Ashtanga sangraha sharira sthana chapter 4 – Garbha Vyapat – disorders of pregnancy;
अथातो गर्भव्यापदं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ॥ १ ॥
Garbhasrava – abortion
स्त्री चेदापन्नगर्भा परिहार्याण्यासेवेत ततश्च यस्या बस्तिपार्श्व श्रोणियोनिभुखेषु शूलं पुष्पदर्शनं च स्यात् । तां मृदुसुखशिशिरास्तरणशयनस्थामीषदवनतशिरसं शीतप्रदेहपरिषेकादिभिरुपाचरेत् ॥ २॥
When the pregnant woman indulges in things (foods and activities) which are to be avoided, she develops in the flanks, the sides of the urinary bladder, pelvis and vaginal opening and also the appearance of menstrual flow. (antenatal haemorrahage). She should then be made to lie on a soft, comfortable and cold bed, with her head slightly bent down, her body covered with cold packs and cold water sprinkled over it and such other measures adopted. (2)
तद्यथा । सहस्रधौतेन सर्पिषाधोनाभेः सर्वतः प्रदिह्यात् । मधुकसिद्धसर्पिषा सुशीतेन पिचुमाप्लाव्य योनिसमीपे स्थापयेत् । गव्येन पयसा मधुकाम्बुना न्यग्रोधादिकषायेण वा परिषेचयेत् । परिपीततत्स्वरसानि च तैलानि योनौ निधापयेत् । तच्छृङ्गसिद्धस्य वा क्षीरसर्पिषः पिचुम् ॥३॥
Such as the abdomen below the umbilicus should be anointed with ghee washed a thousand times(Shatadhauta Ghrita), a diaper soaked in ghee medicated with madhuka should be placed near the vaginal orifice; it should be sprinkled with cows milk, water boiled with madhuka or decoction of drugs of nyagrodhadi (group); the fresh juice of the above drugs and oil processed with them should be applied into the vagina, a diaper soaked in the juice of the sprouts of the above drugs or in ghee obtained from milk can be inserted. (3)
अतिस्रवति तु रक्ते तत एवाक्षमात्रं प्राशयेत् । केवलादेव वा क्षीरसर्पिषः । पद्मोत्पलकुमुद – किञ्जल्कं च समधुशर्करं लेहयेत् ॥४॥
धातकीगैरिक सर्जरसाञ्जनचूर्णं वा मधुना । न्यग्रोधादित्वक्प्रवालकल्कं वा । शशैणहरिणरुधिरं वा सक्षौद्रं पाययेत् । ऋद्धिविदारीजीवन्तीर्वा पयसा । नीलोत्पलसितापक्कलोष्ट चन्दनादि वा तण्डुलाम्बुवासारसान्यतरेण । गन्धप्रियङ्गुसितोत्पलशालूकोदुम्बरशलाटु – न्यग्रोधशुङ्गानि वाऽऽजेन पयसा ॥५॥
If the quantity of blood is too large, she should made to lick one aksa of ghee processed with the above drugs or plain ghee obtained from milk. She should also be made to lick the kinjalka (filaments) of padma, utpala, or kumuda mixed with honey and sugar. (4)
Or powder of dhataki, gairika, sarjarasa, and anjana (sauviranjana) mixed with honey or a paste prepared from the bark or sprouts of drugs of nyagrodhadi group; or the blood of rabbit, deer or antelope mixed with honey can be given to drink; or milk medicated with rddhi, vidari or jivanti; or water processed with nilotpala, sita, heated clay and chandana; or water in which rice is washed or water of a saras (natural lake) or any other (of similar quality); or goats milk boiled with gandha priyangu, sita, utpala, saluka, tender fuits of udumbara and young leaf buds of nyagradha. (5)
कशेरुकमृणालक शृङ्गाटककाश्मर्यपरूषकद्राक्षासारिवाप्रपौण्डरीकानन्तोत्पलकदम्बबीजक्वाथेन वा शर्करामधुमधुरेण शालिचूर्णम् । जीवनीयशृतं वा क्षीरम् । बलातिबलाशालिषष्टिके क्षुमूलकाकोली शृतेन पयसा समधुशर्करेण रक्तशाल्योदनं सुशीतं भोजयेत् । शीतवीर्यजाङ्गलरसेन वा । रक्तपित्तक्रियाश्च शोधनवर्ज्याः प्रयुञ्जीत। सौम्याश्च मनोऽनुकूलाः कथाः ॥ ६॥
