ABSTRACT
In August, 2009, Dr. E.C.Sreevalsan has put into practice his “New Concept”, that” errors of development of the Mullerian Tract ( Mullerian Dysgenesis ) could be corrected and made to grow on normal lines, after the age of 16 years (when growth spurt diminishes ) and become functional, by the use of his ayurvedic regime and lead normal menstrual and reproductive lives.
The basis for this new concept arose, because one case of Mullerian Dysgenesis, wherein clinically, there was no vagina but with introital depression, on imaging, there was a midline nodule without a cavity, at the normal site of the uterus and on diagnostic laparoscopy, showed two tubes arising from the upper and outer aspects of the nodule, thus proving conclusively, that it was a rudimentary uterine nodule. This nodule grew into a uterus with cavity and menstruated on using his regime ( ref. – www.mullerian-malformations.blogspot.com. & http://drecsreevalsan.blogspot.com. ). If one nodule could grow and become normal, it is only reasonable to expect others to respond.
In 2005, after getting a Patent from the Government of India entitled “ An unique combination of ayurvedic compounds for correcting a rare form of Mullerian Dysgenesis “, he started, in a modest way, “Correction of Mullerian Dysgenesis “ at A.G.Chromepet Public Health & Maternity Centre, Chromepet, Chennai as a prospective one, on 01-04-2005. According to him, since it was only a defect and not a disease, one could only attempt a correction and not a cure. The incidence of Mullerian Dysgenesis is nearly 1 %. The cause is not known.
None of the video-lap pictures show any midline uterine swelling. Of the 15 cases undergoing correction, there were 1 each in hypoplastic uterus and unilateral nodule and the remaining 13, were of bilateral nodule variety. All the cases are showing development and of these, 4 (of the bilateral nodule cases) have developed cavity and lining (genetic evolutionary response) and in 3, increased thickening of the lining (early hormonal (functional) response and therefore, it is only a matter of time, for them, to menstruate,(attain menarche), thus lending credence to the “New Concept”.
This medical option now, provides us with a correction procedure for this category of birth defect.
Key Words: Mullerian Tract Defect – Dysgenesis – Primary Amenorrhoea – Correction – Eugenesis – Normal Menstrual and Reproductive Life.
Results at a glance:
(1)Hypoplastic uterus – 1 – progressing
(2) Uni-lateral uterine nodule – 1 – Three dimensional growth.
(3) Bilateral uterine nodule - 13
(a) Pregnancy - nil
(b) Menstruation - nil
(c) Cavity & Lining - 4
(d) Cavity only - 1 (transitory)
(e) 3 dimensional - 4
(f) 2 dimensional - 4
(g) 1 dimensional - 1
(4) No Change - nil
(5) Deterioration - nil
N.B.: The unique feature of this report is that, in three cases (out of four), there has been increase in E.T. (albeit slowly) and is, obviously, evidence of response to ovarian (hormonal) stimulation, thus completing all the basic steps (page.1.), followed by the rudimentary uterine nodule before menstruation. Now it is only a matter of time (since response to ovarian hormones has started) for menarche (first menstruation) to take place.
Introduction: The generative organs in the female are derived from the Mullerian Ducts. Normal development is referred to as Eugenesis. When development is arrested or altered, it is known as Mullerian Dysgenesis. The developmental defects may be fusion or non-fusion defects. Of the Fusion defects, thehypoplastic uterus is rare and uterine nodule is rarer. In the former, the uterus, though possessing all layers and cavity with lining, menstruation does not take place usually and this variety responds to hormonal therapy, due to the presence of end organ – lining. The uterine nodule, on the other hand, has neither the layers nor the cavity and hence, remains inert through-out life. The incidence of developmental defects of the female generative tract is nearly 1 %. In a country, like India, having a population of over 1 billion, presuming women to be 500 million, there would be 5 million with this defect. As this is a defect and not a disease, onlycorrection, may be attempted and not therapy. Women, above the age of 18 years, who have not attained menarche (onset of menstruation), are the ones, who need investigation, to diagnose Mullerian Dysgenesis.
Development: The Mullerian Ducts grow towards each other and fuse in the midline to form Utero-vaginal primodium. The nonfused portion of each duct gives rise to the tubes. The utero-vaginal primodium gives rise to the uterine corpus, uterine cervix and the major portion of the vagina especially the fibro-muscular coat. The formation of the cavity is from below upwards – vagina, cervical canal and endometrial cavity. The formation of the cervix and the corpus also takes place at the same time. At first the cervix is bigger than the corpus – infantile uterus. Next, corpus grows fast and the cervico-corporeal ratio becomes 1: 2 (as seen in the adult uterus). All these changes are complete by 20 weeks of pregnancy. At birth, 20 % of the female babies have vaginal bleeding during the first few days of birth, due to maternal hormones circulating in the baby’s body. Subsequently, they attain menarche (onset of menstruation) between 10 and 14 years and by 16 years menstruation is well established. The cause for the onset of menstruation was thought to be physical growth and hormonal activity. The genetic drive is now being considered as the cause and as proof of this, we find girls
Clinical Problem and Correction : A girl, who was 16 years old and having well developed breasts and other secondary sex characteristics, did not attain menarche and hence, an USG scan was taken. This showed anodule, situated at the normal site of the uterus (sans myometrium, sans endometrial cavity and sans endometrium) and a vagina below it, which was not communicating with the exterior. A diagnostic laparoscopy was performed, which revealed two tubes arising from the upper and outer aspects of the nodule (and the presence of one ovary on either side), thus confirming that the Nodule was a very rudimentary uterus. Normally, after the age of 16 years (end of the growth spurt), none of the organs in a girl develop and become functional. But, in this girl, correction took place, on administration of 11 Ayurvedic Compounds, in 8 phases, for 12 years and during this period Serial USG scans were taken; the serial USG scans provide theclinching evidence of the growth of the uterine nodule. The uterine Nodule grew in stages (akin to growth in utero) into a 3 dimensional (near normal uterus) anteverted uterus, with a Cervix and Corpus, with a cervico-corporeal ratio of 1: 1.9 (normal 1: 2), with an Endometrial cavity and endometrial lining, with evidence offollicular maturation and rupture from Both ovaries (signifying that the HPO Axis had become normal) and the vagina had also developed and communicated the newly formed endometrial cavity with the exterior. She has had two periods. (physical growth and function). Since she is now married, she may conceive.
