Introduction

According to Ayurveda, total well-being is the condition in which all physiological systems, including Dosha, Agni, Dhaatu, and Mala, are in a homeostatic state. A woman's ability to function normally is closely correlated with her menstrual cycle, which is an indicator of her health. Adequate Artavaautpatti (formation) and Nishkramana (expulsion) are necessary to preserve women's health. The three stages of a single Rituchakra, which lasts for 28 days, are the Rajahsrava Kaala, the Ritu Kaala, and the Rituvyatita kala.

Menstrual blood is the blood that accumulates in the body before being expelled (Artava). Every month Rakta in the Stree is evacuated for three to five days after reaching the Garbha Kostha (uterus). This is one of the most important physiological processes that permit the synthesis of Garbha. Artava is Agneya and has many traits similar to that of Rakta. Acharya Vagbhata said that Rajah or Artava is formed by accumulation of Artava (Rakat) in uterus during entire month.^[1]

Artava is considered as Upadhatu of Rasa Dhatu. The factors responsible for Rasa Dhatu Kshay are responsible for Artavaa Kshaya. The vitiated Artavaotpadak Ahar, Agni (Jatharagni and Rasagni) Rasa Dhatu and Artavaavaha Strotas are the main factors for Artava vitiation. Artava is Pitta Pradhan & Agneya in nature. So opposite Vatakaphavardhak Ahar Vihar are responsible for Artava Dushti. Acharya Dalhan in his commentary on Susurata has clearly described that main factor for Artava Kshaya are Vata and Kapha Dosha in combined form. Agni Dushti is the root cause of any Artavavaha Srotas Vikara. Agni plays a crucial role in the creation of Artava. Any disruption in the Utpatti, Vahana and Nishkramana causes Dushti of Artavaa, which leads to a variety of female disorders.^[2]

Pitta particularly Pachaka Pitta also contributes to it as it is responsible for the proper digestion of food and further proper formation of Dhatu. Any deviation of Pachaka Pitta from its physiological function may lead to improper formation of Rasa Dhatu and hence improper formation of Artava Updhatu in turn. Menstruation is a normal monthly occurrence for women and is a natural event. As most women menstruate between menarche and menopause so menstruation can have a significant impact on one's physical,

Hence it is responsible for formation of new Raja. The Kapha dosha continues to function quite actively throughout this time. After performing its function in Rajakal Vata Dosha remains passive. Pitta Dosha becomes activated as it is the main Dosha during Rajovyatit Kala.^[3]

Rutuvyatitakala and Tridosha

Rutuvyatitakala commences soon after the Ritukala is terminated. In this phase of Pitta is in active state whereas Kapha is in passive state as it performs no function. During this stage if fertilization takes place Pitta helps in growth of fertilized ovum.^[4]

Rajahsravakala (Menstrual Phase)

The Rajahsravakala or the menstrual phase comes at an interval of one month. The duration of this phase varies according to different Acharya. In general, the duration is from three to five days. Vata is continually active through Dhamanee. These characters play a great role in diagnosing various types of Roga in Stree in which the normal features of the menstrual blood get altered.^[5]

The characteristics of Shuddha Artava according to different Acharya.

Table 2: Characteristics of Shuddha Artava

It is essentially degeneration and casting off an endometrium prepared for a pregnancy. Regression of corpus luteum with fall in the level of estrogen and progesterone is an invariable preceding feature.^[1]

Decreased level of these two hormones is responsible for menstruation. The function of oestrogen and progesterone is vasodilatation when their level decreased, vasoconstriction takes place due to which blood vessels also constrict and cells starts to necrose and do not get enough blood supply. A vasoconstrictor types of prostaglandins are secreted abundance in the endometrium due to which mucosal layers of the endometrium become vasospastic leads to tortuous blood vessels.

Hence Ayurveda stresses in maintaining proper Agni as a prime factor in the management of many diseases. Due to Kapha Vardhaka Ahara and Vihara, Mandagni results in Artava Kshaya. This Mandagni results in the formation of Ama Kapha along with the Ama first vitiates the Rasa Dhatu. As Artavaa is the Upadhatu of Rasa Dhatu, the Artava is vitiated. The vitiated Kapha along with the Ama obstructs the Artava in the Artavavaha Srotas thereby leading to Anartava (Amenorrhea) or Alpartava (oligomenorrhea). Aggravated Kapha and Ama having vitiated Rasa Dhatu move towards Medo Dhatu as Kapha, Ama and Medas have similar qualities. Hence, they are attracted to each other. Medo Dhatu is one of the first Dhatu along with Rasa Dhatu to reflect a Kapha aggravation. The functions of Kayagni, Bhutagni and Dhatwagni include all the metabolic, neuronal, and hormonal functions of the body. Hence Ayurveda stresses maintaining proper Agni as a prime factor in the management of many diseases. Due to Kaphavardhaka Ahara and Vihara, Mandagni results in Artavaa Kshaya. This Mandagni results in the formation of Ama.^[9]

So the drug having Vata Kapha Shamaka, Pitta Vardhaka, Deepana, Pachana, Rasapushtikara, Lekhana properties should be used to treat Artavaa Kshaya.

Clinical Assessment and Diagnosis

Diagnosing the effect of Agni on Artava requires a comprehensive Ayurvedic assessment, combined with an understanding of the patient’s history and symptoms. Key diagnostic methods include:

1. Pulse Diagnosis (Nadi Pariksha): Evaluates the state of Agni and Dosha A slow, heavy pulse may indicate Manda Agni and Kapha, while a rapid, sharp pulse suggests Tikshna Agni and Pitta.

2. Tongue Examination: A coated tongue points to Manda Agni and Ama, a red tongue indicates Tikshna Agni and Pitta, and a dry, cracked tongue suggests Vishama Agni and Vata.

3. Menstrual History: Assessing cycle regularity, flow, color, duration, and associated symptoms (pain, bloating, irritability) helps identify Dosha involvement and Agni status.

4. General Symptoms: Systemic symptoms like fatigue, weight gain, or heat intolerance provide clues about Agni and Dosha imbalances.