The Clinical Relevance of Artava: From Upadhatu to Modern Proteomic Diagnostic Biofluid: A Narrative Review

Abstract

Background: Artava, as described in Ayurveda is a core determinant of women’s reproductive health, encompassing menstrual function, fertility, and diagnostic indicators of gynaecological diseases. From an Ayurvedic ontological perspective, Artava is conceptualized as an Upadhatu originating from Rasa Dhatu, as described by Acharya Charaka and Vagbhata, whereas Acharya Sushruta emphasizes its manifestation as Rakta that is localized in the Garbhashaya and periodically secretes during menstruation. Classical Ayurvedic texts describe Artava, when endowed with normal colour, consistency, odour, and periodicity, as Suddha Artava, signifying physiological menstruation and reproductive competence in women. In Ayurvedic gynaecology, the assessment of Artava is based on the analysis of qualitative attributes such as colour, texture, odour, volume, and associated clinical features.  Conversely, contemporary biomedical science interprets menstruation as a physiologically regulated process driven by cyclical hormonal interactions within the hypothalamic–pituitary–ovarian axis and changes in the endometrium. Objective: This narrative review integrates classical Ayurveda concepts with modern scientific interpretations of menstrual physiology to elucidate the ontological basis, functional significance, and diagnostic benefits of Artava. Methods: This narrative review is based on a comprehensive analysis of classical Ayurveda texts, including Charaka Samhita, Sushruta Samhita and Ashtanga Hridaya, and their authoritative commentaries. Results: This review emphasizes the convergences between traditional sensory-based assessment and current biological understanding of menstruation, critically examines the clinical relevance of Artavadushti, and outlines future research possibilities, including molecular and proteomic evaluation of menstrual blood. Existing reviews often remain descriptive, fragmented, or confined to either classical exposition or biomedical correlation, without offering a cohesive integrative framework. Conclusion: This narrative review aims to critically analyze classical and contemporary literature to present an integrative understanding of Artava, including the conceptual and clinical significance of Artava Pariksha and Artavadushti, as well as the potential for translational research in this area.

Keywords: Artava, Rasa Dhatu, Upadhatu, Menstrual blood, Artava Pariksha