Critical Understanding of Agni and Artavakshaya in Women’s Health from Ayurveda Perspective

Introduction

The term Artava Kshaya is derived from the combination of two words: Artava and Kshaya. Artava refers to Ritodbhavam Artavam, where Ritu signifies a specific time or period, and Bhavam refers to occurrence. The term thus refers to a bodily substance that flows at a specific time or period, which is termed Artava. On the other hand, Kshaya is derived from the Kshi Dhatu, meaning to cease or get reduced. The reduced quantity of Artava from its normal Pramana (4 Anjali) is called Artava Kshaya or Kshinartava.[1]

The prevalence of oligomenorrhea in 2023 is 13.5% in the general population[2], while hypomenorrhea was found in 3.5% of women[3].

Aarthavakshaya is described as Yathochitha Kala Adarshana, signifying a prolonged intermenstrual interval, which is analogous to oligomenorrhea—characterized by irregular menstruation with cycles exceeding 35 days. Additionally, Alpata, which indicates a menstrual blood flow of less than four Anjali Pramana, represents the clinical manifestation of hypomenorrhea.

Agni, the primary metabolic fire in the body, plays a crucial role in the manifestation of various diseases, including Artava Kshaya[4]. Acarya Sushruta states, ‘Aartavashonitamtvaagneyam’, meaning that Artava is Agneya (related to Agni) and shares characteristics with Shonitha (blood)[5]. Artava, present in women, has characteristics of Pitta. Any dysfunction in the Pachaka Pitta will lead to improper function of Rasa Dhatu, and consequently, the improper formation of Artava.

Conceptual Framework of Agni

There are mainly thirteen types of Agni, namely Jatharagni, Bhutagni, and Dhaatvagni, out of which Jatharagni determines the strength of Bhutagni and Dhaatvagni[6]. Bhutagni digests the food materials composed of the five basic elements and transforms them for utilization by the respective Dhatus (tissues). It is also responsible for the separation of food into the essence portion (Prasad) and the waste products (Kitta) in our body[7].

Acarya Caraka mentions that the seven Dhatus supporting the body each contain their own Agni, which digests and transforms the materials supplied to them, thereby making the substances suitable for assimilation and nourishment. The Dhatvagnis are responsible for the development of Dhatu (tissue formation) through Utpati Kram (the process of development)[8].

The Sara or essence of the food, which is in ultra-fine or minute form, is called Rasa. This, with the help of Rasa Dhatva Agni, forms the Rasa Dhatu, which is directly formed from the essence of the food we consume. Since Artava is an Updhatu (secondary tissue) of Rasa Dhatu, any derangement in Jatharagni will directly affect the formation and quality of Artava[9]. From Rasa Dhatu, Rakta (blood) is formed, and from Rakta, Raja (menstrual blood) is formed. Raja reaches the uterus and is expelled over three days each month, and this is called Artava. Raja is formed from the essence portion of Rasa[10]. Based on the above discussion, it can be inferred that Agni plays a crucial role in the formation and regulation of Artava

Artavashaya in Ayurveda Texts –

Yonivyapat related to Artavakshaya:

1. Lohitakshaya:

Acarya Vagbhata opines that due to the vitiation of Vata and Pitta, Raja (menstrual blood) decreases, and the woman suffers from burning sensations, emaciation, and changes in complexion. This condition is known as Lohitakshaya[12].

2. Arajaska:
   Acarya Caraka states that when Pitta located in the yoni and uterus vitiates Rakta (blood), the woman becomes extremely emaciated, and her complexion changes. This condition is known as Arajaska. Acarya Chakrapani, in his Teeka, described amenorrhea as a symptom of this condition[13].
3. Vatala Yonivyapada:

Acarya Caraka writes that a woman of Vata Prakriti who consumes a Vatapradhan diet and engages in activities aggravating Vayu will experience symptoms such as pricking pain, stiffness, sensations as if ants are creeping on the body, roughness, numbness, etc. Local symptoms include fatigue or lethargy, among other Vata disorders. Due to the vitiation of Vata, menstruation starts with sound and pain, and the menses are frothy, thin, and dry[14].

All the above-mentioned Yonivyapadas have a direct correlation with Artava Kshaya, resulting from different derangements of Agni.

Artavadushti related to Artavakshaya:

“Ksheena Artava Dushti” refers to the reduced quantity of Artava from its normal measurement due to the vitiation of Doshas. This condition is directly correlated with Artava Kshaya (scanty menstruation)[15].

Jataharini related to Artavakshaya:

Acarya Kashyapa has mentioned certain menstrual disorders, such as Shushka Revati, Katambhara, and Vikuta Jataharini, which result from Jataharini Graha Baddha. These can be considered as primary amenorrhea. The following symptoms are found in these conditions:

1. Shushkarevati:

When a woman is 16 years old and still does not experience menstruation, with emaciation of the Sphikapradesha (hip region), she is considered to be suffering from Shushka Revati.

2. Katambhara:

A woman who does not menstruate at the appropriate time, becomes emaciated, weak, and ultimately dies, is known as Katambhara.