Correction of Mullerian Dysgenesis, after relevant investigations is being conducted at A.G.Chromepet Public Health & Maternity Centre, No.2 Bharathi St., Radha Nagar, Chromepet, Chennai. 600044. Telephone No. 22655503. As this is a Trust Hospital, the expenses incurred by the individual seeking relief, will be low.
Dr.E.C.Sreevalsan has been granted a patent for his invention entitled “An unique combination of Ayurvedic Compounds for correcting a rare form of Mullerian Dysgenesis “.
Now, in the 21 st. century, all believe that such a uterine nodule (an extremely rudimentary uterus) especially, after the age of 16 years, will not grow, stands corrected.
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Summary
An extremely rudimentary uterus, in a 16 year old girl, has developed into a near normal sized one and has become functional, on administration of ayurvedic compounds for 12 years.
The ultrasound scan, showed a nodule at the normal site of the uterus (sans myometrium, sans endometrial cavity and sans endometrium) with a vagina below it, which was not communicating with the exterior. A diagnostic laparoscopy revealed two tubes arising from the upper and outer aspects of this nodule (and the presence of one ovary on either side), thus confirming that the nodule was an extremely rudimentary uterus.
The girl was given 11 ayurvedic compounds in 8 phases for 12 years and serial scans taken. The scans showed progressive development of the nodule (akin to growth in utero) into a hypoplastic uterus and the vagina had also developed and communicated the newly formed uterine cavity with the exterior and she has had two periods (physical growth and function).
Now, in the 21st century, all believe that such a defect (an extremely rudimentary uterus), especially after the age of 16 years, will not grow, stands corrected. Correction of this defect , after relevant investigations is being offered, now, at A.G.Chromepet Public Health and Maternity Centre ,Chromepet,Chennai-600044.
Ph:22655503
Dr.E.C.Sreevalsan has been granted a Patent for his invention entitled “An Unique combination of Ayurvedic Compounds for correcting a rare form of Mullerian Dysgenesis.”
Serial U.S.G. Charts - Analysis & Comments.
( Correction of Uterine Nodule - a rare form of Mullerian Dysgenesis.)
Introduction :- Ten pelvic scans, of which scan No. 6 & 7, are follicular scans. The ten scans provide clinchingevidence of growth of a nodule, - situated at the normal site of the uterus ( sans myometrium,sans endo-metrial cavity and sans endometrium ) and a vagina below it, which was not communicating with the exterior, - in stages ( akin to growth in utero ) into
a 3 dimensional ( near normal sized ), with a cervix and corpus, with a cervico-corporeal ratio of 1 : 1.9, anteverted uterus with an endometrial cavity and endometrial lining, with evidence of follicular maturation and rupture from both ovaries ( signifying that the H.P.O. Axis had become normal ) and the vagina had also developed and communicated the newly formed endometrial cavity with the exterior, after administration of 11 Ayurvedic Compounds in 8 phases for 12 years. She has had two periods (physical growth & function). Since she is now married, she mayconceive. Since this is a defectand not a disease, one can think of only correction and not therapy. Correction of this defect, after relevant investigations, is being offered at A,G,Chromepet Public Health & Maternity Centre, Chromepet, Chennai. 600044.
Ph. 22655503.
1.Clinching evidence of development of rudimentary uterus into near normal sized uterus.
Scan No. 1 : ( 04-04-1994 )
Analysis - This scan, of a 16 year old girl, taken 6 months prior to administration of Ayurvedic compounds for correction, shows a nodule at the normal site of the uterus ( sans myometrium, sans endometrial cavity and sans endometrium ) and a vagina below it, which was not communicating with the exterior.
Comments – Normally at 16 years, a girl would have attained menarche (onset of menstruation –Normally 10 – 14 years) and menstruation would have been stabilized. The medical diagnosis for this scan would be Mullerian Dysgenesis. If the vagina had been absent, it would have been designated as Mullerian Agenesis. In this girl, since she had not attained menarche by 16 years, this scan was taken.
Special Comments – It is noteworthy that this 16 year old girl, nearing the end of her physical growth, approached a clinician ( who was qualified in both Allopathy and Ayurveda and registered in both bodies ) for opinion. He was aware that she was otherwise physically normal (with a height of 5 ft. and 4 inches, with well developed breasts and normal secondary sex characteristics). He was also aware that the Mullerian Gene (gene related to the female generative tract ) was yet to be identified and in the absence of endometrial cavity and endometrium, there would be no response to hormones, if at all administered. Therefore, he offered her, Ayurvedic compounds hopefully and insisted, as an abundant caution, serial ultrasonographic scans, to spot any change or growth during administration. He performed a diagnostic laparoscopy which revealed two tubes arising from the upper and outer aspects of this nodule ( and the presence of one ovary on either side ), thus confirming that the nodule was an extremely rudimentary uterus. The incidence of developmental defects of the female generative tract is nearly 1 % . In a country, like India, having a population of 1 billion,presuming women to be 500 million, there would be 5 million women with this defect. As this is a defect and not a disease, only correction and not therapy could be offered.
