DIPLOMA Ayurvedic Practitioners Course Module 5 2 nd & 3 rd March 2019

2. DIPLOMA Ayurvedic Practitioners CourseModule 52nd& 3rdMarch 2019

3. Yoni Roga & Sukradosha (Infertility &gynaecological disorders)

4. Yoni Roga & Sukradosha(Infertility & gynaecological disorders)The Allopathic perspective Infertility • When a couple can't conceive despite having regular unprotected sex. • Affects 1 in 7 couples • 84% of couples conceive naturally within a year if they have regular unprotected sex (every 2 or 3 days). • After 3 years, likelihood of natural conception within the next year is 25% or less

5. Infertility 2 types of infertility: • primary infertility – someone who's never conceived in the past • secondary infertility – someone has had 1 or more pregnancies in the past

6. Treating infertility • medical treatment – for lack of regular ovulation • surgical procedures– treatment for endometriosis, repair of the fallopian tubes, or removal of scarring (adhesions) within the womb • assisted conception – intrauterine insemination (IUI) or in vitro fertilisation (IVF)

7. Treating infertility Treatments for infertility can cause complications: • multiple pregnancy – if more than 1 embryo is placed in the womb in IVF • increased chance of twins • significantly increases the risk of complications for mother and children • ectopic pregnancy – the risk of having an ectopic pregnancy is slightly increased in IVF

8. Infertility Causes: In 25% of cases it isn't possible to identify the cause. Women: • lack of regular ovulation, the monthly release of an egg • blocked or damaged fallopian tubes • endometriosis - where the lining of the womb (the endometrium) is found outside the womb Men • most common cause is poor-quality semen Risk factors • age – female fertility decline with age, biggest decrease in fertility begins during the mid-30s • weight – being overweight or obese (having a BMI of 30 or over) or severely underweight • sexually transmitted infections (STIs) – STIs, including chlamydia • smoking– including passive smoking • alcohol– safest approach is not to drink alcohol at all (the chief medical officers for the UK recommend men and women should drink no more than 14 units of alcohol a week, which should be spread evenly over 3 days or more) • environmental factors – exposure to certain pesticides, solvents and metals • stress – can affect relationships and cause a loss of sex drive; affect ovulation and sperm production

9. Infertility Infertility in women Ovulation problems can be a result of:  • poly cystic ovary syndrome (PCOS) • thyroid problems – both an overactive thyroid gland and an underactive thyroid gland can prevent ovulation • premature ovarian failure – where a woman's ovaries stop working before the age of 40 • Scarring from surgery- can damage and scar the fallopian tubes or cervix • Cervical mucus problems - mucus in cervix fails to become thinner to allow sperm through • Fibroids- Non-cancerous growths in or around the womb can prevent a fertilised egg attaching itself to the womb, or block a fallopian tube

10. Infertility • Endometriosis - small pieces of the womb lining (the endometrium) grow in other places, such as the ovaries and damage the fallopian tubes • Pelvic inflammatory disease(PID) - infection of the upper female genital tract, often caused by an STI leading to scarring of fallopian tubes so egg cannot travel to the womb • Sterilisation - blocking the fallopian tubes to make it impossible for an egg to travel to the womb - rarely reversible  • Medicines and drugs - side effects of some types of medicines and drugs: • non-steroidal anti-inflammatory drugs (NSAIDs) – long-term use or a high dosage • chemotherapy – can sometimes cause ovarian failure • neuroleptic medicines – antipsychotic medicines • spironolactone – a type of medicine used to treat fluid retention(oedema) • Illegal drugs, such as marijuana and cocaine

11. Infertility in men Infertility in men • lack of sperm–very low sperm count or no sperm • sperm that aren't moving properly– harder for sperm to swim to the egg • abnormal sperm– abnormal shape - harder for them to move • Testicles –damage to testicles can affect sperm • an infection of testicles • testicular cancer  • testicular surgery • a congenital defect • one or both testicles hasn't descended into the scrotum • injury to testicles

