Women's health and Ayurveda

Ayurveda is the oldest system of medicine originated in Bharatavarsha. It offers knowledge of various methods to obtain health and longevity, by preventing illness in healthy individuals and eradicating the diseases in diseased individuals. This knowledge encompasses all the aspects of human life and is not restricted to a particular gender. In fact special attention has been given to the peculiar differences arising due to the male or female body types and then the ways to achieve and maintain health considering these specialties have been put forward. Thus one can find ample amount of information and all the details about women's health in Ayurveda. Ayurveda offers natural methods and ways not just to prevent general ailments but also to maintain reproductive health (hormonal balance & menstrual health) and wellbeing.

How Ayurveda differentiates women from men

Darshana shastras discuss about Prakrti and Purusha while explaining the process of srshti utpatti (origin of the universe). Prakrti and Purusha both have some attributes in common while there are few characteristic features that make them different than each other and also are responsible for origin of the universe after their union. Similarly, Ayurveda looks at male and female both as a purusha (human beings) which indicates that despite having different bodies,

there are some common life elements in both of them making them equal. But at the same time, there are few characteristic features of a female body which make her capable of nurturing a life within, giving birth and nourishing a new life till the later becomes capable of surviving by own. These features are not found in men. For this reason, Acharya Charaka has called woman as a root of progeny (child) while discussing various gynecological disorders affecting females in chikistasthanam of Charaka Samhita.

यदपत्यानां मूलं नार्यः परं नृणाम्| (Char. Samh 30.5)

In reference to this, Ayurveda samhitas mention about presence of various body organs like Yoni (योनिः), Garbhashayam (गर्भाशयम्), stana (स्तनौ), artavavaha srotas (आर्तववह स्त्रोतसम् The channels of transformation and transportation of female reproductive constituents) etc in female which make her body different than male. Also, acharyas clearly mention that a female is born after conception when there is abundance of artava (आर्तवम्) or rakta (रक्तम्/ शोणितम् feminine reproductive tissue) in the product of conception. Artava inherently possesses excessive heat. Thus, pertaining to it (high pitta levels in body), a female body develops certain characteristics like generally having less tolerance, strength and emotional stability than male counterpart. These multiple features make a woman different than man and necessitate development of certain health protocols specifically designed for feminine balance. Acharya Chraka also says that a vaidya should keep these differences in mind while selecting the drugs, their dosage for women so as to make the medicine tolerable and effective at the same time. Such peculiarities of female body which are commonly observed in the clinical settings while treating the female patient have been cleverly put forward by Acharya Charaka in Vimanasthanam.

The branch of Ayurveda and treatise for women's health

Ashtanga Ayurveda refers to the 8 branches of Ayurveda dealing with 8 different aspects of life and health. Among these 8 specialties the one named as 'Kaumarabhrtya tantra' (कौमारभृत्यतन्त्रम् ) is that branch which provides knowledge of treating diseases occurring in neonates, infants and children. Diseases in this age group are considered to be caused by imbalances in nutrition, contaminated breast milk from feeding mother etc. Thus many of the feminine disorders particularly related to child birth, breast feeding etc can be considered to be the topic of discussion under Kaumarabhrtya tantra. Most of the gynecological, pregnancy related or ante-natal, post partum health conditions can be found to be described under various sthanas like Sharirasthana, uttarasthana of Ayurveda treatises.

Although all the treatises discuss about women's health, a lesser known treatise named Kashyapa Samhita (काश्यप संहिता) dedicates major part of it towards discussion on Kaumarabhrtyatantra in general and women's health in particular. However, the complete version of this samhita is not available currently. It is available in parts and thus many of the important topics related to women's health discussed in Kashyapa Samhita and known to bharateeyas in earlier times are missing today.

Important milestones in Women's life

In reference to the childbearing capacity of a woman and various structural and functional peculiarities designed to facilitate the reproduction woman, is believed to have 3 important milestones in her life. These are health related milestones which are dependent on the hormones, strength and overall health of that woman. Menstruation is known as Rajapravrtti or rajodharma in Ayurveda. The start and end of the menstruation are considered 2 important milestones and development of ability to conceive and reproduce at a certain age so as to get healthy progeny and uneventful or safe motherhood is considered to be the other milestone. Acharyas have clearly stated the age at which a woman can reach upto these milestones as below.