Scan No. 10 : ( 17-08-2006 )
Analysis - This scan, taken 12 years later, shows a 3 dimensional, anteverted, hypoplastic, near normal sized uterus, with normal endometrial cavity and endometrium and vagina and the cervico-corporeal ratio was 1 : 1.9.
( normal – 1 : 2 ).
Comments – The correction of the uterine defect ( nodule ) and its growth into a near normal uterus, her two periods and her subsequent marriage, raises the hope that she may conceive and have a normal married life thereafter.
Special Comments:-Documentation is the bedrock of any scientific research and progress and the clinician’s insistence for serial scans, has now provided us with clinching evidence of the development of the rudimentary nodule into a normal uterus.
2.Pattern of growth.( akin to that which takes place in utero during the first twenty weeks of Gestation).
1. Mullerian ducts grow towards each other and fuse in the midline to form – utero-vaginal Primodium. The non-fused portion of each duct gives rise to the tubes. The utero-vaginal primodium, gives rise to uterine corpus, uterine cervix and the major portion of the upper
vagina, especially the fibro-muscular coat.
2. Formation of cavity and lining. The formation of cavity is from below upwards (Vagina, Cervical canal
and Endometrial cavity ).
3. Formation of cervix and corpus.
4. At first cervix is bigger than corpus ( infantile uterus )
5. Next corpus grows fast and the cervico-corporeal ratio becomes - 1 : 2.
Scan - 2
(28-08-95)
Scan - 3
(07-04-01) shows increase of size of myometrial streak becoming three
dimensional
Scan - 4
(16-03-02)
Scan - 5
(11-06-02) - Shows follicle in ovaries (appearance of endometrium)
Scan- 4
(16-03-02) – initiation of ? feedback process)
Scan – 6 & 7
shows smaller than normal, anteverted, hypoplastic uterus.
Scan - 8
(24-12-02) - Shows a smaller than normal, hypoplastic uterus,
normal cavity and vaginal length 5 Cm.
Scan-10
(13-02-04) – shows a smaller than normal, hypoplastic uterus,
vaginal length – 5 cms.
Scan - 6
(03-07-02) - Distinct cervix noted – cervicocorporeal ratio 1 : 0.5 (infantile uterus ).
Scan - 7
(30-07-02) - Distinct cervix noted – cervicocorporeal ratio 1 : 0.82.
Scan 10
(17-08-06) - Distinct cervix noted – cervicocorporeal ratio 1 : 1.9 ( Normal ratio 1 : 2 )
Scan - 4
(16-03-02) - Showed- not well differentiated cervix (appearance
of cervix),endometrial thickness 2 m.m. (appearance of endometrium)
Scan - 6
(03-07-02) - Normal differentiation of uterus into corpus and
cervix and the uterus had become anteverted (Normal position).
Ovaries – Functionally normal
Scan - 6
(03-07-02)
Scan -7
(30-07-02) showed follicular maturation and rupture – right ovary 05-07-02 and left ovary 01-08-02.
N.B:- She has had two periods proving that the HPO Axis has become normal. Patient is married and hence mayconceive.
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Birth Defect - Growth towards normalcy - ? Genetic Drive.
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CERTIFICATE OF PATENT ISSUED BY GOVERNMENT OF INDIA
Summary of the problem and correction
1. Rudimentary uterus ( or vestigial uterus or uterine nodule ) is a rare form of Mullerian
Dysgenesis which has an incidence of nearly 1 %.
2. Rudimentary uterus rarely undergo any change in life.
3. It is a birth defect, not a disease. Hence only correction and not cure can
be attempted.
4. Mullerian Gene is yet to be identified.
5. Genetic drive is currently considered as the cause of puberty changes.
6. Non-therapeutic administration of 11 Ayurvedic Compounds in 8 phases
has resulted in the growth of this rudimentary uterus on normal lines to
near normal size and it has manifested functional changes also.
7. These Ayurvedic Compounds have been therapeutically used for more than
1000 years for many conditions in man, woman and child. This is the first
time they have been used non-therapeutically to correct a birth defect
8. The duration of the 8 phases of Ayurvedic Compounds is for a total of not
less than 32 months. The combined and cumulative effect of these
compounds have stimulated genetic drive and made this inert
rudimentary uterus evolve on normal lines.
9. No medical correction in any system of medicine is available for this global
problem. This is the first viable option.
10. This breakthrough will herald new management options for birth defects.
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Genesis and Impact of Correction
Dr.E.C.Sreevalsan’s Regime – its impact on Gynaecology.
I, Dr.E.C.Sreevalsan, formulated a regime of ayurvedic compounds, which has developed, physically and functionally, a uterine nodule ( a rare form of Mullerian Dysgenesis ) into a near normal sized uterus and termed it as “Dr.E.C.Sreevalsan’s Regime “. This regime consists of eleven ayurvedic compounds, given in eight phases, to develop an uterine nodule ( rudimentary or vestigial uterus ). They are mostly herbal. I have been granted a Patent for this invention entitled “ An unique combination of ayurvedic compounds for correcting a rare form of Mullerian Dysgenesis“.
