August 26, 2018
Dear Dr Jasmer Singh
I appreciate your understanding of the Mastitis with the western knowledge system
I am requesting you to just read the understanding of mastitis by the Indian knowledge system
One of the argument I propose is that we do not recognise that bacteria is the sole reason for mastitis and by killing the bacteria is the major method of curing mastitis. the combination we are using and the mode of action is presented below. Please let me know that whether it makes sense
External application is one of the major ways Ayurveda treatment ( oil application and massage )
Nair
STHANA VIDHRADHI (Breast Abscess/Mastitis)
1. Introduction: Sthanya is considered as upadhatu of Rasa dhatu. It is mainly consists of Twak (Skin), Kandara (Connective tissues), Mamasa( Muscle tissue), Rasavahini( Lactiferous ducts) and Granthis( Glandular lobes or acini) with adequate number of Rakthavahinis ( Blood vessels).
Disease afflicting to all these components end up in sthanyaja vikara( Breast diseases) called as Sthana vidhradhi ( Mastitis).
Sthana is also a seat for shotha (Inflammation), Vrana (Ulcers), Granthis ( beningn Tumours) and Arbuda ( Malignat tumors)
The etiopathogenesis, clinical features and treatment of all these conditions is similar to the
diseases of any othe body parts. Though Sthana vidhradhi is similar to other vidhradhi there is
slight difference in the line of treatment. Due to this reason Sushrutha, Madhava nidana and
bhavaprakasha described these disorders under Sthana Roga ( Breast/Udder diseases).
In Vagbhata also there is a short description of Sthana vidhradhi along with general abscess.
Kashyapa has described a disease with the name of Sthanavajra or Sthanakeelaka instead of
Sthanavidhradhi ( Breast abscess). Except difference in etiology, clinical features etc of
Sthankeelaka, Sthanaroga and Sthanavidhradhi are identical hence all the names related to sthana
is one and the same.
2. Classification: 6 types- (Su Ni 10/15, A SA Ni 11/5 , A H Ni 11/3)
Classification of Sthanavidhradhi based on Involvement of dosha and Etiology.
1. Vataja sthanavidhrdahi – Vata humour type – Acute inflammation
2. Pittaja sthanavidhradhi – Pitta humour type – Acute suppuration
3. Kaphaja sthanavidhradhi – Kapha humor type – Chronic Abscess
4. Sannipathaja sthanavidhradhi – Combination of all 3 humors
5. Rakthaja sthanavidhradhi – Blood manifestation
6. Abhigathaja sthanavidhradhi – External Injury/ Microbial type
3. Nidana (Etiology)- (A SA Ni 11/3 , A H Ni 11/1)
1. Consumption of stale (Ama) , Excessive hot (Ushna) and dry foods ( Rooksha).
2. Consumption of food that produces burning sensation (vidahi and Pittakaraka ahara).
3. Sleeping over uneven surfaces.(external injury)
4. Wrong food habits and wrong regimen ( Confining to the one place not having enough movements)
5. Not properly feeding the calf(Baby)
6. Injury to the organ ( Udder)
4. SAMPRAPTI (PATHOGENESIS):
As there is no vishesha samprapti for Sthana vidhradhi samanya samprapti of vidhradhi can be taken into consideration.
Nidana (Etiology)
Pitta pradhana
Tridosha prakopa Vitiation of Doshas (Pitta) Agnimandya
Raktha dhatu dusti External injuries(Abhighatha) Amotpatti
Rakthavihini Srotodushti Srotorodha Rasa Dhatu dusti
Sthanasamshraya of dosha (pitta pradhana) and dushyas (Rasa, Raktha and Mamsa) in Sthana,
Sthanyavaha Srotho dusti
Dhatu dusti and dusti of upadhatu(Sthanya) due to nidana sevana
Dosha Dushya Sammurchana
Lakshonotpatti ( Sthana Vidhradhi)
By indulging in foods, which are stale, of hot potency, dry, this increases the pitta dosa (of acidic nature). Improper sleeping habits, improper lifestyle and all those activities which cause vitiation of rakta, produces a swelling localized in the skin, muscle, adipose tissue, bone, tendon, ligaments etc.
