Karnini – Causative Factors, Symptoms, Pathogenesis, Treatment

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Karnini is one among the 20 gynaecological disorders. It is a condition in which the vitiated vata along with kapha and blood produces round protuberances obstructing the vaginal tract in woman who strains during labour in the absence of labour pains. Read – Signs And Symptoms In Different Stages Of Labor As Per Ayurveda

Causes, pathology

Causative factors
Akale vahamanaya – straining by woman during labour, in the absence of labour pains

Pathogenesis –
1. When a woman in labour strains in the absence of labour pain the vata gets aggravated. This aggravated vata obstructed by the fetus, withholds kapha and gets mixed with the blood.

This vata mixed with kapha and blood produces karnini i.e. rounded protuberances / small muscular balls resembling the shape and size of ear in the yoni i.e. vagina / cervical portion of uterus. This karnika obstructs the passage of menstrual blood. (Charaka) Read – Charaka Chikitsa Sthana 30th Chapter – Yoni Vyapat

2. Vitiated kapha along with blood produces small muscular ball like masses in the uterus. (Sushruta)

3. When woman untimely strains, there occurs premature ejaculation of fluids. As a result, vata gets aggravated. Aggravated vata withholds kapha and blood and produces protuberances in the uterus which blocks the passage of menstrual blood. Further it is said that the premature ejaculation of fluid brought about by untimely straining refers to either

• normal excretion of reproductive system coming at the end of orgasm or
• deliberate discharge of urine to deceive her husband by a woman not interested in sex

Consequentially the vitiated kapha solidifies blood, giving it a shape of abnormal protuberance / muscular structure which gets propelled by vitiated vata. This mass is called karnini. Read – Anatomy Of Female Reproductive System – Ayurvedic Perspective

This structure blocks the orifice of uterus i.e. cervix. As a result, when the semen / sperms are deposited in vagina, they do not ascend upwards due to the block in cervix. This results in absence of fertilisation. Shape of this growth resembles pericarp of lotus or muscular sprouts. (Indu, commentator of Ashtanga) Read – Essential Elements For Conception – Garbha Sambhava Samagri

Sanskrit verse

Correlation

Modern correlation and comparative study

Karnini means – ear or ear like.

The main characteristic feature of this disease is the manifestation of karnini blocking the passage of menstrual blood. Read – Srotas: Body Channels and Duct systems – Easy Explanation

Karnini and polyps

Karnini explanation resembles that of polyps?

Karnini or Karnika has many meanings. They are –

• Resembling ear
• Rounded protuberance
• Resembling pericarp of lotus
• Resembling brush
• Resembling tip of an elephant’s trunk

From the perspective of etymology of the disease i.e. karnini and also from the perspective of its main clinical feature i.e. formation of karnika (after which the disease has been named), the karnika appears to be a muscular structure covered with small sprouts / knots growing over the cervix of the uterus causing blockage of its orifice.

Considering all these explanations, karnini seems to be a condition which resembles with all kinds of cervical polyps. Read – Gynaecological Disorders Causes, Types As Per Ayurveda

Taking the Ayurvedic meanings of karnika and karnini –

Brush like structures / barbed growth – can be seen in cervical papilloma

Shape of the mass resembling with pericarp of lotus flower / knotted structure – can be seen in adenoma and polypodial fibroid developing in uterus

Structure resembling tip of elephant’s trunk – can be seen in mucus polyps Read – Arshas (Hemorrhoids), Ayurvedic Types, Causes And Symptoms

Why karnini cannot be an explanation of polyps?

• Bleeding due to ulceration, blood stained discharges or postcoital bleeding is very common in all polyps. But bleeding has not been mentioned in Ayurvedic references of karnini.
• Similarly, all polyps are treated with surgical removal. Surgical methods have not been mentioned as part of interventions of karnini gynaecological disorders.
• All kinds of polyps are different types of growths and are explained under the heading of arbuda, which are forms of tumours. Fibroid polyps can be considered under mamsa-arbuda and these conditions are said to be incurable in Ayurvedic texts. On the other hand, karnini gynaecological disorder is curable.

Due to the above mentioned reasons, karnini should not be equated to cervical polyps. Read – Menarche And Menopause – Ayurvedic Viewpoint

Karnini v/s Cervical Erosion

Some authors have compared karnini gynaecological disorder with cervical erosion.

Cervix of uterus becomes hypertrophic, congested and covered with small red projections resembling sprouts explained by commentator Indu in cervical erosions. This erosion is associated with nabothian cysts which are pea sized smooth nodular structures. Due to presence of small sprouts, the cervix assumes the shape of barbed wire or that of small brush. When the erosion is associated with nabothian cysts, it assumes the shape of pericarp of lotus. Read – Granthi: Cystic Swelling, Types, Features, Ayurvedic Treatment

When we see the number of lesions, Ayurveda explains the development of only one round protuberance i.e. karnika in this disease. On the other hand, cervical erosion does not look like rounded protuberance in spite of the erosion presenting with growth of small sprout like structures.

To match this condition with the classical explanation of karnika, we need to assume that the cervix of uterus itself becomes rounded and protuberant due to congestion, hypertrophy and nabothian cysts, assuming the shape of lotus pericarp i.e. karnika. Read – Cancer- Ayurvedic Understanding And Hopeful Treatment Modalities

Summary

On the basis of the above said descriptions, karnini seems to closely resemble with –

Cervical polyp – from the perspective of etymology

Cervical erosion – from the perspective of etio-pathogenesis, clinical features and treatment principles Read – Vaginitis: Ayurvedic Treatment, Medicines, Home Remedies

Treatment

Treatment of Karnini gynecological disorder

Uttara basti – the oil processed with Jeevaniya group of herbs is used for administering enema through vaginal route

Varti – a wick prepared with Saussurea lappa, long pepper, tender leaves or tip of twig of Calotropis and rock salt pestled with goat’s urine should be administered in the vagina / uterus

Shodhana varti – pessary prepared with cleansing herbs should be used Kapha nashaka chikitsa – all the measures capable of suppressing the kapha should be used.

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