Introduction : Birth Defects are galore in clinical practice and one such condition is Mullerian Dysgenesis. Mullerian Ducts are responsible for the development of the female generative tract. Normally, the two ducts fuse in the human embryo and their subsequent canalization and hypertrophy result in the formation of the female generative tract, - consisting of tubes,uterus ( corpus and cervix ) and vagina ( major portion ), especially the fibromuscular coat. The lowermost part of the vagina is derived from the uro-genital sinus. This is designated as Eugenesis.
Normally, the non-fused ducts become the tubes, the fused one on canalization from below upwards, become vagina, cervical canal and uterine cavity and the uterus, in turn, has a muscular coat ( myometrium ),a lining layer ( endometrium ) and a cavity ( endometrial cavity ) with lining and this process is over by 20 weeks of pregnancy. This process may be arrested or altered, at any stage, producing fusion and non-fusion defects. This Is called Mullerian Dysgenesis and its incidence is 1 %.
Of the fusion defects, the Hypoplastic uterus is rare and the uterine nodule is rarer. In the former, the uterus, though possessing all layers and cavity with lining, menstruation does not occur usually and this variety responds to hormonal therapy, due to the presence of end-organ,- lining. The uterine nodule,on the other hand, has neither the layers nor the cavity and hence, remains inert throughout life. In this individual, natural growth of uterus was arrested during embryological growth and canalization ( from below upwards ) was restricted only to the upper part of vagina below the rudimentary uterus ( uterine nodule ) and from birth till 16 years manifested as an inert, erect tissue of minimal proportions and devoid of its normal layers and cavity, shape and position. It is this inert variety, which has now responded to the ayurvedic compounds and developed into a near normal sized uterus and has become functional. What is noteworthy is that ( akin to a person sleeping on duty, on being nudged, waking up and proceeding to complete his duties, albeit slowly ), natural development ( without any further abnormality ), which should have been completed in 10 months of intra-uterine life, has taken more than 10 years to complete the growth. Females, having this defect ( nearly 1 % ), do not menstruate. In other words, they do not attain Menarche ( onset of menstruation ). About 20 % of female babies have bleeding per vaginum in the first few days of life. This is because of maternal sex hormones circulating in the newborn’s blood. Why the remaining female babies do not have bleeding is not known. Normally girls begin to menstruate between the ages of 10 and 14. Physical growth and hormonal production were considered the cause for this onset. Now, genetic drive is considered as the cause and as proof of this, we find girls less than 10 years, menstruating. Unfortunately the Mullerian Gene is yet to be identified.
Facts of the Case :- In the year 1994, a 16 year old girl was brought to me with the above problem. The Scan result done in 1994 showed the following features :-
(1)A rudimentary uterus in place of uterus
(2)A canalized vagina below it and
(3)Left ovarian cyst and right ovary normal.
A diagnostic laparoscopy was done which confirmed the above findings and in addition, showed two tubes arising from the upper and outer aspects of that rudimentary tissue, thus confirming that it was an uterine nodule. As there was no medical option in Allopathy, I, being qualified in both Allopathy and Ayurveda, advised that ayurvedic compounds could be given and the changes or improvements, if any, could be monitored by serial scans. The patient agreed and ayurvedic compounds for correction of the condition were given in 1994.
Results :- The ayurvedic compounds mentioned in the Regime were given, initially singly and subsequently in combination – an optimum combination - to produce synergism, resulting in the stimulation of the genetic drive and thus the growth. These ayurvedic compounds helped the uterine nodule to develop into an uterus ( vide serial Scan reports enclosed ). The patient had a normal HPO Axis as evidenced by ovulation from both ovaries. The patient had two periods after the uterus developed over a period of 10 years. In this case, initially, there was no cavity ( end organ non-existence ) and therefore, no bleeding occurred. Later, when the cavity and endometrial lining developed and since there was no end organ resistance, she had bleeding. This, according to me, is a pioneering effort, as there is no reported case in medical history, where such a change has occurred and has to be regarded as a breakthrough.
The scan on 17-08-2006 showed
(1) a hypoplastic uterus,5.8 X 2 X 3 cms.
(2) a normal endometrial cavity and having endometrial lining and
(3) vagina had also developed and was communicating the newly formed cervical canal and endometrial
cavity with the exterior.
The cervico-corporeal ratio has become 1 : 1.9 ( normal 1 : 2 ).
Now that growth has reached near normalcy, what is yet to be achieved are
(1) Regularity of periods ( which, many with normal generative tract do not have. Even this can be
corrected ).
(2) Pregnancy. – as she is married, one can expect this to take place. Pregnancy will prove to be an acid test for both the endometrium and the myometrium to carry the pregnancy to term and deliver normally. The natural growth till date suggests that there will be no problem.
The spectacular progress ( hitherto unheard of ) would be viewed by
(a) the devout – as a divine dispensation
(b) the scientist – as an expression of the persevering scientific spirit
against odds
(c) the woman having an uterine nodule – as a ray of hope and
sunshine in life’s tunnel of darkness.
Is this really a pioneering effort ?
The explanation for these changes could be
(1) Chance – ( scientifically not acceptable )
(2) Miracle – ( supernatural event – usually non-repetitive ) or
(3) An extreme case of persistent M.I.H. ( Mullerian Inhibiting Hormone ) getting over at 16 years ( exceptional ) or
(4) Ayurvedic Compounds acting
(a) On the Mullerian Gene – stimulation of the Mullerian Drive or
(b) On the Mullerian tissue or
(c) By cancelling M.I.H.