3. Vikuta:

When the menstrual discharge is irregular in time, color, and quantity from the very beginning, accompanied by Balahani (weakness) and Glani (fatigue), the woman is considered to be suffering from Vikuta Jataharini.

From the above descriptions, the first two conditions can be considered as primary amenorrhea, and the last one as Oligomenorrhea.

Agni and Dosha Interaction:

The irregular digestive fire (Agni) causes improper digestion, leading to disequilibrium of the Dhatus (tissues). In cases of insufficient fuel (food), the strong Agni desiccates the Dhatus as described in the verse: ‘Vishamo Dhatuvaishamya Karoti Vishamam Pachan’.

Vishamaagni and Vatadosha:

Vishama Agni is the state where digestion and metabolism are irregular, i.e., sometimes normal and sometimes abnormal. When Vishama Agni is affected by Vata Dosha, it causes irregularities in the formation of Rasa Dhatu (the precursor to Artava), leading to Artava Kshaya[18].

Vyanavata:

The Vyana Vayu, which has the function of dispersing, distributes Rasa Dhatu throughout the body. When the Rasa Dhatu is scattered due to the vitiation of Vyana Vayu, it localizes in the areas where there is morbidity in the channels carrying Rasa, leading to disease at those specific locations, just like clouds that rain at obstructed places[19].

Samanavata:

The main location of Samana Vata is near the Agni in the Grahani (stomach), and it is responsible for food intake, digestion, separation of Sara (essence) and Kitta (waste), absorption of the essence, and expulsion of waste. Any vitiation of Samana Vata leads to improper formation of Sara, affecting the formation of Artava as its precursor is Rasa Dhatu.

Apanavata:

Apana Vata moves downward and is responsible for the expulsion of Artava (menstruation).

Pittadosha and Tikshnagni:

Tikshnagni refers to very sharp or fast digestive fire. A person with Ksheena Kapha, aggravated Pitta, and Vayu will have very rapid digestion, even consuming the Dhatus (tissue elements). This can lead to tissue depletion, including Artava Kshaya[20].

Kaphadosha and Mandagni:

Mandagni refers to slow digestion. People with Mandagni consume little food and struggle to digest even small amounts. Mandagni leads to Kaphaja Vikara, which can cause Marga Avarodha (obstruction of channels), ultimately leading to Artava Kshaya[21].

Samprapti (Pathophysiology):

The pathophysiology of Artava Kshaya involves two primary mechanisms:

1. Margaavarodhajanya:

This type of Artava Kshaya involves the vitiation of Vata and Kapha causing obstruction in the Artava Vaha Srotas (channels of menstrual blood). According to Acarya Caraka, the obstruction occurs due to Sanga (blockage), which can be caused by either Kapha or Vata, or both. Pitta does not cause obstruction but contributes to Artava Vriddhi (excessive menstruation). According to Sushruta, trauma or injury to the Artava Vaha Srotas results in conditions like Vandhyatwa (infertility), Maithuna Asahishnuta (dyspareunia), and Artava Nasha (loss of menstruation)[22].

The treatment approach involves relieving the obstruction caused by Kapha or Vata through therapies such as Snehana (oleation) and Swedana (sudation). In cases of Kapha vitiation, Vamana (emesis) is performed, while in Vata vitiation, Niruha and Anuvasana Basti (medicated enemas) are indicated. Uttarabasti (medicated vaginal administration) may be used when both Kapha and Vata are involved.

2. Dhatukshayajanya:

In this type of Artava Kshaya, the vitiation of Doshas occurs due to improper Ahara (diet) and Vihara (lifestyle). These vitiated Doshas affect Rasa Dhatu and its Dhatvagni (digestive fire). The Rakta Dhatu (blood) becomes depleted due to an anemic condition, and the Rasa Dhatu is diverted to the Rakta Dhatu. This leads to the depletion of other Dhatus, causing reduced formation of Artava as its precursor, Rasa, is depleted. There is a relationship between Rakta and Pitta, and when Rakta is vitiated, it leads to Pitta Kshaya, ultimately resulting in Artava Kshaya. Sushruta has described Rakta as both a Dosha and a factor that vitiates Artava through improper Ahara and Vihara[23].

Nidana of Arthavakshaya

                                       Table no :1 Aharaja hetu of Arthava kshaya[24]

                            Table no:2 Viharaja & Manasika hetu of Arthava kshaya[25]

Cikitsa (Treatment) –

In Ayurveda, the treatment (Cikitsa) approach revolves around breaking the pathogenesis (Samprapti Vighatana) and avoiding causative factors (Nidana Parivarjana). In the case of Artava Kshaya, there is an imbalance or increase in Vata and Kapha, along with a depletion of Pitta, Rasa, and Rakta Dhatus, primarily due to impaired digestion (Agnimandya). Therefore, all these pathological factors (Samprapti Ghatakas) must be addressed to ensure effective treatment.

