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 advocates use of natural methods and ways not just to prevent general ailments but also to preserve reproductive health (hormonal balance & menstrual health) and overall 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 from 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 from a man and necessitate development of certain health protocols specifically designed for their feminine balance. Acharya Charaka 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 or its specific response to a drug or certain situation (which is different than a male counterpart) are commonly observed in the clinical settings while treating the female patients. And these 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 a 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 life 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.
  • ऋतौ प्रथमदिवसात् प्रभृति ब्रह्मचारिणी - It suggests that a menstruating woman should ideally practice sexual abstinence during 3 days of menstruation.
• 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.

Apart from these, many cultural and traditional restrictions are prevalent in many societies in the form of menstrual taboos in which isolation, not to perform domestic work, religious activities, and sexual activities are major. However there is no clear mention about most of these restrictions in Ayurveda literature. The observance and non observance of menstrual restrictions and taboos are under debate since a decade. The issue of gender inequality and women empowerment is raised while discussing about the restrictions to be followed by female during menstruation. The 21st century woman considers these restrictions as burden and a path of obstruction towards her empowerment but the shastra behind following certain rules is not emphasized. One should understand the Ayurveda's perspective behind advocating paricharya and decide what is beneficial and not blindly follow all the campaigns.

Rtumati

Rtumati or rutumati refers to a woman in that time period of her life which appears regularly, at intervals, in a menstrual cycle. It is the fertile period in a monthly cycle which comes after the menstruation stops. Rtuchakra in Ayurveda refers to the menstrual cycle. "Rtu" means a specific time period while "chakra" indicates regular onset at regular intervals. 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. Once the menstruation stops a woman is called as Rtumati for a period of next 12 days. This period is considered suitable for conception. Therefore the code of conduct that a woman is advised to follow during this period is believed to enhance the chances of healthy conception and promote successful fertilization. According to the vedic scriptures and culture the purpose behind the act of union of male and female is reproduction and not just pleasure. Therefore the rtumati paricharya was propounded to facilitate the process of reproduction. It includes codes of conduct or practices which prepare a female not just physically but also mentally to make her more receptive for conception.

Rtumati paricharya

At the beginning, the acharyas have described the general appearance and signs of a woman who is Rtumati (which develop as a result of particular state of hormones in her body at that time). Then the paricharya has been suggested. On the fourth day after stoppage of menstruation, a woman should take a bath, preferably a head bath. Then she is advised to wear the clean and new cloths (which are untorn or in good condition) and can adorn herself with the jewelry and ornaments. She should then start her by offering prayers, performing puja, reading sacred scriptures etc. Some acharyas have also mentioned about the Putreeya vidhi that one can perform in this period. Specific diet for a male and female partner in this period has also been recommended. A woman is advised to have a diet composed of Masha (black) grams and tailam (oil) ideally for lunch. After all these the ideal time for union is said to be of that of night. Also the husband and wife are advised to communicate in such a way that they both would develop faith and confidence in each other and create positive and conducive atmosphere for their union

Garbhini

Garbha refers to the fetus in a womb while Garbhini means a pregnant woman. A specific regimen for a pregnant woman which includes specific diet and lifestyle has also been recommended in Ayurveda for wellbeing of mother and child in womb and it is known as Garbhini paricharya. Ayurvedic text states that, “If a pot filled with oil right up to the brim is to be carried without spilling even a single drop, every step  has  to be  taken with  care”,  the texts  emphasis  that a similar  care  and  attention  is  required in  taking care  of  a garbhini (pregnant woman). Along with Garbhini paricharya Ayurveda acharyas have also mentioned garbhopaghatakara bhavas which refer to the various lifestyle factors of a pregnant woman that could cause serious harm to the baby developing in her womb.

Garbhini Paricharya

Charaka Samhita, Sushruta Samhita, Ashtanga Hrudayam, Ashtanga Samgraham and also a treatise Harita Samhita describe Garbhini paricharya in depth. All the acharyas have suggested a month wise specific diet starting from liquid to solid foods. The recommended diet includes use of various recipes of milk, medicated ghee, butter and rice gruel. A specific type of basti is also advised in the last month of pregnancy to facilitate easy flow of vata dosha resulting in smooth delivery. Such measures to facilitate normal delivery like use of pichu (medicated vaginal tampon), basti have been suggested by Ayurveda and one seeking help for the same should also consult a trained vaidya .

It is advisable that a pregnant woman seeking guidance on garbhini paricharya for safe, uncomplicated motherhood and also for wellbeing of a baby should consult a nearby Vaidya for appropriate guidance and should not practice it just by reading the information.

Suprajanana Samskara

Main article Suprajanana samskara .

The influence of factors like diet, psyche and other routines of mother on the fetus has been talked since ages. Ancient Ayurveda scholars believed that, if we make an effort to enhance the quality of these factors which affect the final status of the developing new life, we can certainly obtain healthier, stronger and superior offspring. To achieve this, one can eliminate the adversely affecting dietary and lifestyle factors from pregnant woman's daily regime and at the same time make use of beneficial food, activities and herbs to gain the lacking attributes. It also includes mother's counseling, motivation and meditation for developing a balanced and Sattva (सत्वम् one of the 3 attributes of mind that indicate the quality of goodness or excellence) predominant mind of a baby. Ayurveda describes many such simple methods to procure a healthy offspring and the planning of which starts from detoxifying the bodies of the partners for conception. These methods are popularized now-a-days as ‘Garbha samskaras’ (गर्भसंस्काराः) however, the classical treatises describe this regimen as 'Suprajananam' (सुप्रजननम्) samskara.

