Dr L. M. Shah, MD. FCPS.

for the use only of registered medical practitioners  

Paper before

2nd Conference of The Bombay Obstetric

&   Gynaecological     Society.

Bombay – 16th & 17th December 1972.

HERBAL  DRUG  “AYAPON”  (ALARSIN)

IN DYSFUNCTIONAL UTERINE  BLEEDING.

By

Dr L. M. Shah, MD, FCPS.,

Ghatkopar  Maternity & Surgical Hospital, Bombay-86.

& Dr. (Mrs.) Sarla Visaria, Ghatkopar, Bombay.

HERBAL  DRUG  AYAPON (ALARSIN)

I N   DYSFUNCTIONAL  UTERINE  BLEEDING

by

Dr L. M. Shah, MD. FCPS.

Ghatkopar Maternity & Surgical Hospital, Bombay – 86.

&

Dr. (Mrs.) Sarla Visaria,

Ghatkopar, Bombay.

Introduction :

It is becoming increasingly evident now that in a number of diseased conditions, indigenous herbal medicines can offer an equivalent or often better chance of cure as compared to an allopathic formulation. One such striking example is the use of Ayurvedic herbal drugs to treat Dysfunctional Uterine Haemorrhages. The Dysfunctional Uterine Bleed­ ing may be defined as abno·rmal and excessive uterine bleeding for which a  gross organic cause cannot be found.

Moreover, in the recent period, a number of cases come with excessive uterine bleeding where the loop has been inserted as a  contraceptive measure.

These days due to various factors incidence of    Dysfunctional “”‘-(Jterine Haemorrhages is surprisingly high both in general as well  as consulting. practice.

Material & Methods :

This study was carried out on 150 cases of Dysfunctional Uterine Haemorrhage and Haemorrhage after abortion,  miscarriage or delivery. No apparent case with an organic pathologic condition, such as Flbro­ myomas, Adenomyosls, Tube-ovarian masses etc., was selected.  100 cases were used as controls, wherein the usual modes of treatment were employed. The study was carried out over  32-  years from  July 1968 to December 1971 .

 Drug used : Tablet AYAPON  (ALARSIN)  was used in the trial.

 Each tablet contains :

1. Ayapan (Eupatorium ayapana) 130 mg
2.   Ashoka (Saraca lndlca) 130 mg
3. Godanti (Gypsum) 32 mg
4. Nagkeshar (Mesua ferrea) 32  mg . 32 mg
   Pharmacology :
  1. AYAPAN : (Eupatorlum ayapana): Is prepared from the dried leaves of Eupatorium ayapana, contains ayapln (6 : 7 methylene dioxycouma­rln),  ayapanin   (7-methylene   coumarin)   and an essential volatile 0·11. Both ayapin and ayapanin possess haemostatic property when applied locally or taken internally. Ayapan has been used effectively to check internal haemorrhage.
  2. ASHOKA (Saraca lndica) : is the bark of the tree possessing strongly astringent and uterine sedative properties. It acts on the muscular fibres of the uterus and exerts a stimulating effect on the endo­ metrium and the ovarian tissue, and has been used In uterine affections, specially  menorrhagia,  due  to  uterine  fibroids  and  other
  3. GODANTI (Gypsum):: Is hydrated calcium It has been recommended in  Ayurvedic literature  for  treatment  of  menorrhagia
  4.  NAGKESHAR (Mesua ferrea): It is astringent and haemostatic. It decreases acute bleeding  and  is therefore useful in Uterine  Bleeding. Ashoka and  Nagkeshar combination give  pronounced  haemosta effect in arresting  Functional Uterine Bleeding.
Dosage :

in cases of Functional Uterine Bleeding, Ayapon treatment was started, at the outset with 2 tablets 3 times a day till bleeding was checked.  (usually, bleeding  was  checked  within  5-10  days.)

This was followed by  2  tablets  of  Ayapon twice a  day after  meals for two months continuously. These patients were also given usual haematinics simultaneously .

TABLE-I : Age  group  &  Parity 
Below 20 20-30 30 – 40 30 – 40 Total.
Unmarried 18 8 27
Nulliparous 14 8 3 26
With  1-3  children 10 12 30 7 59
With 4 or more children 10 23 5 38
 Total 42 38 57 13 150

 TABLE-II : Aetiology     

Ayapon  Control
Menorrhagia  after  abortion 41 28
Miscarriage or Delivery 109 72
Functional  Uterine  Haemorrhage ___ ___
  Total :  150 100

  RESULTS :

Results  were  evaluated depending  upon  the  degree  of  response. They were classified as :

Excellent  _, Good _, Fair

Poor_  (Little or no response)

                  TABLE – Ill

Excellent Good   Fair   Poor  Total
Ayapon  98(65%)  24(16%) 16(11%)   12( 8% ) 150
Control 20(20%)  38(38% ) 8(18% ) 24 (24%) 100

 DISCUSSION :

Functional Uterine Haemorrhage has so far been  treated with haemostatics and hormones. All the three sex  hormones  have  been used  by  various  authors  and  In varying  dosage.