Such a swelling when lodged in the breasts of the woman in her reproductive age, either a pregnant or a female who has just delivered forms a breast abscess, which is not seen in young females.
The channels in the breasts in a pregnant as well as female who has just delivered are dilated and so are vulnerable for the manifestation of internal abscess of the breasts. In virgins, due to minuteness of the breast channels there is no possibility of breast abscess to occur.
The term “dosa” signifies the dùsana svabhàva – the nature of vitiation and so they are the basic triggering factors in the disease causation. These are vàta, pitta and kapha. These in turn vitiate the tissue elements such as blood, muscle fat etc and manifests in the form a diseases. The same dosa can produce plethora of diseases due to the fact that it is dependent on the following factors,
5. Samprapthi Ghatakas ( Components of pathogenesis)
Dosa (Humours) - Pitta pradhana tridosha
Dushya (Tissue elements) – Rasa, Raktha and Mamsa
Srotas (Channels) – Sthanyavaha Srotas
Agni – Jataraghni and Dhatwagni
Roga Marga – Madhyama
6. Lakshanas (Clinical features):
Swelling, breast engorgement, pain, inflammation and unbearable pain on touch (tenderness) of the female breast. Others include, indigestion, lassitude, uneasiness, anorexia, arthralgia, headache, pain and stiffness of body parts, nausea, fever thirst, retention of urine, diarrhea.
No stage wise explanation in the text – as mentioned above the disease has to be understood in terms of dosa predominance.
Àyurveda emphasizes on the disease and the individual with the disease. The individual with the disease is examined by darsana, sparsana (clinical examination) and prasna (history taking). The disease is understood by the nidàna -cause (etiological diagnosis), pragrùpa - prodormal symptoms / signs, rùpa – signs / symptoms (morphological diagnosis), sampràpti – pathogenesis (clinical diagnosis) and by upasaya (trial and error method). In the case of abscess, the colour of discharge and the smell of the discharge indicate the predominance of particular dosa(s). Management is based on the dosic predominance besides considering the stage of the disease and the diseased.
In the case of unsuppurated abscess, bringing suppuration by means of application of heat etc, is the way of expelling the pus and the unwanted debris. But in the case of Sthana vidradhi, as the breast tissue is very delicate, application of excess heat etc are contraindicated. If applied it destroys the delicate soft tissue and pus gets formed quickly. On the other hand, mild application of heat as per requirement is advisable (heat generated by rubbing the palm). Oral administration of drugs as per the dosa. These drugs expel the dosa though bowels and urine.
Surgical methods are to be adopted in case of suppurated breast abscess. The operation is performed by avoiding injury to milk ducts, nipple and areola.
During all stages of the breast abscess, the breast should be milked out.
Signs and symptoms
• Local changes: Reddish/blackish swollen udder with extreme pain and tenderness at times, hard and warm to touch.
• Milk changes: Milk is often yellow or curdled, has blood tinge at times, and also a few suspended particles seen in the milk of the affected udder.
There are three stages of this disease:
• Samavastha: When the doshas have just lodged themselves in the breast – heaviness in the breasts, slight pain, anorexia, etc.
• Pachyamanavastha: When the doshas start getting expressed – tenderness in the breasts, swelling, fever (slight), reddish or blackening of the udder.
• Pakvavastha: When the doshas are fully expressed –extreme pain and tenderness, swelling, fever, etc.
Different types and its signs and symptoms
1. Vataja Type : Black or reddish in colour , hard, stiff, rough associated with severe pain, has very unusual types of beginnings such as swellings and suppurations which are slow in nature.