To confirm which of these 4 possibilities is the cause, further clinical studies are required. Correction of Mullerian Dysgenesis ( uterine nodule ), after relevant investigations, is being offered at A.G.Chromepet Public Health & MaternityCentre,No.2.BharathiStreet.,RadhaNagar,Chromepet,Chennai.600044. Telephone No. 22655503. As this is a Trust Hospital, the expenses incurred by the individual seeking relief would be low.
What is the need for exploring/researching on this finding ?
Mullerian Dysgenesis is a global problem and the incidence of this condition is nearly 1 %. Moreover, the Mullerian Gene is yet to be identified. The maternal instinct is one of the strongest instinct in the human female. Any female born with a uterine nodule, given a choice, would undergo correction in the hope of attaining womanhood and subsequently achieving motherhood. It is my intuition that further clinical studies might help in identifying the Mullerian Gene, which will be a major breakthrough in the field of genetics. In a country, like India, having a population of over 1 billion, presuming the number of women to be 500 million, the number of women having this defect would be 5 million. It would be a Herculean task to trace these afflicted women, but by using modern technology, it can be done.
Drugs :-
Medicinal drugs have two functions.
(1) Therapeutic – therapy or treatment of diseases, where drugs are given to combat and conquer Disease.
(2) Non-Therapeutic – drugs are given to those who do not belong to category (1), to supplement body resources, so that the vim, vigour and vitality of the individual is maintained. This category includes
(a) Vegetarians – their diet lack one or more essential amino-acids, as vegetable proteins are biologically incomplete. This holds true even for fat soluble vitamins such as A and D and as well as water soluble, such as B 12, which are essentially animal based and supplementation becomes mandatory.
(b) Elderly – Prone for deficiency of vitamins and minerals, resulting in low bone density. The combination of amino-acids, vitamins and minerals can offset the deficiency and contribute to physical wellbeing.
(c) Pre-menopausal and Post-menopausal Women – Due to deficient intake of dietary Calcium and vitamin D. Supplementation of these along with an anti-osteoporotic agent has a beneficial effect.
(d) Pregnancy and Lactation – A physiological process, wherein there is a high risk of nutritional deficiency.
(e) Stress and Convalescence – Every process in the body is associated with number of Interlinked processes. Modern life is full of stress. Nutritional Supplementation becomes the cornerstone of management.
(f) Congenital Anomaly or Birth Defect – Nature has come to a standstill. Since this is not a disease but a defect, at least, non-therapeutic drugs may be given to correct the problem. At present, there is no method of correction – of improving or developing –( a state of equipoise ), the rudimentary uterus, which is a global problem. Luckily for us, this non-therapeutic administration of ayurvedic drugs, has shown that it not only increases wellbeing but also stimulates the rudimentary nodule to grow.
The regime uses 11 ayurvedic compounds, given in 8 phases ( phases may be advanced depending on response ), as well as allopathic investigations, not only to confirm the diagnosis, but also for confirmation of improvement. Monthly USG.Scan is done and any increase, in any dimension of uterus, of more than 0.5 cm., is considered significant. Other parameters mentioned in the checklist noted and special entry made, to signify that the next phase of the correction may be brought forward. At this point, the geneticist as well as the endocrinologist are alerted so that any additional test or investigation may be done. It is this integration of medical systems ( 5000 year old Ayurveda and in India, 500 year old Allopathy ) that augurs well for the future. This integrated step, though not small, might prove to be a giant stride for womankind.
Ayurvedic Medicine
In India, Ayurveda – “the science of life “ –expounded more than 5000 years ago, is still being practiced all over the subcontinent and caters to the health needs of the majority, especially in the villages. Unlike other countries, the history of medicine can be traced to the remote past. Ayurvedic medicine as enunciated by Charaka and surgical management especially plastic surgery – rhinoplasty – as enunciated by Susrutha held sway for many centuries. The efficacy of herbal medicine is built upon the practical experience of generations, nay, centuries and the data available now, has been obtained at a high price, namely, countless lives dedicated to progress. With its vast area and abundance of greenery, India can cater to the needs of the whole world.
The basis of Ayurveda is the “ Tridosha Theory “ – the three humours – Vatha, Pitta and Kapha. When these are in equilibrium, the individual is healthy. Vitiation of one or more doshas leads to disease. Hence, restoration of health is achieved by setting right the imbalance, after clinical evaluation to assess the condition of the doshas. Herbal medicine has contributed many drugs to modern medicine. Today, we are on the threshold of a massive genuine research in herbal medicine of all nations.