A mess prepared from rice flour processed with the decoction of kaseruka, mrunala, srigataka, kasmarya, parusaka, draksa, sariva, prapaundarika, ananta, utpala, kadamba bija, mixed with sugar, honey or other sweet things; or milk boiled with drugs of jivaniya gana (group of drugs) or boiled red rice along with milk boiled with atibala, sali, sastika, iksumula and kakoli along with honey and sugar and made cool; it can be eaten mixed with juice of meat of animals of desert-like regions and which is cold in potency; therapies prescribed for the treatment of raktapitta (bleeding disease) except the purificatory ones, should be resorted to; stories which are pacifying and pleasant to the mind should be narrated to her. (6)
अदृष्टशोणितां तु मधुकपयस्यासुरदारुभिः सिद्धं पयः पाययेत् । ताम्रवल्यश्मन्तकशतावरीपयस्याभिर्वा । विदार्यादिगणेन वा । श्वदंष्ट्रास्वरसक्षीरसिद्धं वा सर्पिः । पलाण्डुरससिद्धं वा सौद्रम् ॥ ७॥
The woman who has no menstrual flow (but who has only pain) should be given milk boiled with madhuka, payasya and suradaru to drink; or (milk) boiled with tamravalli, asmantaka, satavari and payasya; or milk boiled with drugs of vidaryadigana (group): or ghee medicated with fresh juice of svadamstra and milk; or ghee processed with juice of palandu and mixed with honey. (7)
असम्पूर्णत्रिमासायास्तु पुष्पदर्शने गर्भः प्रायो न तिष्ठत्यसञ्जातसारत्वात् ॥८॥
If menstrual flow appears (antenatal haemorrhage) before the completion of three months (of pregnancy) the foetus will not usually continue inside, because of nonformation of the essence (elements like tissues). (8)
आमान्वये चोर्ध्वमपि विरुद्धोपक्रमत्वात् । तत्र रूक्षशीतानि प्रयुञ्जीत ॥९॥
Menstrual flow appaering, even after that period, the pregnancy does not continue because the treatments needed (to stop bleeding) will be of opposite nature. In that condition, treatment should be therapies which are dry (causing dryness ) and cold (in effect). (9)
तद्यथा । प्रागुपवासं ततो दुरालभामृतोशीरपर्पटकघनचन्दनातिविषाबलाकट्वङ्गधान्याक- :: क्वाथपानम् । तृणधान्यशालिषष्टिकपेयामशनं च मुद्गादियूषैः । जिते त्वामे स्निग्धशीतानि पूर्ववत् ॥१०॥
Such as; firstly, fasting (before the use of medicines), next a drink of the decoction of duralabha, amrita, usira, parpataka, ghana, chandana, ativisa, katvanga, dhanyaka; thin gruel to drink prepared from trna dhanya (millets), rice (ordinary) and rice maturing in sixty days; or mess of rice along with soup of mudga and such others (pulses). When the ama (premature bleeding) is controlled (by these measures) she should be treated with fatty and cold things ( drugs and foods) as before. (10)
Garbhapata – miscarriage
आमगर्भे तु पतिते मद्यानामन्यतमं सामर्थ्यतः पाययेत् गर्भकोष्ठविशुध्यर्थमार्तिविस्मरणार्थं च । अमद्यपां पाचनीयद्रव्योपहिताभिः स्नेहलवणवर्ज्याभिः सतिलाभिरुद्दालकादियवागूभिरुपाचरेद्यावन्तो मासास्तावन्त्यहानीति ॥११॥
In case of expulsion of the premature foetus (miscarriage), the woman should be given wine or other alcoholic beverages to drink to her capacity, in order to cleanse the cavity of the uterus and to prevent the feeling of pain.