2. Pittaja Type : Resembles ripe fruit of udumbara ( Fig) associated with fever, burning sensation, sudden onset and quick suppuration after ruptures yellow discharges comes out.
3. Kaphaja Type : Resembles earthen late ( slightly protuberant in centre with wide base), is yellowish white, cold in touch, stiff, mild pain, develops and suppurates gradually, has itching and discharge white after rupture.
4. Sannipathaja Type: Multiple colours(black, white, yellow) varied pains ( Piercing pain, Burning sensation and itching), discharges of thin, yellow or white, raised, irregular , incurable and suppurates irregularly.
5. Abhighataja Type: when person consumes noncongenial diet gets an injury, the heat of the injury excited or spread by Vayu withholding Raktha and aggravates pitta. Fever, Thirst and burning sensation and also will have pittaja type of lakshanas.
6. Rakthaja Type : Very acute in nature, resembles early stages of gangrene.
7. Management
• The treatment prescribed for abscess holds good here also along with wound or vrana treatment.
• In the beginning for suppuration, poultice or sudation should not be used (Yoga Ratnakara advised). Suppuration should be enhanced by oral use of appropriate drugs or diet.
• Once suppuration of this is established, the instrumentation should be done protecting lactiferous ducts, areola, and nipples.
• Repeated milking should be done in all the stages; i.e., inflammation, beginning of suppuration and suppuration of abscess.
• Drugs capable of suppressing the Pitta and cold drugs should be used.
• Bloodletting with the help of leeches should be done.
8. Chikitsa – Smaprapthi vightana (Principles of Treatment)
1. Agni deepana – Improves the status of metabolism
2. Ama pachana – Cleanses the toxins of whole animal and udder
3. Pitta and Raktha Shamaka – Paccifies the aggravated Pitta dosha and Raktha dooshya
4. Srotoshodaka – Cleanes the channels of Lactiferous glands.
5. Vrana Shodaka and ropaka – Cleanses the wounds( Lactiferous)
6. Shothahara – Paccifies the inflammation due to Infection
7. Krimihara – Decreases the microbial load
This formulation consists of 3 ingredients…
1. Aloe vera
2. Curcuma longa
3. Calcium hydroxide
Aloe vera is ( B P N 420)
? Deepana ( Digestive),
? Pachana ( Carminative),
? Cold in potency ( pacifies pitta),
? Pitta and Raktha shamaka ( Paccifies Pitta and Raktha)
? Krimighna ( Anti-microbial)
? Vrana shodaka and Vrana ropaka ( Cleanses wounds)
? Shothahara ( anti-inflammatory)
Curcuma longa is (B P N 115)
? Deepana ( Digestive),
? Pachana ( Carminative),
? Uttejaka( Stimulanat)
? Rakthashodaka ( Bllod purifier)
? Shothahara ( Anti-inflammatory)
? Krimighna ( Anti-microbial)
? Vrana shodaka and Vrana ropaka ( Cleanses wounds)
Clacium hydroxide is (Indian Materia Medica)
? Srotoshodaka ( Channel cleanser)
? Shothahara (Anti-inflammatory)
? Raktashodhaka (Blood purifier),
? Vrana shodaka and Vrana ropaka ( Cleanses wounds)
Mastitis can be compared with sthanavidhradi as described in Ayurveda. Sthanavidhradi is a disease of pitta origin, the drugs used in this formulation are potent pitta shamaka
(Paccifies pitta humour). Hence the disease mastitis (Sthanavidradhi) can be efficiently managed with this formulation.
This formulation consists of Aloe vera, Curcuma longa and Calcium hydroxide which are having the properties of Agni deepana ( digestive), Amapachana (Carminative), Krimighna (anti-microbial), Vranashodaka (Wound cleanser), Vranaropaka (Wound healing) and Shothahara (anti-inflammatory), Srotoshodaka ( Channel cleanser) so this formulation holds good in combating the disease Mastitis.