Ayurvedic Compounds used in this regime :
11 Ayurvedic Compounds are given together, not in a mixture, but in 8 phases, to a total of minimum 32 months and more, to achieve a beneficial change in the rudimentary uterine nodule. They are given at different timings during the day depending on the phase. Phases may be advanced, depending on response. Of the eleven compounds Ghrithams – 3, Arishtam – 1, Lehyam – 1, Vati – 2, Kashayam 2, Thailam – 1 and Choornam Tablet -1. Ghrthams are medicated ghee preparations, which contain the fat soluble medicinal principle of the drugs used in the particular preparation. Arishtams are alcoholic medicaments, which are prepared by allowing the juices or decoctions of raw drugs mixed with sugars to undergo fermentation. They are mixed with an equal volume of water before taking i.e. given in 1 : 1 dilution. Lehyams are linctuses or confectioneries or sweetened extracts equivalent to confections, electuaries and conserves of British Pharmacopiae. Vatis are pills or tablets. Kashayams are decoctions made from coarse powders. Given in 1 : 4 dilution. Thailams are medicated oils. Choornam are fine dry powders of drugs. Choornam Tablets are made by the help of tablet making Machines. Some suitable adhesive and disintegrant are used to facilitate tablet pressing. Ayurvedic Compounds are available all over the country. The name of the compound in Ayurveda is based usually on the dominant ingredient or ingredients in the formulary. At times, the author’s name is included in the name. Drug firms usually mention the text and the chapter, from which the compounds formulary taken and the dosage. Drug firms normally provide, both drug formulary as well as therapeutic index. Merely verifying the name of the drug is not enough. One must make sure that it is from the text referred to in the drug list ( unlike Allopathic Medicine ). There are drugs with the same name, but from different text books and their indications may be different. Some ayurvedic firms manufacture compounds from two formularies with the same name and therefore designate the ayurvedic compounds as No. 1 and No. 2. The formulary for the compounds used in the regime give the chapter and text from which it is taken and is, therefore, the sheet anchor of the correction schedule. Hence care taken to prevent mistakes These ayurvedic drugs have been used for centuries for the treatment of various conditions in man, woman and child as per the indications of the respective compounds. All of them are not specific for uterine problems. They have always been used therapeutically as per indications. This is, probably the first time, they have been used non-therapeutically as the problem is not a disease, but a birth defect.
In India, Astrology is intimately linked with the lives of the people. An Astrological aphorism states “When Seventh House, or Navamsa of Seventh Lord be owned by Sun, Mars or Saturn, with benefic Aspects disowned, such an afflicted natal chart points to a defective generative tract - ( Mullerian Dysgenesis )”. Incidentally, the natal chart of this case shows Mars occupying the Seventh House and It happens to be its own house ( indicating that there is scope for further research ).
The Impact of this study:
The impact would be mainly in the following fields :-
(1)Medical – Since there are no medical option for this problem ( state of equipoise ), one can undertake further studies without controls. In Mullerian Dysgenesis we rarely come across such a rudimentary uterus ( hypoplastic uteri are more common ) and since this uterus has evolved on normal lines, one can be reasonably sure, that the corrective medication, would be effective in other cases.
(2)Genetics – During further study, when improvement noted, one should involve the geneticist, since there is every chance of the Mullerian gene being identified ( just as serial scans in pregnancy helped in evolving antenatal and intra-natal manipulations ) and
(3)Phytochemical Research: The study will serve as a pointer to the phytochemist to concentrate his efforts based on the Ingredients ( specific herbs ) of the compounds.
Is there any possibility of diagnosing the condition early ?
( 1 ) Antenatal Scans : may spot out an uterine nodule. (N.B.: In India , there is a ban on sex determination during the antenatal period; hence this method is mentioned only for completion sake. )
( 2 ) Newborn :
(a) Absence of withdrawal bleeding per vaginum in the first week of life - probability.
(b) Neonatal scan ( USG )
(c)Palm Print – According to Dr.Arunachalam Kumar, palmar dermatoglyphics reveal “ open fields “ over thenar areas . The presence of the transverse palmar crease ( the Simian crease ) in Down’s Syndrome is well known.
(d) Natal Chart. – As mentioned earlier, there is scope for further research.
( 3 ) Infants. - Scan
( 4 ) Children. – Scan
( 5 ) Adolescents. –
(a) who have not attained menarche. ( menarche - usually between 10 and 14 years can wait up to 16 years. - Scan.
(b) 16 to 18 years – Scan and other investigations to find out the cause for Delayed Menarche – scan.
(c) Above 18 years – Primary Amenorrhoea – scan.
Phases :- The 11 ayurvedic compounds have been given in 8 phases, each phase of different duration, to a total of not less than 32 months. The phases have been brought forward on observation of improvement during the monthly scans. The phases act as the correction procedure. They produced canalization of the vagina, cervical canal and endometrial cavity. They induced development of the lining of the cervical canal and the endometrial cavity. They produced growth of the uterus and subsequently differentiation of the uterus into cervix and corpus as well as the corpus into myometrium and endometrium. They made the lining of the endometrium responsive to the effect of the ovarian hormones and thus the patient has had two periods. It is evident that the ayurvedic compounds have acted in a combined and cumulative manner to produce these changes.
Hope :- This is the first viable option. One can hope that this breakthrough will herald new management options for birth defects.
A Sonnet.
Mullerian Dysgenesis.- Natal Chart. ( 19-8-04 ).
Many have wandered, aimlessly,
In the realms, of Astrology.
I have also wandered, but purposefully,
Trying to cull the tenets, hopefully,-
Of female horoscope, difficult to decipher,
For many things, one has to consider.
Being an obstetrician and a gynaecologist,
I yearned to become, a ‘ female ‘ astrologist.
One aphorism, I managed to get, in fact,
Pointing, to a defective, generative tract.
When Seventh house, or Navamsa of Seventh Lord be owned,
By Sun, Mars or Saturn, with benefic aspects disowned;
Such an afflicted natal chart, on analysis,
May turn out to be – Mullerian Dysgenesis.
Naslav Eersce.
Some of the Recent Publication in Magazines and Newspapers for Awareness
MATHRUBHUMI-LEADING MALAYALAM DAILY
The First Correction Report.( 01 -02 - 2010 ).
Introduction.