If she is averse to wine drinking, she should be given yavagu (thick gruel) which is processed with drugs possessing digestive properties and devoid of fats and salt, or yavagu (gruel) of tila, uddalaka and others, for such number of days as equal to the number of the month (of pregnancy). (11)
ततः प्रीणनैर्बलानुरक्षिभिरस्त्रेहैराहारैरादोषधातुक्लेदशुद्धेः । आमगर्भशेषेण हि पुनःपुन – रकुशलमनुषज्यते । तस्मात्तीक्ष्णैरनवशेषयन्नुपाचरेत् । ततः परं स्नेहपानैर्बस्तिभिराहारैश्च दीपनीयपाचनीयजीवनीयबृंहणीयमधुरवातहरैरिति ॥ १२ ॥
Afterwards, with such foods which are nourishing, strengthening and non-fatty for such period till the doshas, dhatus and water of the body get purified. The residue of abortion remaining inside, is the main cause of many troubles occurring frequently, hence the treatment should be with powerful drugs and complete (without leaving any residue inside). Later on, therapies like oleation (drinking of fat) and enemas, and foods which kindle hunger, digestive, nourishing, causing stoutness, sweet in taste and mitigate vata should be given. (12)
Upavistaka-Upasuska – Nagodara
यस्याः पुनर्महति जातसारे गर्भे वर्ज्यानामवर्जनात् पुष्पदर्शनं स्यादन्यद्वा योनिस्रवणम् । तस्यास्तन्निमित्तं वायुः प्रकुपितः पित्तश्लेष्माणौ परिगृह्य गर्भस्य रसवहां नाडीं प्रतिपीड्यावतिष्ठते । ततो नाड्यां दोषैः कुल्यायामिव तृणपत्रादिभिः प्रतिच्छन्नायां रसस्यासम्यग्वहनाद्दर्भों वृद्धिमनाप्नुवन्नुपविशत्युपशुष्यति वा ॥१३॥
If the woman, who has the foetus well nourished and still indulges in things (foods and activities) forbidden, (she) will soon develop discharge of menstrual blood or other types of exudations from the vagina; because of this, vata getting increased and associating with pitta and kapha cause troubles in the channels of rasa of the foetus; these channels getting blocked, by the doshas, just as aqueduct ( in the field) gets blocked by grass, leaves, etc. do not allow the rasa (nutrient fluid) to get into the foetus; the foetus not getting nourishment will remain as such, without growing further or gets dried up (becomes small). (13)
तत्र यस्याः कदाचित्कार्तवपरित्रावावल्पौ च दृश्येते सततं च गर्भः प्राप्तात्परिमाणादपरिहीयमान एव स्फुरति । न च कुक्षिर्विवर्धते । तमुपविष्टकमित्याचक्षते । यदा तु प्रतिमासमार्तवं प्रत्यहं वा परित्रवणं नात्यल्पं च तथा परिहीयमाणो गर्भश्चिरात् किञ्चित् स्पन्दते । कुक्षिश्च वृद्धोऽपि परिहीयते । तदुपशुष्ककं नागोदरं च ॥१४॥
When the menstrual flow and or other vaginal exudations appear rarely and in little quantity, the foetus appears underdeveloped, makes movement often, but the abdomen is not enlarged, that is a condition known as Upavistaka.