The management of Artava Kshaya involves detoxification (Samshodhana) using substances with heating properties (Agneya Aushadhi). Dalhana emphasizes that detoxification should be carried out using Vamana (emesis) rather than Virechana (purgation). This is because Virechana reduces Pitta, which further depletes Artava. On the other hand, Vamana eliminates Kapha, a cooling and stabilizing factor, leading to a relative increase in the fiery (Agneya) elements within the body. This ultimately helps in enhancing the production of Artava.

Role of Srotoshodhana (Purification)

Acarya Chakrapani, in his commentary, highlights that purification therapies clear bodily channels (Srotas). Vamana Karma (upward cleansing) and Virechana Karma (downward cleansing) are both effective in clearing blockages in their respective channels. Hence, both therapies may be considered in Artava Kshaya, depending on the patient’s condition.

Use of Agneya Dravya

Artava Kshaya is characterized by a qualitative depletion of Pitta and a quantitative reduction in Artava. Therefore, remedies with heating and digestive-enhancing properties (Agneya and Agnivardhaka Dravyas) are beneficial. Such substances also have Pittakara properties, which help address the root cause by restoring digestive fire and balancing Pitta. As per classical texts, substances like Tila (sesame), Masha (black gram), Sura (fermented preparations), and Shukta (fermented sour preparations) are recommended for their Pitta-enhancing and Artava-increasing effects.

By combining these principles, Artava Kshaya can be effectively managed, restoring balance and promoting reproductive health.

Discussion

In Ayurveda, the concept of Agni is central to maintaining overall health, including reproductive health. It governs digestion, absorption, and tissue formation, and any imbalance in Agni can lead to the improper formation of Rasa (plasma), which is essential for producing Artava (menstrual blood). Artava Kshaya, or reduced menstrual flow, is often seen in Ayurveda as a consequence of impaired Agni. This aligns with modern biomedical research that links metabolic disturbances and hormonal imbalances to menstrual irregularities.

Research in modern medicine has begun to highlight how metabolic disorders, gut dysbiosis, and hormonal imbalances contribute to menstrual irregularities. Conditions such as oligomenorrhea (infrequent menstruation) and hypomenorrhea (scanty menstruation) have been linked to disturbances in metabolic processes, including poor digestion, insulin resistance, and dysregulation of sex hormones like estrogen and progesterone. In this context, the Ayurveda concept of Agni can be seen as an ancient framework that predates modern understanding of metabolic health. Specifically, Agni in Ayurveda refers not only to the digestive fire in the stomach but to a broader metabolic fire that influences all bodily functions. Disruption in this fire leads to the accumulation of Ama (toxins), which are believed to obstruct the normal flow of Rasa Dhatu, causing menstrual irregularities such as Artava Kshaya. Ayurveda’s emphasis on Agni can thus be viewed as a holistic approach to these issues, where restoring digestive fire is believed to support the formation of Rasa and improve menstrual health.

Additionally, Ayurveda treatments often use dietary adjustments and herbs to strengthen Agni. For example, Tila (sesame) and Masha (black gram) are thought to enhance digestion and support the proper formation of Rasa. These traditional remedies align with modern nutrition principles, which focus on bioavailability of essential nutrients to support hormonal balance and metabolic health.

Furthermore, Srotoshodhana (cleansing of channels) is a key Ayurveda practice used to eliminate toxins (Ama) from the body, which could otherwise block the normal flow of menstrual blood. Scientific research has also shown that toxins, both metabolic and environmental, can affect reproductive function. Detoxification therapies, such as Panchakarma, could complement modern treatments like hormone therapy, offering a more integrated approach to managing menstrual disorders.

Finally, the Ayurveda framework recognizes the role of the three doshas—Vata, Pitta, and Kapha—in influencing reproductive health. Vata imbalances are linked to irregular or scanty menstruation, while Pitta and Kapha imbalances can also affect the flow and timing of menstruation. By addressing these imbalances, Ayurveda offers a personalized, holistic approach to treating conditions like Artava Kshaya.

 Conclusion

Ayurveda understanding of Artavakshaya highlights the vital role of Agni in maintaining menstrual and overall reproductive health. By emphasizing the balance of Vata, Pitta, and Kapha, Ayurveda provides a holistic framework for addressing menstrual irregularities, focusing on the metabolic and tissue imbalances that lead to reduced menstrual flow. The treatment strategies, including dietary modifications, detoxification, and the use of Agneya (heating) therapies, aim to restore digestive health and balance the bodily humors, offering potential benefits in managing conditions like Artava Kshaya. This approach aligns with modern scientific concepts that recognize the interconnectedness of metabolic and hormonal balance in reproductive health. Combining Ayurveda wisdom with contemporary medical practices could provide a more comprehensive and personalized approach to managing menstrual disorders and promoting overall reproductive wellness.

Conflicts of interest: Nil

References:

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25. Padmavati Venkatesh | Dr. Priyanka Bhadargade | Dr. Anita Halgatti “Critical Review on Artava Kshaya” Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456- 6470, Volume-7 | Issue-6, December 2023, pp.4-11, URL: www.ijtsrd.com/papers/ijtsrd60080.pdf