12. Infertility in men • Sterilisation- vasectomyinvolves cutting and sealing off the tubes that carry sperm out of testicles– reversible but not guaranteed to work • Ejaculation disorders - difficult to release semen during sex • Hypogonadism - abnormally low level of testosterone - could be caused by • Tumour • taking illegal drugs • Klinefelter syndrome - rare syndrome where a man is born with an extra female chromosome • Medicines and drugs • sulfasalazine – an anti-inflammatory medicine used to treat conditions such as Chron’s disease and rheumatoid arthritis • anabolic steroids – are often used illegally to build muscle and improve athletic performance • chemotherapy– can sometimes severely reduce sperm production • herbal remedies – eg. root extracts of the Chinese herb Tripterygiumwilfordii, can affect the production of sperm • Illegal drugs- such as marijuana and cocaine

13. Fertility tests Fertility tests for women • Blood tests–for progesterone level to check whether you're ovulating • Chlamydia test- an STI that can affect fertility • Ultrasound scan- can be used to check ovaries, womb and fallopian tubes for conditions such as endometriosis and fibroids, blocked fallopian tubes • X-ray– of womb and fallopian tubes to detect blockages in your fallopian tubes • Laparoscopy- keyhole surgery - involves making a small cut in lower tummy so a thin tube with a camera at the end can be inserted to examine your womb, fallopian tubes and ovaries

14. Fertility tests Fertility tests for men • Semen analysis - to check for sperm problems • Chlamydia test –urine test

15. Treating infertility Treatment • Medicines: • clomifene – encourages the monthly release of an egg (ovulation) • tamoxifen – an alternative to clomifene • metformin– for PCOS • gonadotrophins– stimulates ovulation in women, improve fertility in men • gonadotrophin-releasing hormone &dopamine agonists– to encourage ovulation

16. Treating infertility • Surgical procedures: • Fallopian tube surgery - to break up the scar tissue in the fallopian tubes, making it easier for eggs to pass along them • Endometriosis, fibroids and PCOS • Laparoscopic surgery for endometriosis to destroy or remove fluid-filled sacs called cysts or to remove submucosalfibroids • For PCOS, a minor surgical procedure called laparoscopic ovarian drilling (using heat or laser to destroy part of the ovary • Correcting an epididymal blockage and surgery to retrieve sperm • epididymis is a coil-like structure in the testicles that helps store and transport sperm - surgery can be used to correct a blockage there • Surgical extraction of sperm • For obstruction that prevents the release of sperm • Absence of tube that drains the sperm from the testicle (vas deferens) • After vasectomy

17. Assisted conception Assisted conception • Intrauterine insemination (IUI) • artificial insemination • involves inserting sperm into the womb via a fine plastic tube passed through the cervix • In vitro fertilisation (IVF) • the egg is fertilised outside the body • the woman takes fertility medication to encourage ovaries to produce more eggs • Eggs are removed from the ovaries and fertilised with sperm in a laboratory • Fertilised egg called an embryo is returned to the woman's womb • Egg and sperm donation • Treatment with donor eggs is usually carried out using IVF • Anyone who registered to donate eggs or sperm after April 1 2005 can no longer remain anonymous • child born is legally entitled to find out the identity of the donor when they become an adult (at age 18) • Complementary therapy • There's no evidence to suggest complementary therapies for fertility problems are effective.

18. Yoni Roga & Sukradosha(Infertility & gynaecological disorders)The Ayurvedicperspective Yoni Roga • Considerable focus on infertility and gynaecological disorders • ‘Yoni Roga’ = vaginal or reproductive disorders in women • ‘Yoni’ = the womb or place of birth for every living or non-living being • CharakaSamhita: • “sthree yoni” = the creator of humanity • Humans should know how to respect and keep that area free of disorders

19. Yoni Roga 20 Yoni Roga are identified: • Vata – 5 • Pitta – 5 • Kapha – 5 • Tridosha – 5 • The vagina and womb are situated in the apanavata area. • All Yoni Roga due to vitiated vata even though the involvement of other dosha is recognised

20. Yoni Roga Nidhana • Incompatible foods • Intake of excessive alcohol (or different types of alcohol consumed together) • Eating before previous meal digested • Indigestion • Consuming raw food or food that is hard to digest • Terminations or abortions • Excessive sex • Excessive libido / craving for sex all the time • Horse or camel riding • Cart riding • Long distance walking • Extreme sadness / worrying • Excessive fasting • Excessive weight loss • Weight lifting • Accidents / abuse to the area • Daytime sleeping