When the menstrual flow appears regularly every month or daily along with vaginal discharges, both in large quantity; the foetus becoming small, makes slight movements rarely, the abdomen though enlarged becomes small in size slowly – this condition is known as Upasuskaka or Nagodara. (14)
तौ तु मातुराहारतेजसाल्पेनाप्याय्यमानौ यदा पुष्टौ स्यातां केशदशनादियुक्तौ । तदा वर्षगणैरपि प्रमदा प्रसूयेत एव ॥१५॥
In both these conditions, the foetus develops even by the little amount of nourishment and strength from the mother and becomes endowed with hairs, teeth etc; the woman will deliver (such foetus) after many years. ( 15 )
तत्र वातेनोपविष्टकोपशुष्ककयोर्वायुः प्रतिहन्यते सशब्दं फेनिलं विच्छिन्नं शकृदुपवेश्यते मूत्रमुपरुध्यते कटीपृष्ठहृदयेषु वेदना जृम्भा निद्रानाशोऽभीक्ष्णं प्रतिश्यायः शुष्ककासः सादः क्ष्वेडेते इव कर्णौ तुघेते इव शङ्खौ पिपीलिकाभिरिव संसृज्यते शरीरं परिकृन्तन्निव वायुर्भ्रमति कुक्षौ तम इव प्रवेश्यते दुःखेनान्नस्य जरणमहरहः परिहानिः स्फुटितविवर्णपरुषत्वक्त्वं च भवति ॥१६॥
Upavistaka and upasuskaka, having the predominance of vata, it (vata) gets increased and produces elimination of frothy, broken faeces, accompanied with sound (of flatus), non-elimination of urine, pain in the waist, back and (region of) the heart, yawning, loss of sleep, frequent running in the nose, dry cough, debility, ringing in the ears, piercing pain in the temples, feeling as though ants are crawling over the body, entering into darkness (unconciousness); movement of gas inside the abdomen accompanied with pain, digestion of food with great difficulty, emaciation day after day, and skin becoming cracked, discoloured and rough. ( 16 )
पित्तेन ताम्रहरितमुपवेश्यते धूमकोऽम्लकश्छर्दिर्मूर्छा कुक्षिहृदयदाहः पीतरक्तगोमूत्राभनेत्रमूत्रनखत्वक्त्वं काली दुर्बला नित्यशूना च नारी भवति ॥१७॥
With the predominance of pitta, there will be elimination of faeces of coppery-red or green colour, feeling of hot fumes inside the abdomen, sour taste, and vomiting, fainting, feeling of burning sensation in the abdomen and (region of) the heart; eyes, urine, nails and skin assuming black colour; weak, and having constant oedema. (17)
श्लेष्मणा मधुरास्यत्वमुत्क्लेशः श्लेष्मोद्वमनं भक्तद्वेषः श्वेतहस्तपादनेत्रता कासः श्वासश्च ॥ १८ ॥
With the predominance of kapha, there will be a sweet taste in the mouth, nausea, vomiting of kapha, aversion to food, white discolouration of hands, feet and eyes; cough and difficulty in breathing. (18)
तयोर्जीवनीयबृंहणीयमधुरौषधसिद्धानां सर्पिषामुपयोगः । तथा पयसां रसानामामगर्भाणां च गर्भवृद्धिकरः । तथा सम्भोजनमेतैरेव च घृतादिभिः । सुभिक्षाया अभीक्ष्णं यानवाहनापवर्जनबृंहणैरुपपादनम् ॥ १९॥
For both these disorders the use of ghee medicated with drugs of jivaniyagana, brimhaniya (stoutening) and of taste (is ideal), milk, meat juice and eggs should be used for the development of the foetus; similarly use of these even for meals along with ghee etc; the woman getting satisfied (nourished) in this manner should avoid riding on animals and vehicles and use strengthening foods and drinks. ( 19 )
अथ विशेषेण वाते पूर्वमेव सैन्धवोपहितं क्षीरबस्तिं दत्वा शीतोदकस्त्रातां मृदु शाल्योदनं भोजयेत् । ततो विदार्यादिगणसाधितेन सर्षिषानुवासयेत् । निवातं च सेवेत । पित्ते मधुक विदारीनिर्यूहसिद्धं पयः पिबेत् । तिस्त्रः स्थूलकुक्कुटीर्निस्तुषमाषाढकं च क्षीरोदकेनोलूखले सङ्क्षद्य तद्रसेन सर्पिषा च तित्तिरिकपिञ्जलान्यतररसं साधयित्वा पाययेदुपविष्टकविवर्धनार्थमुपशुष्ककबृंहणार्थं च । अजासर्पिषा क्षीरेण जीवनीयैश्च संस्कृतां यवागूं पिबेत् ॥२०॥
पयस्याकाकोलीद्वयसुनिषण्णककल्केन पयसा च सर्पिर्विपाचयेत् । तत् काल्यं क्षीरानुपानमुपयुञ्जीत । आमगर्भरसेन चानीयात् । तानेव च तत्र भृष्टान् भक्षयेत् । जलचरमांसानि च ॥ २१॥
Specially in cases of predominance of vata, the woman should be administered an enema with milk mixed with saindhava, followed by a bath in cold water and lunch of soft boiled rice. Next an oil-enema with ghee processed with drugs of vidaryadigana should be administered and she should be made to reside in a place devoid of breeze.
