Ayurvedic Management of Inguinal Hernia

Article by Dr Raghuram Y.S. and Dr Manasa, B.A.M.S
Inguinal Hernia is compared to Aantra Vruddhi in Ayurveda. It is one of the 7 types of Vruddhi (Vruddhi = scrotal swellings as explained in Ayurvedic texts).

Vriddhi means ‘to increase’.
This term has been used at many instances in Ayurveda. The term necessarily doesn’t denote scrotal swelling. It has to be understood according to the context and situation.

When the term ‘Vriddhi’ is not used with any suffix or prefix, it indicates – ‘Vrushana Vruddhi or Mushka Vruddhi or Andakosha
Read related: Inguinal Hernia – Prevention, Home Remedies, Effective Yoga

Pathogenesis

Pathogenesis of Aantra Vruddhi (Samprapthi)
The Vayu getting aggravated due to the consumption and exposure to the above said causes narrowing (shrinks) of a part of intestine and displaces it from its normal site. After displacing the intestine from its normal site, the vitiated vayu further pushes the part of the intestine into the groin (inguinal region, folds between thigh and scrotum) and causes a swelling which resembles a granthi (cyst, a cavity filled with fluid). If neglected, the vitiated vayu further pushes the intestinal part downwards. At the same time, the vitiated vayu also moves further down into the scrotum and causes swelling of the scrotum. This condition is called Aantra vruddhi (Aantra=intestine, Vruddhi=enlargement, swelling, protrusion).
Read related: Vruddhi Causes, Types, Symptoms, Prognosis, Ayurvedic treatment

Symptoms

Symptoms of AANTRA Vruddhi (Lakshanas) –
– Vankshana shotha – swelling in the groin
– Vrushana (mushka) vruddhi – swelling in the scrotum
– Aadhmana – distension of the scrotum
– Ruk – pain
– Stambhana – stiffness or rigidity of the scrotum
– Prapeedayanto antaha swanavaan prayaati pradhmaapayanneti punaha cha muktaha – if the scrotum is pressed, the intestinal part moves back into the abdomen (inguinal canal) and when the pressure is released the intestine once again bulges and protrudes into the scrotum causing the swelling of scrotum

– Vata purna dhruti sparsha – the scrotum looks like an air filled sac or bag (or balloon)
– Ruksha – scrotum looks dry
– Ahetu ruk – pain without any reason

Note: The last 3 symptoms from Vata purna to Ahetu Ruk are same as Vataja Vruddhi, we can recollect that Aantra Vruddhi is a variant of Vataja Vruddhi.
Aantra vriddhi is said to be asaadhya (difficult to cure).

Treatment

Treatment of Aantra Vriddhi (CHikitsa)
Vata Vriddhi chikitsa – Vata Vruddhi Chikitsa should be done in the Aantra Vruddhi which is devoid of discharges or in aantra Vruddhi which hasn’t reached the phalakosha or scrotum

Agni karma – Swedana (fomentation) should be given to the scrotum with agni (fire), i.e. fire cauterization in cases of aantra vruddhi which has not reached the scrotum.

Vankshana daha – According to Sushruta, agni karma should be done over the vankshana (inguinal region) to prevent the descent of the intestine into the scrotum. This should be strictly done in cases of vruddhi wherein the intestine has not yet reached the scrotum but is causing a bulge in the groin (about to enter the scrotum). Agni karma or cauterization with fire should be done using ardhendu shalaka (cauterization instrument which is having the shape of ardha indu or half moon). The aantra vruddhi which has descended into the scrotum should be discarded or rejected. (According to Sushruta, the hernia which has descended into the scrotum is difficult to treat).

Padangushta daha – Daha karma (fire cauterization) should be done on the Big toe (angushta) in viparyaya method. To do this, the skin over the Angushta Madhya (middle of the toe) is cut open and cauterization is done. If it is right sided hernia, daha karma should be done over the left toe. If it is left sided hernia, daha karma should be done over the right toe. This method is called vyatyasa krama.

Sira vedha – To prevent the progression of the aantra vruddhi into the scrotum, siravedha or vein-section should be done. This siravedha should be done over the vein located above the Shanka sthana (temple) and near to the ear. Care should be taken to protect the sevani or suture therein. The sira vedha should be done in vyatyasa krama i.e. sira vedha should be done on the right side in left sided hernia and on the left side in right sided hernia.

Ayurvedic formulations

Formulations for Aantra Vruddhi
Bala-Eranda – Eranda Taila (castor oil) prepared and processed with the decoction of Bala (Sida cordifolia) is highly effective to relieve Aadhmana (distension and flatulence) and cure Antravruddhi associated with pain.

Radnadi Kwatha – The decoction prepared from the below mentioned ingredients should be taken mixed with eranda taila (castor oil) to get relieved from aantra vruddhi.