The correction of a rare form of Mullerian Dysgenesis was started at A.G.Chromepet Public Health & Maternity Centre, Chromepet, Chennai.600044, as a prospective one, on 01-04-2005. The first case came on 13 - 08 – 2006, after reading a write-up, in “ Muttram “( April, 2006), the official organ of the Tamil Nadu Corporation for Development of Women. Subsequent to a news item, which appeared in a Malayalam daily – “ Mathrubhoomi “ dated 19 - 07 – 2009 ( Sunday ), there has been a spurt of cases from among Keralites ( mainly from Kerala, a few from Mumbai and Bangalore.
The salient features of the correction are as follows: At first appointment, all cases of primary amenorrhoea underwent pre-correction evaluation – (a) clinical examination, followed by (b) biochemical tests and (c) an abdominal scan to identify and confirm the diagnosis of Mullerian Dysgenesis. One notable feature of the scans needs emphasis, (since scans are the sheet anchor of correction), a single observer is bound to give the best results for correction. All who had 46, XX, as karyotype, were then subjected to video-laparoscopy for confirmation and record and then given medicine for one month. They were informed that the karyotype result would be the deciding factor for eligibility for correction. Subsequently every month they were scanned and given medicine. When a scan showed increase of dimension by 0.5 c.m., in any dimension, it was regarded as progress and the next phase of the regime brought forward. The Ayurvedic Regime consists of 11 compounds given in 8 phases. At the end of each quarter the physical response, hormonal status and imaging changes were reassessed and a report made.
(A) Clinical examination: - When one is treating a disease, one checks the relevant body system physically and investigation is directed to it. When one is attempting to correct a birth defect, the response to drugs will depend on the individual’s physical fitness and therefore, the main tests pertaining to all systems have to be done. Moreover, an individual with a defect in the reproductive system may exhibit defects in other systems as well.
(B) Biochemical Tests of blood and urine are done. In the blood, chromosome analysis, hormone assays and general tests of various systems are done. Karyotyping, as mentioned earlier, is the decisive test, as only 46, XX,cases are eligible for the corrective procedure. Hormone assays to find out the levels of the following hormones are done; - Estrogen, Progesterone, Follicle Stimulating hormone, Luteinising hormone, Testosterone and Prolactin. Thyroid hormones are also assessed. General blood tests such as Grouping and Typing, bleeding time, clotting time, haemoglobin estimation, packed cell volume, total and differential counts, erythrocyte sedimentation rate, HbsAg, H.I.V. Tests – I, II, Blood sugar estimation (both fasting and post-prandial), urea, creatinine and uric acid are done. In urine, routine tests for pH, albumin, sugar and deposits.
(C) USG. Scanning done in all cases, after clinical examination. The impression of the sonologist was recorded under the following heads:
(a) Mullerian Dysgenesis: Normal uterus visualized ( with cervical aplasia/hypoplasia and/or vaginal aplasia/hypoplasia ), hypoplastic ( wherein the cervico-corporeal ratio is 1 : 2 ), infantile uterus ( wherein the cervico-corporeal ratio is 2 : 1 ), nodular uterus, rudimentary uterus, vestigial uterus, streak uterus(like a line), or uterine tissue with length, breadth and thickness, no uterus seen but cervix and/or vagina seen
(b) Mullerian Agenesis: when uterus, cervix and vagina are absent.
(c) Gonadal Agenesis: when ovaries are absent.
(d) Gonadal and Mullerian Agenesis: when uterus, cervix, vagina and ovaries are absent.
(e) Mullerian Dysgenesis and Gonadal Dysgenesis.
(f) Mullerian Agenesis and Gonadal Dysgenesis.
(D) Magnetic Resonance Imaging is done, if there is any doubt.
(E) Diagnostic Video-Laparoscopy –to confirm diagnosis, record and commence correction.
From 26 – 07 – 2009 till 31 – 10 – 2009, 26 cases of Primary Amenorrhoea reported for study. As mentioned above, clinical examination followed by karyotyping was done in all cases. This revealed 20 cases with 46, XX, of whom 5 had additional features ( translocation, deletion, mosaicism and insertion ). 5 of them were married and 2 had vaginoplasty before marriage. Of the remaining 6 cases 5 were Turner’s Syndrome and 1 of 46, XY. The 5 who had additional features were as follows:-
(a)mos 46, XX,t(1;3)(1p34.1;3p21) – translocation of chromosome 1p34.1;3p21 in 60% of cells. (1p34.1;3p21) karyotype has been reported with reproductive failure in both men and women. This case has not reported for further evaluation.
(b) 46, XX, ins(2q)(11.1;21.2) mosaic in 20 % of cells. This case has reported and correction started.
(c)46, XX,ins(7p)(p21;p14) mosaic in 20 % of cells She has not reported till date.
(d) Mos 46, XX,del(xy)(q25;q28) in 14 % of cells. She is yet to report.
(e)46, XX,add(22)(p13) in all the cells. She is undergoing correction.
Pre-Correction Evaluation :-
Pre-correction Evaluation is a three fold study based on (1) clinical examination (2) Biochemical tests and (3) USG Scanning to identify and set right deficiencies, if any, so that they become fit and their chances of responding to the correction process become optimal. Of the 20 cases 12 had undergone diagnostic video-laparoscopy and are now undergoing correction. The evaluation of these 12 cases, prior to correction is given below:-
A. Clinical ( including family history and relevant earlier reports )
(1) Age. In the group 14-16 there were 4 cases and 3 cases in 17-19
group but the majority (5) were in the 20-39 group.
(2) Height. Only 1 case was below 155 cms.
(3) Body Mass Index. 8 were normal and the rest underweight.