In case of predominance of pitta, the woman should drink milk processed with decoction of madhuka and vidari; meat of three fat kukkuti (hen), dehusked masa (black gram) one adhaka in quantity should be grinded in a stone morter and added with milk and water, this juice mixed with ghee; or juice of meat of tittiri (grey partridge), kapinjala (black partridge) or any others should be given as a drink for the development of the foetus in upavistaka and for nourishing the foetus in upasuskaka. She should also drink yavagu (gruel) mixed with goats milk medicated with drugs of jivaniya group and added with ghee; medicated ghee is to be prepared with paste of payasya, the two kakoli, and sunisannaka, along with cows milk. It should be consumed in the morning followed by milk; lunch should be par taken along with juice of eggs, or it can be fried and used, and also the meat of animals and birds living in water. (20-21)
कफे त्वानूपौदकपिशितोपदंशामच्छसुरां त्रिरात्रं पञ्चरात्रं सप्तरात्रं वा पिबेत् तिलमुद्गमाषलवणबिल्वपात्त्रैः पञ्चभिर्घृतपात्रं संयोज्य स्वनुगुप्तं निधापयेत् । ततः प्रातः पिण्डं बिल्वमात्रं शृतशीतच्छागदुग्धानुपानं वाश्नीयात् । अत्रैव वा बदरचूर्णपात्रमपि निदध्यात् । एवमवृद्धौ तीक्ष्णैर्विरेचयेदपरापातनीयैश्च पातयेत् ॥ २२ ॥
In case of predominance of kapha, she should eat flesh of animals living in marshy places and in water, condiments, scum of sura ( beer) etc. for three, five or seven days. Tila, mudga, masa, saindhava and bilva each one patra should be mixed with five patra of ghee and kept in a vessel for some time (one night), next morning this mixture one bilva in quantity should be eaten followed with a drink of goats milk boiled and cooled. In the same way even the powder of badara can be taken. If, by these measures, the foetus does not grow, it should be expelled out with strong uterine purgatives and measures to expel out the placenta should also be done. (22)
Lina garbha
यस्याः पुनर्वातोपसृष्टस्त्रोतसि लीनो गर्भः प्रसुप्तो न स्पन्दते तं लीनमित्याहुः । तत्र श्येनोत्क्रोशगोमत्स्यगोधाशिखिकुक्कुटतित्तिरीणामन्यतमस्य रसेन भूरिसर्पिष्केण वा माषयूषेण घृताढ्येन रक्तशाल्योदनं भोजयेत् । सक्तून्वा तिलमाषबिल्वशलाटुयुक्तान् पयसा पाययेत् । मेद्यमांसोपदंशं वा माकम् । तैलेन चाभीक्ष्णमुदरवड्ङ्क्षणोरुकटीपार्श्वपृष्ठान्यभ्यज्यात् । मुहुर्मुहुश्चैनां हर्षयेत् । पूर्वोक्तं चेक्षेत । यस्याः पुनरुदावर्तविबन्ध: स्यात्तां वातहरस्निग्धान्नपानैरुपाचरेत् ॥२३॥
In the woman who is afflicted with increase of vata, the foetus getting shrunk (to a small size) if found to be sleeping without making any movements, such a condition is known as Linagarbha.