• Rasna – Pluchea lanceolata
• Yashtimadhu – Liquorice
• Guduchi – Tinospora cordifolia
• Erandamula – Roots of Castor plant
• Bala – Sida cordifolia
• Aragwadha – Cassia fistula
• Gokshura – Tribulus terrestris
• Patola – Pointed gourd
• Vasa – Adhatoda vasica

Vishala kashaya – Decoction prepared with Vishala mula churna (powder of the roots of Citrullus colocynthis) mixed with Eranda Taila (castor oil) and milk is beneficial in aantra vruddhi

Pippalyadi Lepa – Paste of Pippali (long pepper), Jeeraka (cumin seeds), Kushta (Saussurea lappa), Badara (jujube), Shushka gomaya (dried cow dung) made in Kanji (fermented herbal liquid)

Devadarvadi Pralepa – Paste of Devadaru (Cedrus deodara), Mishi (fennel seeds), Vasa (Adhatoda vasica), Takali mula (roots of Clerodendrum multiforum) and Saindhava Lavana (Rock salt) mixed in honey should be applied on the scrotum swelling to relieve aantra vruddhi

Vata Vriddhi Chikitsa

Treating Aantra Vruddhi on the lines of Vata Vruddhi

Since Aantra Vruddhi is basically caused by vitiated Vata, the treatment of Vataja Vruddhi also can be skillfully implemented in Aantra Vruddhi after analyzing the condition and seeing the predominance of doshas in the disease.

Treatment of Vata Vruddhi –
In Vata Vruddhi, snigdha virechana (purgation with medicated oils or ghee) should be administered.
For this milk mixed with Eranda Taila (castor oil) should be consumed daily for at least 1 month.
Eranda taila (castor oil) mixed with Guggulu (Commiphora mukul) and go mutra (urine of cow) is also beneficial in Vataja Vriddhi.

According to Sushruta:
Initially Traivrut sneha should be administered for snehana (oleation). Later Swedana (steaming treatment) should be given followed by Virechana (therapeutic purgation). After the Virechana and after a gap of 8 days, Niruha Vasti (herbal decoction enemas) prepared with kwatha (decoction) and kalka (paste) of Vatahara dravyas (herbs which are anti-vata or antagonistic to morbid vata) should be administered. Later Anuvasana Vasti (oil enemas) is administered with Yashtimadhu taila (oil)

External treatments:
Later application using sneha (medicated oils), upanaha (poultices) and Vatahara pralepa (paste prepared from herbs having anti-vata properties) is done over the afflicted area. After this Pachana or treatments (medicines) to ripen the immature Vruddhi is given followed by Bhedana (incision on the scrotum below and to the side of the midline of scrotum.

Pathya

Pathya (beneficial and wholesome things)

• Samshodhana – cleansing treatments in the form of panchakarma methods of treatments, mainly Virechana (therapeutic purgation) and Vasti (therapeutic enemas)
• Vasti karma – therapeutic enemas
• Raktamokshana – bloodletting
• Sweda karma – fomentation, sudation, sweating or steaming therapy
• Lepa – anointments, application of medicinal pastes
• Vankshana daha – giving heat or cauterization using heated ardhachandrakara loha (iron instrument in half moon shape) over inguinal region
• Bahu sira vyadha – bloodletting should be done through vein-section i.e. cutting the veins in the shoulder in vyatyasa krama i.e. if the right part of scrotum is swollen, the sira in the left shoulder should be cut and if the left scrotum is swollen, the sira in the right shoulder should be cut
• Shastra vidhi – surgical process according to the condition of the disease should be done
• Aruna or rakta shali – red variety of rice
• Eranda taila – castor oil
• Vamana – therapeutic emesis
• Dhanwa amisha – flesh of animals living in desert areas
• Ushna jala – hot water
• Takra – buttermilk

Panchakarma treatment

Role of Panchakarma in dealing with Hernia vis-à-vis Aantra Vruddhi
Panchakarma has almost limited or no role n treatment of hernia vis-à-vis aantra vruddhi once the intestine or abdominal contents have totally come into the scrotum.

But when Vata is predominant in aantra vruddhi and when the contents have not yet moved into the scrotum, and when they are limited to the inguinal canal, Panchakarma measures can be administered because this condition should be treated on lines of Vata Vriddhi chikitsa.

Virechana, Asthapana Vasti and Anuvasana Vastis are said to be useful in these conditions. They will, along with some disease modifying medicines and bandhana (bandages) will prevent the abdominal contents from dripping down into the hernia sac.

Limitations

Limitations of Ayurveda in handling Hernia (aantra vriddhi)
The first line of treatment for hernia remains surgery in the modern medicine (surgical repair). Sushruta too has considered Aantra Vruddhi as Asadhya i.e. difficult or impossible to treat especially once the abdominal contents especially the intestine drips into the scrotum He has only explained situational treatment for hernia which is limited to the inguinal canal. In these conditions we can implement the treatment principles and medicines explained in Ayurveda along with dietetic and lifestyle corrections with a view of providing substantial relief from symptoms and also to prevent the disease from progressing (as far as possible).

Just before finishing –
This article is to present to our readers the information about vruddhi vis-à-vis inguinal hernia as explained in the Ayurvedic treatises. This is also to highlight the ancient wisdom about the disease and different strategies done by the ancient vaidyas to combat this condition in olden days, including surgical methods. This is also to bring forth the options of treatments and medicines explained for hernia in Ayurveda to our knowledge thirsty readers.
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