata Dosha and helps in the regulation of functions of Pitta Dosha. Its action on Kapha and Vata improves tubal functions and works on ovulatory dysfunctions.[20]Triphala guggul[21] and Sahacharadi Kashaya[22] normalize the vitiated Vata and Kapha Dosha. Thus, the comprehensive therapeutic strategy aimed at removing Vata-Kapha Prakopa in the Artavavaha Srotasa successfully removed the bilateral tubal blockage in the patient.


  Conclusion Top


In the present case study, a remarkable result was obtained in treating tubal blockage by administering therapeutic cleansing procedures such as Virechan, Basti, and Uttarbasti, along with Ayurvedic medicines. However, the efficacy of such a strategy may be shown through RCT studies in a larger sample size.

Financial support and sponsorship

Not applicable.

Conflicts of interest

There are no conflicts of interest.





 
  References Top

1.
Katole A, Saoji AV Prevalence of primary infertility and its associated risk factors in urban population of central India: A community-based cross-sectional study. Indian J Community Med 2019;44:337-41.  Back to cited text no. 1
    
2.
Infertility statistics 2022: How many couples are affected by infertility. Available at: https://www.singlecare.com/blog/news/infertility-statistics. [Last accessed on 2022 Oct 12].  Back to cited text no. 2
    
3.
Dutta DC Text Book of Gynaecology. 6th ed. London: New Central Book Agency; 2013. chapter 16, infertility-tubal factor; p. 219  Back to cited text no. 3
    
4.
Sushruta, Sushruta Samhita, Ambikadatta Shastri (editor), Sharirasthana, 2/35, Varanasi: Chaukhambha Samskrita Sansthana; 2018. p. 19.  Back to cited text no. 4
    
5.
Sushruta, Sushruta Samhita, AmbikadattaShastri(editor), Sharirasthana, chapter 9/11, Varanasi: Chaukhambha Samskrita Sansthana; 2018. p. 97.  Back to cited text no. 5
    
6.
Vagbhat, Astanga Hridaya, KavirajAtridev Gupta (editor), Sutrasthana, 15/22, Varanasi: Chaukhambha Prakashan; 2007. p. 105.  Back to cited text no. 6
    
7.
Khattar V, Wal A Utilities of Crataevanurvala. Int J Pharm Pharm Sci 2012;4.4:21-6.  Back to cited text no. 7
    
8.
Agnivesha, Charaka Samhita, Bramhananda Tripathy (editor), Kalpasthana, 1/5,Varanasi: Chaukhambha Bharati Academy; 2011. p. 1072.  Back to cited text no. 8
    
9.
Choudhary N, Prasad SB, Singh AS, Khatik GL, Prabhu KS, Mishra V, et al. Phytochemistry and pharmacological potential of Operculinaturpethum. Plant Arch 2020;20: 683-92.  Back to cited text no. 9
    
10.
Vriddhajivaka, Kasyapa Samhita, Vatsya and PanditHemraj Sharma (editor), Sutrasthana, 27/29. Varanasi: Chaukhambha Vishwabharati; 2019. p. 61.  Back to cited text no. 10
    
11.
Agnivesha . Charaka Samhita, Bramhananda Tripathy (editor), Siddhi Sthana, 1/39,Varanasi: Chaukhambha Bharati Academy; 2011. p. 1169.  Back to cited text no. 11
    
12.
Moharana H. Evidence based review on mechanism of action of Basti. Int Ayurved Med J 2017:5:3.  Back to cited text no. 12
    
13.
Vagbhat . AstangaHridaya, KavirajAtridev Gupta (editor), Sharirasthana, 2/52, Varanasi: Chaukhambha Prakashan; 2007. p. 183.  Back to cited text no. 13
    
14.
IndradevaTripathi, Chakradutta, Vaidya Prabha Hindi Commentary, Karnaroga Chikitsa, 57/25,Varanasi: Chaukhambha Sanskrita Bhavana; 2012. p. 339.  Back to cited text no. 14
    
15.
Sushruta, Sushruta Samhita, Ambikadatta Shastri (editor), Sutrasthana, 11/03, Varanasi: Chaukhambha Samskrita Sansthana; 2018. p. 45.  Back to cited text no. 15
    
16.
Surendran N, Patel AK Apamargaksharain the management of cervical erosion–a pharmacological review. Int J Ayurved Pharm Res 2020;8:31-6.  Back to cited text no. 16
    
17.
Neogi NC, Rathor RS, Shreshtha AD, Banerjee BK Studies on anti-inflammatory andantiarthritis activity of achyranthine. Indian J Pharmacol 1969;1:37-47.  Back to cited text no. 17
    
18.
Vasudeva Rao Y, Das BK, Jyotyrmayee P, Chakrabarti R Effect of achyranthes aspera on the immunity and survival of labeo rohita infected with aeromonas hydrophila. Fish Shellfish Immunol 2006;20:263-73.  Back to cited text no. 18
    
19.
Meena P, Trapti A, Gaurav P Role of phalasarpiuttarbasti in the management of low antral follicles: a case study. Int J Ayurved Pharm Res 2017;5:80-2.  Back to cited text no. 19
    
20.
Buduru P, Kumaramangalam B, Sharma S Ayurvedic management of infertility due to polycystic ovaries and tubal block: A case study. J Ayurveda 2022;16:170-4.  Back to cited text no. 20
    
21.
Acharya Sharngadhar, Sharngadharsamhita, Dr. Shailajasrivastav (editor), madhyamkhanda, 7/83. Varanasi: Chaukhambha oriental; 2017. p. 205.  Back to cited text no. 21
    
22.
Vagbhat, Astanga Hridayasamhita, Kaviraj Atridev Gupta (editor), chikitsasthana, 21/69. Varanasi: Chaukhambha Prakashan; 2007. p. 421.  Back to cited text no. 22
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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