Sutika

The term Sutika in Ayurveda refers to the woman in her post partum period upto 1.5 months (or 6 months according to some acharyas) from the child birth. Ayurveda described different types of sutika rogas (post partum diseases) which specifically affect Sutika due to inappropriate management of her delicate state post childbirth. Thus Ayurveda has advised a specific diet & lifestyle regimen called Sutika Paricharya (post natal care of a woman) to prevent further complications & restore the health of a mother.

Sutika paricharya

At least 12 days post delivery a new mother is advised to follow a strict diet plan. This diet plan includes use of ample amount of ghee, rice gruel, jaggery, milk, various soups made up from barley/horse gram etc and also meat broths for a non vegetarian woman. All these recipes have been described in brief and their day-wise schedule has also been given. Alon with the diet specific therapies like abhyanga (oil massage), udara-aveshtanam (wrapping the abdomen with a long cotton cloth), parisheka (pouring hot water in a stream), avagaha (sitz bath), dhupana (vaginal fumigation) use of rakshoghna dravyas (similar to anti-microbial which protects mother and child from various disease causing micro-organisms) has been recommended. All these measures employed under sutika paricharya. The Sutika who is weak due to development of fetus, loss of Dhatus, excretion of Kleda, blood and exhaustion due to labour pain can regain  her  pre-pregnancy  state  by  following this Paricharya.

It is advisable that a woman in post natal period seeking guidance on sutika paricharya for safe, uncomplicated motherhood and also for wellbeing of a baby should consult a nearby Vaidya for appropriate guidance and should not practice it just by reading the information.

Various woman's health conditions described in Ayurveda

Ayurveda acharyas have discussed in depth about various menstrual disorders, gynecological conditions, infertility issues and also obstetrical disorders. Although the medical conditions described in Ayurveda are not identified with the same nomenclature in today's time, their causes, signs, symptoms match with multiple reproductive health issues in woman found in today's time. Ayurveda acharyas have explained 8 different types of menstrual disorders specifically arising due to vitiation of rajas (menstrual blood) which is the upadhatu of Rasa dhatu. Rajas is vitiated by vata, pitta or kapha dosha or even by combination of any 2 or 3 doshas. These are known as Rajo doshas or rajodushti. Medical conditions like Asrugdara (menorrhagia/dysfunctional uterine bleeding) Anatomical (structural) and functional issues related to the tryawarta yoni (uterus, cervix, vagina) known as yonivyapadas, their causes and medical management has also been described in depth. Various types of specialized panchakarma therapies have been effectively employed in these conditions. Along with these multiple Garbhavyapada (antenatal problems / pregnancy related medical conditions) and Sutika rogas (post natal disorders / health issues arising post delivery) have also been addressed. At each stage of her reproductive life, the care has been taken to maintain her fertility to the best possible level and to achieve this various paricharyas (code of conduct) have been suggested. If at all the woman happens to face infertility problems then the guidelines are given for assessment of her health status, finding out and working on the actual causative factor and multiple measures to treat such health concerns have been described in depth.

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

With westernization and adoption of modern lifestyle which is not in tune with the nature, health of a woman is adversely affected. Modern day woman have all kinds of roles to fill in. They are expected to be feminine and masculine; powerful and gentle; attractive and motherly at the same time. This has led to build an excessive amount of stress, anxiety and tension in a woman right from her childhood. In the pursuit of her dreams and pressure to balance all these aspects smartly, somewhere the health is not given priority and thus neglected. The lifestyle and diet which are backbone of the health and well-being in any individual are not always carefully selected. Increase in the stress levels is directly proportional to the hormonal imbalances and menstrual disorders. At the same time unwholesome diet which is deficient in necessary nutrients and sedentary stressful lifestyle untuned to the biological clock inside body negetively impacts health leading to weaker constitution and low immunity. It is seen that now-a-days there is high incidence of a variety of menstrual health problems in pre-menarche, during menstruation, perimenopause and postmenopause. PCOS like conditions are widely prevalent in today's woman causing menstrual irregularities and infertility. Therefore there is an urgent need of measures for prevention and control of generalized an well as reproductive health disorders in woman. The ancient shastra of Ayurveda has already given the ways to prevent these disorders and preserve a woman health. Thus there is need to adopt the various paricharyas related to different phases of woman life to as much extent as one can. Along with that natural herbal medicine and panchakarma therapies can definitely help modern day woman to preserve her health while trying to maintain the work-life balance. Here is brief account on the common health issues faced by today's women and how the wisdom of Ayurveda can help them come out of these conditions and preserve health and well-being.

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

Rajaswala paricharya scientific aspect.

PCOD

Menopause

Infertility - According to a report by the World Health Organization (WHO), one in every four couples in developing countries is affected by infertility.[4] The magnitude of the problem calls for urgent action, particularly when the majority of cases of infertility is avoidable.

Skin, hair and beauty

Cancers

Others