KASHTARTAVA (PRIMARY DYSMENORRHOEA): AYURVEDIC PATHOPHYSIOLOGY AND CLINICAL EVIDENCE FOR HERBAL AND PANCHAKARMA INTERVENTIONS — A NARRATIVE REVIEW
Background: Primary dysmenorrhoea is the most common gynaecological complaint of young women and a leading cause of school and work absenteeism. Conventional first-line therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptives is effective for many women, but a proportion do not respond, cannot tolerate long-term use, or prefer non-hormonal options. Ayurveda describes painful menstruation mainly under Udavartini yonivyapad and the contemporary term Kashtartava, both centred on disturbed Apana vata. Objective: To review the classical Ayurvedic understanding of Kashtartava, correlate it with current knowledge of prostaglandin-mediated uterine pain, and summarise the clinical and experimental evidence for Ayurvedic herbal and Panchakarma interventions. Methods: Classical texts (Charaka Samhita, Sushruta Samhita, Ashtanga Hridaya) were reviewed for descriptions of painful menstruation and its management. PubMed was searched for reviews, randomised controlled trials, meta-analyses, protocols and case reports on primary dysmenorrhoea, Ayurvedic interventions and herbs used in Ayurvedic practice. Findings were synthesised narratively. Results: The classical description of Udavartini yonivyapad, in which obstructed and reversed movement of Vata produces painful, difficult menstrual discharge relieved after flow, corresponds closely to the modern model of prostaglandin-driven uterine hypercontractility and ischaemia. Meta-analyses support ginger and members of the Apiaceae family, including dill (Shatapushpa) and fennel (Mishreya), as being superior to placebo and broadly comparable to NSAIDs for pain intensity, although trial quality is generally low. Evidence for classical formulations and Basti therapy is limited to small open studies, case reports and ongoing trials. Conclusion: Ayurvedic Vatanulomana and Shulaprashamana strategies are biologically plausible and partly supported for primary dysmenorrhoea. Adequately powered, placebo-controlled trials of standardised classical formulations and Basti protocols are now required.