21. Yoni Roga Samprapti Association with causative factors Contamination / obstruction of Arthavavahasrotas (Srotoavarodha) Imbalance of apanavata Yoni Roga (gynaecological disorders)

22. Yoni Roga Examples: • menstrual disorder • infertility • Endometriosis • Fibroids • PCOS (Beejadosha – ovary / eggs)

24. Endometriosis

25. Polycystic ovary

26. VataYoni Roga & Sukradosha • Causes • Obstruction of vata in the apanavata area which affects vata function. Signs / symptoms • Pain and pressure • Pins and needles • Sensitivity • Rough / dryness • Loss of sensation (difficult to achieve orgasm) • Menstrual blood (thin / frothy / vaginal popping sounds) and painful

27. Pitta Yoni Roga • Causes • Vata + pitta causes (katu, amla, lavana) • Signs / symptoms • Burning sensation • Like fever / flu • Excessive sweating • Fishy smell / bad odour • Vaginal discharge / yellow / slimy • Menstrual blood dark red / blackish / clots

28. Kapha Yoni Roga • Causes • Vata + kapha prominent diet / lifestyle • Daytime sleep / oily food • Signs / symptoms • Phlegm like vaginal secretions • Lots of white odourless discharge • Mucus in menstrual blood • Itchiness • Light colour menstrual blood and only a little amount • Little pain or pain less

29. Vataja Yoni Roga– MadhavaNidhana • Udavarta – painful / frothy menstruation (dysmenorroea) • Vandhya and vipluta – absence of menstruation (amenorrhoea). In vipluta pain is constantly present (vaginismus) • Paripluta – severe pain during coitus (dyspareunia) • Vatala – vagina is rough and stiff with spasmodic and pricking pain (dryness of vagina - hypoestrogenaemia)

30. Pittaja Yoni Roga – MadhavaNidhana • Lohitaksaya – excessive loss of menstrual blood with burning sensation (menorrhagia and metrorrhagia) • Vamini – failure to fertilise the ovum (natural killer cells / NK cells). Bija (sperms) and raja (ovum) are expelled with vayu • Prasramsini – prolapse of uterus due to straining (raised intra-abdominal pressure) making conception difficult • Putraghni – habitual abortion where product of conception repeatedly aborted due to bleeding • Pittala – severe burning sensation and formation of pus with fever

31. Kaphaja Yoni Roga – MadhavaNidhana • Atyananda – unable to be satisfied with any amount of sexual intercourse (sexual insatiability) • Karnini – nodular swelling formed in genital organs due to vitiation of slesma and rakta • Acarana – inability to retain the male seed due to early discharge of the woman • Aticarana– inability to retain the male seed due to desire for longer sexual intercourse • Slesmala – vaginal canal is unctuous, itchy and excessively cold (vaginitis)

32. Tridosha Yoni Roga – MadhavaNidhana • Sandi – amenorrhoea (absence of menstruation), amazia (absence of mammary glands and vagina feels rough during coitus • Andali – disease created by adolescent girl having sexual intercourse with a man with an excessively big penis • Mahayoni – big and wide vagina • Sucivaktra – vagina is excessively constricted and narrow • Sannipataja – features due to vitiation of all the doshas are present

33. Yoni roga - Chikitsa • All Yoni Roga due to predominantly vata imbalance • Yoni, ovary, all associated organs are housed in pelvic area, governed by apanavata • Balancing vata is the main goal of the treatment • Secondary focus is pitta or kapha imbalance which may cause obstruction in arthavavahasrotas • Thirdly all sexual and gynaecological organs lie on the second chakra in which the water element is prominent (buta). Hence, this area needs frequent rejuvenation and nutrition and water to this area have to be enhanced.

34. Yoni roga - Chikitsa Aims of the treatment: • Vata = (balancing) • Pitta  (reducing) • Kapha (increasing) • Reduce or cut down vata and pitta aggravating diet and lifestyle • Introduce moisture and oleation and nourishment to the area

35. Yoni roga - Chikitsa Treatments • Sneha • Sweda • Vasthi • Sheeta karma

36. Yoni roga - Chikitsa Powders • Apanavata balancing: • Triphala powder + Dhatri + Pipilichoorna and honey • Agni deepana to balance pitta: • Hinguwastaka • Amahara • Paakachoorna • To reduce pitta: • Chandana (sandalwood powder) • Nimbadi (neem) • Bu nimbha (Andrographispeniculata) • Manjisthachoorna • Pushyanagachoorna