In this condition the woman should be given food consisting of boiled red rice along with juice of meat of syena (hawk), utkrosa (fishing eagle), go (cow), matsya (fish), godha (iguana lizard), sikhi (peacock ), kukkuta (fowl), tittiri (black partridge) and such others added with more of ghee; or with soup of masa, mixed with ghee; or mixture of corn flour added with tila, masa, bilvasalatu (tender fruits of bilva). along with milk to be given as a drink; meat containing fat can be given along with dry grapes; oil should be smeared often over the abdomen, groins, thighs, waist, flanks and back and massaged; she should be made happy frequently. Measures described earlier (those which promote development of the foetus) should also be adopted. The woman who develops udavarta (upward movements of gas/reverse peristalisis) and constipation should be treated with foods and drinks which mitigate vata and which are unctuous. (23)
अष्टमे तु मासे मधुकसिद्धेन तैलेनानुवासयेत् । तदसिद्धौ वीरणशालिकुशकाशेक्षुवालिकावेतसपरिव्याधमूलानां भूतीकानन्ताकाश्मर्यपरूषकमधूकमधुकमृद्वीकानां च पयसार्धोदकेनोद्गृह्य रसं तेन प्रियालविभीतकमज्जतिलकल्कयुक्तेनेषल्लवणोष्णेन निरूहयेत् । विगतविबन्धां च स्त्राताशितां सायं तेनैव तैलेनानुवासयेत् ॥ २४॥
During the eighth month (if expulsion of the foetus is threatend) she should be administered enema with oil processed with madhuka; if that does not succeed, a decoction enema prepared with roots of virana, sali, kusa, kasa, iksuvalika, vetasa, and parivyadha (jalavetasa) along with bhutika, ananta, kasmarya, parusaka, madhuka, madhuka, and mrdvika to be boiled in milk, diluted with half its quantity of water; after taking out the essence (after filtering) it should be mixed with a paste of priyala, vibhitaka majja, tila, and little quantity of salt; this liquid, slightly made warm should be used for an enema. After the relief of constipation, she should take bath, have her food and in the evening another enema administered with the same oil (which is processed with madhuka ( 24 )
उदावर्तो हि समुपेक्षितः सहसा सगर्भा गर्भिणीमतिपातयेत् ॥२५॥
Udavarta (upward movement of vata inside the abdomen/reverse peristalis is) if neglected will quickly harm both the foetus and the pregnant woman. (25)
यस्याः पुनरतिमात्रदोषोपचयाद्यथोक्तैर्वा व्यवायादिभिरन्यैर्वा व्याधिभिः पूर्वोपचितेन वा जनन्यपत्ययोः कर्मणा बन्धनान्मुच्यते गर्भः फलमिव वृन्तात् स मुक्तबन्धनो गर्भशय्यामतिक्रम्य यकृतप्लीहान्त्रविवरैरवस्त्रंसमानः कोष्ठसङ्क्षोभमापादयति । ततः कोष्ठसङ्क्षोभाद्वायुरपानो मूढः कुक्षिबस्तिपार्श्वोदरयोनिशूलानाहविण्मूत्रसङ्गानापाद्य गर्भं च्यावयति तरुणं शोणितभावेन । सोऽभिहितः प्राक् ॥ २६॥
In a woman who has great increase of doshas or who indulges in sexual intercourse and such other forbidden acts or by the effect of other diseases or due to cessation of mother-child relationship earned by earlier acts (activities of previous lives of both mother and child) the foetus gets disconnected from the bed of the uterus, moves into the space in between the liver, spleen, and intestines causes severe distress inside the abdomen. By such a event the apana vata becomes inactive, causes pain in the lower abdomen, sides of urinary bladder, in the flanks of the abdomen, and vaginal pain, distention, obstruction to faeces and urine, and premature expulsion of the foetus in the form of bleeding; this has been described earlier already. (26)
Mritagarbha – dead foetus