Rajapravrtti and Rajonivrtti (Menarche and Menopause)

Menarch which means the beginning of menstrual cycle is the first milestone which is achieved mostly at the age of 12 years. From this time the menstrual cycle known as Rajapravrtti or Rajapraseka starts and continues till the conception occurs. At the age of around 50 years when the dhatus of sharira become senile or mature completely the rajapraseka stops permanently and it is known as Rajonivrtti meaning menopause. Thus age of 12 years and 50 years is thus considered significant in terms of menstrual cycle and hormonal balance as per Ayurveda.

तद्वर्षाद्द्वादशात् काले वर्तमानमसृक् पुनः | जरापक्वशरीराणां याति पञ्चाशतः क्षयम् ||११|| (Sush. Samh. 3.11)

Samatavagata veeryam (Minimum age appropriate for conception)

If the age of rajapravrtti is normal as per the standards, the age at which that woman can bear a child or conceive and have a safe motherhood as well as a healthy progeny is considered the second milestone. This time was previously considered to be the minimum standard age of a woman to conceive so as to maintain good health and life as per Ayurveda. Samatavagata means to attain and veerya refers to the necessary strength woman needs for reproduction. Ayurveda acharyas have stated that the age of 16 years in woman's life can be considered to be such an age.

पञ्चविंशे ततो वर्षे पुमान् नारी तु षोडशे | समत्वागतवीर्यौ तौ जानीयात् कुशलो भिषक् ||१३|| (Sush. Samh. 35.13)

Commentary of Dalhana: समत्वागतवीर्याविति समत्वं परिपूर्णत्वमागतं वीर्यं ययोस्तौ समत्वागतवीर्यौ, रसादिधातुपरिपूर्त्या वीर्यपूर्तिः, परिपूर्णसर्वधातुकावित्यर्थः| अन्ये त्वेवं पठन्ति ‘समन्वागतवीर्यौ’ इति; “सम्यगनु पश्चादागतं वीर्यमुपचयशक्तिलक्षणं ययोः” इति च व्याख्यानयन्ति||

Different epochs of woman health and related health regime

Ayurveda helps women in the journey of her life by offering a helping hand in the form of guidelines on code of conduct that a woman should follow during epochs of her life like Rajaswala (Menstruating woman), Rtumati (Woman in a fertile period/pre-conceptional), Garbhini (pregnant), Sutika (Post partum) etc. All these mentioned epochs in her life are significant events related to her health since major physiological and even psychological changes occur within her during these times and those have potential to affect her overall health in present as well as future. Therefore considering the repercussions of these events on health of a woman Ayurveda acharyas suggested a particular diet and also lifestyle recommendations to be followed during these periods. These code of conducts are called as paricharyas. One can find Rajaswala paricharya (for menstruating woman), Rtumati paricharya (for preconceptional or fertile woman), Garbhini paricharya (for pregnant woman) and sutika paricharya (for mother post child birth) in Ayurveda literature. Such guidelines on code of conduct during these phases are known as Paricharyas.

Rajaswala

The term Rajaswala refers to the menstruating woman. Usually a woman menstruates form the age of 12 to 50 years. That means for the major part of her life she menstruates and passes through the phase of rajaswala every month. Thus Rajaswala is the largest and the most important period in the lifetime of a woman and thus impacts her reproductive health to great extent. Also, it is the fertile period in her lifetime necessary for reproduction. The rajaswala paricharya helps women adapt well to the physiological changes taking place in the body during the menstruation and thus helps prevent occurrence of various diseases related to hormones, reproductive system and general health. It also helps her in conceiving a healthy offspring. But it is seen that the rajaswala paricharya is not followed now-a-days. Although the paricharya described in Ayurveda was exclusively designed for preserving the health of that menstruating woman and her progeny, in the past years it was misunderstood as a practice to protect others from her (rajaswala) who is dirty and impure. This notion led to the development of the general consensus that bharatieeyas have always considered menstruation as dirty and impure and thus the practice of rajaswala paricharya was being followed. However Ayurveda has always looked at the process of menstruation as a completely physiological event in a woman's life and understood it in terms of doshas, dhatus, malas, agni etc. In fact the rajaswala paricharya was propounded for betterment of a menstruating woman and maximize her chances of delivering a healthy offspring. Ayurveda scholars studied, observed and concluded as to what type of diet, lifestyle would be suitable for such a woman so that she would suffer the least during this period and preserve her health like the normal healthy individual once the menstruation stops. Therefore all the guidelines given under Rajaswala paricharya in Ayurveda have relevance, background and logical explanation when those are studied from the lens of Ayurveda physiology. The rajaswala paricharya is described below.