The original and best tried mode of therapy is using Estrogenic preparations especially in pubertal menorrhagia, while pro·gesterone ls used in premenopausal bleeding; i.e. in cases of metropathia haemor­ rhagica  to  induce the  medical  curettage.   Parenteral  preparations  has been tried time  and again,  but do  not seem to have  any  major adva tage  over  oral  treatment,  though  premarine  Injection  is given  success­ fully in some cases.  These forms of therapy have certain disadvantages, one  of  the  most  discomforting  being  nausea  during  the  administration of  estrogens.   Moreover  these  drugs  must  be  taken  very  punctually failing  which  another  bout  of  withdrawal  bleeding  results.

Androgens are used mainly parenterally and given in Intramuscular Injections of 25 mg. per day. This Is capable of completely arresting haemorrhage in 48-72 hours. Androgens act by antigonodotropic activity through the hypothalamic hypophyslal effect on the ovary (inhibition of follicle formaticm), by direct action on the estrogens In the blood and endometrium or by local haemostatic action on the endometrlum. Some times androgens are combined with Oestrogens and  some  times  with both Oestrogens  and  Progesterone.

However, the  use  of  androgens  is  necessarily  restricted  because  of the   ever   present  danger  of  virilisation   which   can   never  be  completely reversed,  and so  androgens  can only  be  used in women  over  35. Recent reports  show  encouraging   results with  the  use  of  non-virilising  androgens gens  which   have  still  to  be  substantiated.

Progesterone by Itself was some times used in the initial treatment of functional uterine haemorrhage. The advent of the newer progesterones has radically altered this and  today  the  mainstay  of  treatment  is  lhe use  of  various  contraceptive  tablets  in  various  doses.

All these drugs however If used for a long time have a number of side effects which are very well known by now like migraine, thrombo embolic phenomena etc. Moreover menorrhagia recurs as soon as the drugs are withdrawn.

For long term use therefore all these drugs do not11aahieve -the maxin:ium   safety  and  effectiveness   desired.   Here  lies  the   usefulness of an indigenous  drug  which  is  both  safe  and  effective  either  for  short or  long  term  therapy.

Conclusion : In cases or dysfunctional uterine haemorrhages AYAPON (Alarsin) :

  1. Controls Irregular  and  profuse  uterine

Ii.    Restores  the  normal  function  of  the  uterus.

Iii.   Restores  normal  rhythm  of  the  menstrual  cycle.

Acknowledgement :  I am  thankful  to  M/ s.  ALARSIN,   Bombay-1  for their  continued  co-operation  for  completion  of  these  trials.

REFERENCES :

  1. Ghosh : Pharmacology (1957), Materia Medica and Therapeutics; 20th Edition,  Hilton  &  Co., Calcutta.
  2. R.  Jahagirdar  (1970)  Place  of  Indigenous  drug  AYAPON  in  D. U.B .; Paper before XVI  Conference  of  International  College of Surgeons, Hyderabad.
  3. Javeri Veenaben : (1965) Treatment of Functional Uterine Bleeding (A clinical  study  with AYAPON);  Indian Practiticmer,  18 : 783.
  4. Kodkany Kamal B(1968) Use of  ‘AYAPON’  in  Uterine  Bleeding after  IUCD;  Indian  Practitioner,  21 : 901.
  5. Mehta A . (1964) Use of an Eupatorium AYAPAN combination in Functional Uterine  Bleeding;  Paper  before  the  Scientific  session of 40th All  India Medical Conference at Kakinada.
  6. Rama Mitra : (1968) Value of Herbal drug in Functional Uterine Bleeding ; Mediscope, 11 : 11,
  7. Pandya C.et al : (1963) Value of indigenous drugs in Menorrhagia; Current Medical Practice, 7 : 8,543.
  8. Phadnis N. : (1964) Use of Ayapon Compound in Functional Uterine Haemorrh.ages . Antiseptic,  61 : 1O .683.
  9. Rohatgi Pratibha (1966) Functional Uterine  Bleeding :  Treatment with an Indigenous Drug AYAPON; Antiseptic , 63 : 11,674.
  10. Shelat Ramesh and Shah  Usha (1966)  Value of  Herbal Drugs in Functional Uterine  Bleeding; Indian Practitioner,  19 : 11,697.

ALARSIN Post Box 1 4, Bombay G .P. O., Bombay 400 001