विवृद्धे तु गर्भे स्तब्धं स्तिमितं शीतमश्मगर्भमिवोदरमाभाति शूलमधिकमुपजायते न च स्पन्दते गर्भो नाव्यः प्रादुर्भवन्ति न स्रवति योनिरक्षिणी चास्याः स्स्रंस्येते तथा भृशमरतिपरीता व्यथतेऽन्यथा चेष्टते ताम्यति भ्राम्यति रोदित्यहर्निशं न स्वपति पूत्युच्छ्वासा कृच्छ्रात्श्व-सत्यतिकष्टं प्राणति जक्षतीत्येवंविधां स्त्रियं मृतगर्भां विद्यात् ॥२७॥
A woman who has a well grown foetus remaining inside static, fixed cold, hard like stone, causing severe pain, the foetus making no movement, labour pains not manifesting, no exudation in the vagina, eyes are drooping down, suffers from severe restlessness and pains, faints, feels giddiness, cries all through day and night, does not sleep at all, has bad smell in expiration, breathes with difficulty, performs all works with great difficulty, lives with severe distress, eats with great difficulty; such a woman is to be understood as having a dead foetus. ( 27 )
Mudha grabha – impacted foetus
तं तु गर्भं कदाचिदसम्यगपत्यपथमनेकधा प्रतिपन्नं विगुणेनेव वायुना पीडितं मोहितं च मूढ गर्भमित्याहुः । विगुणानिलप्रतिपीडनवैचित्र्यादसङ्ख्यगतिं च ॥२८॥
The foetus which moves into the gential tract in very unusual manner due to action of vata which is abnormal (increased) and gets fixed without making any movement (to come out) is known as Mudha garbha (impacted foetus); its direction of movements (position inside the genital tract) are innumerable due to the peculiarities of abnormal anila (vata). (28)
समासतस्तु त्रिविधा गतिरूर्ध्वा तिर्यङ् न्युब्जा च । संस्थानानि पुनरष्टौं । तान्यत्रैवोत्तरत्र वक्ष्यन्ते ॥२९॥
In brief, the directions of the foetus are three; head upward, head-sideward, and head-downward. Its lie ( positions) are eight, these will be described elsewhere later. ( 29 )
तेषु सर्वेष्वपि विपरीतेन्द्रियार्थामाक्षेपयोनिभ्रंशसंवरणमक्कल्लश्वासभ्रमभिन्नां शीतगात्रां पूत्युद्गारां च वर्जयेत् ॥३०॥
Among all of them, the woman who has developed abnormalities of sensory perception, convulsions, prolapse and contractions of the vagina, makkalla (pain in the lower abdomen), difficulty/increased breathing, giddiness, cold body and foul smelling belching should be refused (treatment). (30)
न तु क्षणमप्युपेक्षेत गर्भशल्यम् । तद्धि निरुच्छ्वासीकृत्याशु जननीं हन्यात् ॥३१॥
Foetus, thus acting as a foreign body should not be neglected even for a second. It causes death of the mother by making her breathless. (31)
सचेतनश्च गर्भः शस्त्रेण विदार्यमाणो विषममङ्गानि विक्षिपेत् ॥३२॥
तस्मात्तत्सङ्गे सूत्यः प्रयतेरन् पूर्वोक्तानि च मन्त्रौषधानि प्रयुञ्जीत । त्रिविधस्तु सङ्गो भवति । शिरस्यंसे जघने वा ॥३३॥
Even the foetus which, is living will kill the mother by making violent movements when its parts are cut by sharp instruments. Hence, when the living foetus gets impacted, the sutya (woman skilled in techniques of delivery), should adopt all measures described earlier including chanting of hymns and administration of drugs. ( 32 )
Obstruction (of the foetus) is of three kinds-viz-by the head, by the shoulders and by the pelvis (breach). (33)
Garbhasanga chikitsa – management of obstruction
मूढगर्भस्य तु जरायुपातनसामान्यं कर्मेत्येके । मन्त्रादिकर्माथर्ववेदविहितमित्येके । दृष्टकर्मणा शल्यहर्त्रा शल्याहरणमित्येके ॥३४॥
Some authorities opine that the management of impacted foetus is similar to that of delivery of the (impacted) placenta; some others opine that chanting of hymns and other methods described in Atharvaveda are to be done; yet others say that is should be like removal of foreign body by the skilled surgeon. (34)
न त्वतः कष्टतममस्ति शस्त्रकर्म । यतो योनियकृत्प्लीहान्त्रगर्भाशयादीनां मध्ये ताननुपहिंसता स्पर्श वता शस्त्रमवचार्यमुत्कर्षणव्यावर्तनोत्कर्तच्छेदनभेदनपीडनर्जूकरणानि चैकेन पाणिना कार्याणि ॥३५॥