Rajaswala paricharya

All the Ayurveda samhitas (treatises) have discussed about Rajaswala paricharya and suggested following regimen for a menstruating woman.

• Thoughts and emotions: कल्याणध्यायिनी - The first important thing listed in the paricharya is about the thoughts and emotions of the rajaswala. It is advised that she should focus her attention on virtuous, generous and noble thoughts. It will naturally helps her balance her emotions that might have got affected due to hormonal changes during menstruation. She shouldnt cry.
• Lifestyle: मृजालङ्काररहिता - Apart form basic cleaning and menstrual hygiene, she should abstain from other cleaning procedures she other wise performs in a day. This includes most of the activities under dinacharya morning routines like anjana, abhyanga, nasyam, snanam etc. Also she refrain from wearing ornaments or taking efforts to beautify herself. Skipping these activities does not damage her image but instead save her efforts, gives her resting time and facilitate easy menstruation.
  • Exertion, running should be avoided. Rest is advised.
  • She should not cry or even laugh excessively. She should refrain from talking excessively or listening to anything for a long time. These activities can exhaust a female who is already feeling weak during menstruaiton.
• Sleep and mattress: दर्भसंस्तरशायिनी - It is advisable that she rests and sleeps on a mat made up from darbha (Desmotachya bipinnata) grass which is believed to be a detoxifying and sacred grass traditionally. However, Ayurveda scholars have specifically identified this grass since it is cooling in nature and has all the necessary gunas and karmas (medicinal properties) to treat menorrhagia (excessive bleeding during menstruation), urinary tract infections and also pain in abdomen which can be present in a menstruating woman. She is also advised to avoid day time sleeping.
• Diet: There are certain rules described related to the diet of a rajaswala. These are designed on the basis that during menstruation naturally the appetite of a woman decreases, her agni is weak, vata dosha is aggravated in her body and also that excess pitta (heat energy) levels can possibly aggravate her blood loss. Therefore rajaswala should follow a certain diet as described below.
  • क्षैरेयं यावकं स्तोकं कोष्ठशोधनकर्षणम् - Eat Havishya (meal made from Sali rice, ghee and milk) The food that is made up from Yawaka or meal made of barley and milk should be taken. She should eat in lesser amount that usual and the diet should be such that it facilitates easy evacuation of bowels. This suggests she should avoid food that is constipating in nature and heavy to digest. She should make sure that the entire process of digestion and excretion is easy and smooth during this period.
  • पर्णे शरावे हस्ते वा भुञ्जीत ब्रह्मचारिणी - She should eat in food plate made up of leaves, clay pot or food in her hands. This is possibly to ensure that the food that she consumes is lesser in quantity or in quantity which such vessel can accommodate.
  • तीक्ष्णोष्णाऽम्ललवणानि च वर्जयेत् - It is advised to avoid spicy, sour, salty food and food that is teekshna & ushna (hot) in gunas.
• ऋतौ प्रथमदिवसात् प्रभृति ब्रह्मचारिणी - It suggests that a menstruating woman should ideally follow sexual abstinence during 3 days of menstruation.

Reasoning: (TBE)Recognizing the changes infemale’s body during menstruation (Rajaswala),Ayurveda peers have described certain do’s and don’tsin the form of Rajaswala paricharya to maintain her balance of Doshas and help in proper menstrual func-tion. These modifications are in the form of eatinglight meal, observing celibacy, to eat directly orthrough leaf or clay vessel, avoiding pungent andspicy foods, not to sleep during daytime, not to per-form strenuous activities, avoiding use of scents in theform of anointments.1,2 Apart from these, many cul-tural and traditional restrictions are prevalent in manysocieties in the form of menstrual taboos in which iso-lation, not to perform domestic work, religious activi-ties, and sexual activities are major.The observance and non observance of menstrual re-strictions and taboos are under debate since a decade.The issue of gender inequality and women empower-ment is raised while discussing about the restrictionsto be followed by female during menstruation. The21st century woman considers these restrictions as burden and a path of obstruction towards her empow-erment but the science behind following certain rulesare not emphasized. One 3should understand the sci-ence behind this and not blindly follow all the cam- paigns. The role of Apana vayu, menotoxins andvolatile compound like pheromones should never beoverlooked.3 Menotoxin – a substance with certain pharmacological and chemical reactions is believed to be secreted in sweat, saliva, menstrual blood, milk andother secretions in menstruating women. The researchshows that chemically these menotoxins exhibited properties near to oxycholestrin which causes prolon-gation of blood coagulation. The properties of this substance menotoxin were considered identical to Ne-crosin in another work. Necrosin is a toxic substance(inflammatory exudates) that induces leucopenia. 4,5 Pheromones, volatile compounds released in sweat,known for sexual attraction are supposed to influencemenstrual cycle of other female in contact. The inter-val of menstrual cycle of recipient female is short-ened.6,7,8 This is known as menstrual synchronizationwhich is common in hostel inmates and female mem- bers of same family Many explanations have been offered for the apparent effects of exercise on menstrual cycles, including lossof body fat (resulting in estrogen deficit), overallweight loss, dietary factors (especially low percentageof calories from protein and less dietary cholesterolwhich is building block of estrogen) emotional stressand exercise triggered release of endorphin (naturalsedative akin to morphine).3  Non observance of certain rules and restrictions leadsto sickness related to reproductive health of female.The tremendous increase in the infertility and PCODare the results of diet and lifestyle changes which are harmful for reproductive function

