Chapter 61 – Asrgdara Nidanam

The 61st chapter of Madhava Nidana is Asrgdara Nidana which deals with Menorrhagia. Menorrhagia is the medical term for menstrual periods with abnormally heavy or prolonged bleeding. Although heavy menstrual bleeding is a common concern, most women don’t experience blood loss severe enough to be defined as menorrhagia.

Etiology — 

विरुद्ध – मध्याध्यशनादजीर्णाद् गर्भप्रपातादतिमैथुनाच्च |
यानाध्व – शोकादतिकर्षणाच्च भाराभिघाताच्छयनाद्धिवा च |
तं श्लेष्म – पित्तानिल – सन्निपातैश्चतुष्प्रकारं प्रदरं वदन्ति || १ ||

viruddha – madhyādhyaśanādajīrṇād garbhaprapātādatimaithunācca |
yānādhva – śōkādatikarṣaṇācca bhārābhighātācchayanāddhivā ca |
taṁ ślēṣma – pittānila – sannipātaiścatuṣprakāraṁ pradaraṁ vadanti || 1 ||

Pradara is a disease that usually means excessive discharge of menstrual fluid. It is caused due to the following:

• women indulging in excess of incompatible eatables,
• over eating
• alcoholic beverages;
• frequent abortions
• excessive sexual intercourse
• riding on animals
• walking long distances,
• grief
• exhaustion
• emaciation due to any factor
• carrying heavy loads,
• trauma,
• sleeping at day time and other reasons.

It is of four kinds, the three generated by kapha, pitta and vata separately and the fourth by provocation of all of them together. 1

General Features — 

असृग्दरं भवेत् सर्वं साङ्गमर्दं सवेदनम् |

asr̥gdaraṁ bhavēt sarvaṁ sāṅgamardaṁ savēdanam |

Generally, the woman suffering this disease suffers from aches all over the body and pain in the abdomen during menstrual period.

Complication of excessive blood loss in menorrhagia — 

तस्यातिवृत्तौ दौर्बल्यं भ्रमो मूर्च्छा मदस्त्रुषा |
दाहः प्रलापः पाण्डुत्वं तन्द्रा रोगाश्च वातजाः || २ ||

tasyātivr̥ttau daurbalyaṁ bhramō mūrcchā madastruṣā |
dāhaḥ pralāpaḥ pāṇḍutvaṁ tandrā rōgāśca vātajāḥ |

If there is excessive blood loss in menorrhagia, it generates debility, giddiness, fainting, a toxic state, thirst, burning sensation, delirium, and pallor of the skin, stupor and some of the symptoms of Vata origin. 2

Kaphaja Menorrhagia — 

आमं सपिच्छाप्रतिमं सपाण्डु पुलाकतोयप्रतिमं कफात्तु |

āmaṁ sapicchāpratimaṁ sapāṇḍu pulākatōyapratimaṁ kaphāttu |

The blood discharged in Kaphaja menorrhagia remains immature (aama), unctous in appearance, pale. Moreover, its colour resembles the rice washings.

Pittaja Menorrhagia — 

सपीत – निलासित – रक्तमुष्णं पित्तार्तियुक्तं भृशवेगि पित्तात् || ३ ||

sapīta – nilāsita – raktamuṣṇaṁ pittārtiyuktaṁ bhr̥śavēgi pittāt || 3 ||

If geneated through menorrhagia induced by vitiated pitta, the menstrual discharge could be yellow, blue, black, or red in colour, warm. In addition, it comes out in gushes. 3

Vataja Menorrhagia — 

रुक्षारुणं फेनिलमल्पमल्पं वातार्ति वातात् पिशितोदकाभम् |

rukṣāruṇaṁ phēnilamalpamalpaṁ vātārti vātāt piśitōdakābham |

If generated through menorrhagia induced by vitiated vata the discharge would remain dull, crimson in colour, frothy, scanty, resembling in shape to the mutton washed water and accompanied with vataja type of pain.

Sannipataja Menorrhagia — 

सक्षौद्र – सर्पिर्हरितालवर्णं मज्जाप्रकाशं कुणपं त्रिदोषात् || ४ ||

sakṣaudra – sarpirharitālavarṇaṁ majjāprakāśaṁ kuṇapaṁ tridōṣāt || 4 ||

If the disease is generated by all the three doshas together, the flow could be like honey, ghee, orpiment, or bone marrow in colour. It would emit a cadaveric smell. This pathological condition is incurable and the physician should not treat this variety of menorrhagia.

Incurable Menorrhagia — 

तं चाप्यसाध्यं प्रवदन्ति तज्ज्ञा, न तत्र कुर्वीत भिषक् चिकित्साम् |
शश्वत् स्रवन्तीमास्रावं तृष्णा – दाह – ज्वरान्विताम् |
क्षीणरक्तां दुर्बलां च तामसाध्यां विनिर्दिशेत् || ५ ||

taṁ cāpyasādhyaṁ pravadanti tajjñā, na tatra kurvīta bhiṣak cikitsām |
śaśvat sravantīmāsrāvaṁ tr̥ṣṇā – dāha – jvarānvitām |
kṣīṇaraktāṁ durbalāṁ ca tāmasādhyāṁ vinirdiśēt || 5 ||

Menorrhagia with continous blood discharge along with thirst, burning sensation and fever and severe deficiency of blood and emaciation is also incurable. 5

Normal Menstruation — 

मासान्निष्पिच्छादाहार्ति पञ्चरात्रानुबन्धि च |
नैवातिबहुलात्यल्पमार्तवं शुद्धमादिशेत् || ६ ||

māsānniṣpicchādāhārti pañcarātrānubandhi ca |
naivātibahulātyalpamārtavaṁ śuddhamādiśēt || 6 ||

Menstruation should be regarded as normal when it occurs regularly every month, for a period of five days, the fluid not having mucus in it, it should be neither too much nor too less in quantity and it should come out without burning sensation or pain. 6

” शाशासृक् प्रतिमं यच्च यद्वा लाक्षारसोपमम् |
तदार्तवं प्रशंसन्ति यच्चाप्सु न विरज्यते ”|| ७ ||

” śāśāsr̥k pratimaṁ yacca yadvā lākṣārasōpamam |
tadārtavaṁ praśansanti yaccāpsu na virajyatē ”|| 7 ||

The normal menstrual fluid should be like a rabbit’s blood or a solution of lac (both are red in colour). If one washes a piece of cloth soaked in it, the piece of cloth does not retain any stain. 7

इति श्रीमाधवकरविरचिते माधवनिदाने अस्रुग्दरनिदानं समाप्तम् || ६१ ||

iti śrīmādhavakaraviracitē mādhavanidānē asrugdaranidānaṁ samāptam || 61 ||

Thus concludes the chapter on Asrgdara

Source — 

1. Menorrhagia