(4) There was no obvious case of goiter or hirsutism.
(5) There was no case of discharge from nipples and Tanner
staging of the breasts showed 1 of stage 3, 2 of stage 4 and the
rest stage 5.
(6) As regards hair, in the axillae – there were no case of stage 1, 1
case of stage 2 and the rest showed stage 3 and in the pubic
region all the cases were in stage 5.
(7) External Genitalia examination did not reveal any case of fused labia and vagina was present in 6 cases and in 4 cases there was introital depression and in2 cases vagina was totally absent.
(8) Vaginal examination in the 2 married women revealed uterii smaller than normal but in 1 it was in the midline and in the other it was laevo-posed.
(9) Rectal examination showed presence of uterus or uterine nodules in 6 cases and in the rest nothing was palpable. Right ovary was palpable in 2 cases, of which 1 was tender.
(10) Family History. Two of the cases were married and the rest single. Neither of them had attained menarche but one had withdrawal bleeding from the age of 15 for 8 years. She stopped medication 8 years ago and since then, has not had any bleeding P.V. The other did not respond to any medication. There was no case of delayed menarche in any family member and no other member in the family had a similar complaint.
(11) Associated Anomaly. 1 case had associated congenital anomaly
of the Cervical vertebrae and had partial loss of hearing.
B. Biochemical Tests.
(1) Karyotyping: ( only 46,XX, were taken up for correction )
As mentioned earlier, 2 who showed additional features, are undergoing correction. The laboratory has suggested molecular test for SRY Gene in 2 cases and FISH in one case.
(2) Hormone Assays. Estrogen, Progesterone, FSH and LH were within normal limits in all cases. Testosterone estimation revealed 1 of low level and 1 of high level. Prolactin levels were within normal limits in 11 cases and the last one showed below normal limits. As regards Thyroid profile, T3 and T4 were within normal limits in all cases but TSH Levels were high in 1 case and low in the other case.
(3) Blood Group and Type.- Of these 12 cases, 3 were A group, 4 were B group and the remaining 5 were O group. There was 1 case of Rh negative and the remaining 11 were Rh positive.
(4) General –
Hb. – the least was 10.5 and the highest 12.5 and P.C.V. ranged between 32 and 38. Other blood parameters were within normal limits.
Urine – Except for aciduria in all cases, there were no specific changes.
(5) Palm Print – The presence of ‘ Open Fields ‘ over the thenar eminences was studied. There were 7 cases of bilateral O.F., 2 on right, 1 on left and in 2 cases there were no O.F.
(6) Natal Chart – The study is not complete and hence will be given in the next correction report.
C. USG Scanning. Impressions.
|
Mullerian Dysgenesis |
7 |
|
Mullerian Dysgenesis and Gonadal Dysgenesis |
1 |
|
Mullerian Agenesis |
1 |
|
Mullerian Agenesis and Gonadal Dysgenesis |
2 |
|
Mullerian Agenesis and Gonadal Agenesis |
1 |
In one case there was a pelvic kidney on the left side.
D. M.R.I. ( abd. ) was resorted to in 1 case viz., the case in which both M.Agenesis as well as Gonadal Agenesis were reported, as it was felt that no purpose would be served by developing the M.System in the absence of the gonads and to exclude ectopic site of gonads. The impression of the MRI was as follows;- uterus and cervix not visualized, visualization of vagina between bladder and rectum – 6 cms., bilateral ovaries seen, normal in size and contour just deep to the anterior abdominal wall above the inguinal ligament, right ovary being anterio-medial and left ovary anterior to external iliac vessels.
E. Diagnostic Video-laparoscopy. There were 2 uterii, one in the midline and 1 to the left of midline. In 8 cases, there were bilateral nodules. There were 2 cases of unilateral nodules, 1 on the left and 1 on the right.
F. Serial USG Scans. The first phase of correction is for 4 months and is intended to increase size. Only 4 cases have completed the first phase of correction.
|
Case # |
Clinical |
Biochemical |
Imaging |
|
Case 1 |
BMI
|
Hormones - Estrogen
|
Uterine Nodule
|
|
Case 2 |
No change |
Hormones - Testosterone
|
Breadth from 0.9 to 1.1 |
|
Case 3 |
No change |
Normal |
Length from 4.5 to 6.0
|
|
Case 4 |
No change |
Normal |
Breadth from 0.6 to 1.1
|
It is too premature to assess progress but indications are present.
Bio-data of the Investigator.
Name: Dr. E.C.Sreevalsan.
Address: "Padmasree",
Plot no.10.V.G.P.SRINIVASA NAGAR,
No.25.Madambakkam Road,
Chennai.600073.Ph.No.044-22280041
E.mail: ecsreevalsan@yahoo.co.in
Age: 76 years
Date of birth: 12-03-1933
Place of birth: Syrium, Lower Burma.
Qualifications: B.A. (Bachelor of Arts) – Madras University.
G.C.I.M. (Graduate of the College of Integrated Medicine)
D.M.& S.(Diploma in Medicine & Surgery)
M.B.B.S.( Bachelor in Medicine & Bachelor in Surgery )
D.G.O. ( Diploma in Gynaecology & Obstetrics )
M.D. ( Doctorate in Medicine )
Post last held: Resident Medical Officer,
I.O.G.,& Govt. Hospital for Women & Children,
Egmore, Chennai, 600008. &
Additional Professor of Obstetrics & Gynaecology,
Madras Medical College, Madras.
Present Occupation: Consultant Obstetrician & Gynaecologist.
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