Rtumati

RUTUCHAKRA The menstrual cycle in Ayurveda is defined as Rutuchakra. “The word “chakra” signifies its regular onset at regular intervals, just like a cycle. Rutu means a specific time period. A single Rutuchakra covers a period of one Chandramasa (28 days) and it has been divided into 3 phases, the Rajahsravakala, the Rutu kala and the Rutuvyatita kaala.21”.(Dr. Aayushma and Dr. Neeta Mahesekar, “Rutuchakra: An Ayurveidc Perspective on Menstrual Cycle”, AIIRI, https://www.aiirjournal.com/uploads/Articles/2018/02/2859_24.Dr%20Aayushma%20&%20Dr%20Neeta%20Mahesekar.pdf)

Rtumati paricharya

Ritumati Paricharya are the rituals which prepares afemale physically and mentally for conception. Ayur-veda emphasizes on attaining a healthy progeny andfor this all the procedures beginning from the selec-tion of partner to the act of achieving conception isdescribed in detail. The best period for conception istermed as Ritukala which is after the stoppage of men-struation till next 12 days. 10 The female during this period is termed as Ritumati . After stoppage of men-struation, taking a head bath, offering prayers and preparing herself by using scents of flowers and goodclothes 11 acts as aphrodisiac and favors conception.The cervical glands which secrete alkaline mucus with pH of 7.8 is nutritive for spermatozoa. The character-istics of cervical secretions change throughout men-strual cycle. Under the influence of estrogen in prolif-erative phase of menstrual cycle (1 to 13 th day) thecervical mucus is rich in water and electrolyte, whichrenders it thin and clear favoring sperm penetration.Whereas after ovulation, under the influence of progesterone, the cervical mucus with increased proteincontent renders it thick, scanty and preventing furthersperm penetration. Hence before ovulation is the per-fect time for conception mentioned rightly as Ritukala under Ayurveda.

Woman's health issues in current time and how Ayurveda can help

Thus, it is very difficult or rather next to impossible to follow the regimen as mentioned. Due to the adaptation to the western way of life there is aversion or rather ignorance towards our classical science. The so-called outdated system has lost its importance in today’s generation. In past few years there has been a drastic rise in the menstrual problems and infertility which is posing as a major threat to the present-day population. The symptoms like lower abdominal pain, backpain, mood swings, nausea etc are considered as associated symptoms of menstrual cycle and as normal. But our classics has mentioned that a normal menstruation should be devoid of pain burning sensation. Menstrual irregularities

Menstruaiton and PMS - The health of the female reproductive organs is essential for a woman’s healthy life. Any disturbance in the menstrual cycle lead to disturbances in her daily activities. Classical texts show a deep understanding of the menstrual cycle in relation to the doshas, thus giving women a profound natural and individualized way to treat various female health issues and avoid side effects of western medications. Although western medicine recommends lifestyle changes, like food, exercise and avoidance of stress these are not fully described nor treated individually. It has been shown that PMS is a complex syndrome which affects manny women today. Even though classical texts do not mention PMS specifically, all the descriptions related to yoni roga, are symptoms present in the description of PMS today. It has been shown that ancient practices are still gems which alleviate many symptoms and that can improve the quality of life of many women

PCOD

Menopause

Infertility

Skin, hair and beauty

Cancers

Others