37. Yoni roga - Chikitsa Vrnghana • Shatawarichoorna • Ashwagandhachoorna Tablets • Triphala • Ashwagandha • Shatawari • Pittahara Coriander sheetakashaya – cold infusion • Coriander + coconut water

38. Yoni roga - Chikitsa Alepa – application of medicinal pastes • Triphala with warm water applied to vaginal area • Sandalwood / manjistha applied to vaginal area • Mahanarayana oil / pinder oil applied to vaginal area Avagahana – vaginal bath • Panchavalkalakashaya • Manjistha water • Sandalwood red / white decoction • Milk + triphala decoction Oil tampon • Neelyadee oil • Balasheradhe oil

39. Yoni roga - Chikitsa Tonics • Dashamoola arista • Ashoka arista • Shatawarigopakanyadi • Ashwagandha arista Nutritive jam • Soma jam • Surya jam • Chayawanaprash

40. Sukradosha (male infertility) Nidhana • Excessive exercise • Excessive sexual indulgences • Incompatible food / lifestyle • Excessive intercourse • Asexual (avoiding sex) • Excessive consumption of salt / sour / astringent • Excessive consumption of hot food / pungent food

41. Sukradosha (male infertility) Nidhana • Being with women with low libido • Excessive ejaculation • Jara (emaciation) • Excessive sadness / worries • Excessive exposure to heat • Accident to pelvic / genital area • Fever / tiredness • Excessive anger / suspicion • Excessive diarrhoea • Suppression of natural urges

42. Sukradosha (male infertility) Samprapti • After association with the causative factors, rasa dhatu becomes vitiated. • Rasa dhatu is responsible for preenana (satisfaction to the body) and as it the first dhatu, once vitiated all steps below are malnourished as a result (rasa, rakta, mansa, medas, asthi, majja, sukra). • Hence there are two ways in which the sukradhatu can become imbalanced: • Inadequate nutrition to the sukradhatu produces malnourished sukra • Preenana (satisfaction) is obstructed even where there are nourished sperms. Without a signal of sensual satisfaction to the brain either sperms are not produced or not released. As a result sukradosha can appear (psychological factors).

43. Sukradosha (male infertility) Love is explained in different capacities: • Sneha = mothers love • Kama = sexual love • Raga = attachment love • Prema = universal love If one has prema, he is capable of the other three naturally

44. Sukradosha (male infertility) Chikitsa Avoid: • Drinking lots of water • Incompatible foods • Heavy carbohydrate • Heavy food • Acidic food • Red meat / yoghurt • Greed for processed food like blue cheese

45. Sukradosha (male infertility) Treatment Main aims of treatment are: • Srotasshodana (Panchakarma is the best treatment) • Rejuvenation

46. Sukradosha (male infertility) • Oleation (snehana / abyanga) – apply oil and massage pelvic and penis area • Mahanarayana oil • Ashwagandha oil • Bala oil • Shodana • Purgative (if patient is not emaciated) • Vasti (enema) • Anuvasanavasti decoction with rejuvenate herbs like Ashwagandhabala • Agni deepana • Hinguwastaka (aphrodisiac)

47. Sukradosha (male infertility) • Rasayana • Shatawarichoorna • Ashwagandhachoorna • Ashwagandharasayana • Chayawanaprash • Arista • Dashamoolarista • Bala arista • Ashwagandha arista

48. Arbuda(Cancer)

49. Arbuda (Cancer) The Allopathic perspective • Cancer development: • cells in a specific part of the body grow and reproduce uncontrollably • cancerous cells can invade and destroy surrounding healthy tissue, including organs • cancer sometimes begins in one part of the body and spreads to other areas (metastasis) • more than one in three people will develop some form of cancer during their lifetime • In the UK, the four most common types of cancer are: • breast cancer • lung cancer   • prostate cancer  • bowel cancer • There are more than 200 different types of cancer, and each is diagnosed and treated in a particular way

50. Arbuda (Cancer)The Allopathic perspective Breast cancer • most common type of cancer in the UK • most diagnosed are over 50 • one in eight women are diagnosed with breast cancer during their lifetime • good chance of recovery if detected early • women advised to check their breasts regularly for changes