No other surgical operation is more difficult than this; because surgery is to be done in the space between the vagina, liver, spleen, intestines, uterus and other organs, without causing any damage to them, by inserting the instruments (to the required place) only by touch (feeling it on the abdomen by the hands) and carrying out elevation, rotation, cutting, tearing, puncturing, squeezing, streightening etc. by only one hand. (35)
तस्मादीश्वरमापृच्छ्य परं च यत्नमास्थाय तद्विद्यसहितस्तमुपक्रमेत् । अक्रियायां ध्रुवं मरणम् । उपक्रमे संशयः । तथोदराश्मरीप्रभृतीनपि ॥३६॥
So, after obtaining the permission from the master ( husband), the physician should undertake a surgical operation with the help of experts in the techniques; for death is sure if (surgery) is not done, and if done success is doubtful. It is so, even in diseases like udara (enlargement of the abdomen) and ashmari (renal calculii). (36)
अथोत्तानाया व्याभुग्नसक्थ्या वस्त्रचुम्बलोन्नमितकटिप्रदेशायाश्च धन्वनागवृन्तिकाशाल्मलीपिच्छाघृतैरभ्यज्य हस्तं योनिं च गर्भमाहरेत् ॥ ३७॥
Next, the woman should be made to lie with face upwards, legs folded at the knees (and kept erect), the waist raised up by soft pad of cloth kept underneath. The hand (of the physician) and the vaginal tract should be smeared with ghee processed with dhanva, nagavrntika and salmalipicha (soft silk of salmali) the hand should then be inserted inside the vagina) and the foetus pulled out. (37)
तत्र सक्थिभ्यामागतस्यानुलोममाञ्छानमेव । एकसक्थिप्रपन्नस्येतरं सक्थिः प्रसार्य । स्फिग्देशागतस्य स्फिग्देशं प्रतिषिध्योर्ध्वमुत्क्षिप्य सक्थिनी प्रसार्य । तिर्यगागतस्य परिघस्येवापरार्धमुत्क्षिप्य पूर्वार्धमपत्यपथं प्रत्यार्जवमानीय | पार्श्वापवृत्तशिरसों ऽसं प्रतिपीड्योर्ध्वमुत्क्षिप्य शिरोपत्यपथमानीय | बाहुद्वयप्रपन्नस्योर्ध्वमुत्पीड्यासौ शिरोमूलमानीय निर्हरेत् ॥३८॥
If the foetus is found with both its legs having come out, a downward pull has to be attempted; if only with one leg, the other leg should be brought out by extending it (and then both legs pulled out)if it is impacted with the buttocks, the buttocks should be pushed in, rotated, legs brought down by extending it and then pulled out; if it is impacted by the side just like a bolt, then the lower portion of the body should be pushed up, the upper portion rotated and brought into the genital tract, and pulled out; if it is impacted by the head turned sidewards, the shoulders should be pushed up and the head brought into the genital tract to be pulled out; if the impact is by both the arms coming out, they should be pushed in again, the base of the head pulled down to bring the head into the genital tract and then pulled out. ( 38 )
यस्त्वाभुग्नमध्यः पाणिपादशिरोभिर्मोनिं प्रतिपद्यते यश्चाभुग्न एवैकेन पादेन योनिं द्वितीयेन पायुम् । तौ मूढौ हस्तेनाहर्तुमशक्याविति शस्त्रमवचारयेत् ॥३९॥
That (impaction) caused by curvature of the middle portion of the body, with the arms, legs or head in the genital tract; and that in which the body is curved, with one leg coming out through the vagina and the other through the rectum-both these being impossible to be pulled out by the hand, should be treated by using the sharp instruments. (39)
अथ स्त्रियमाश्वास्य मण्डलाग्रेणाङ्गलिशस्त्रेण वा विदार्य शिरः कपालान्यहृत्य गर्भशङ्कुना गृहीत्वा चिबुके ताल न्युरसि कक्ष्यायां वापहरेत् । अभिन्नशिरसं चाक्षिकूटे वा । तथांससक्तस्यांसदेशे बाहुं छित्वा दृतेरिवाध्मातस्य वातपूर्णमुदरमवदार्य निरस्यान्त्राणि शिथिलीभूतमाहरेत् । जघनसक्तस्य जघनकपालानि दारयित्वेति ॥४०॥
Then the woman should be consoled (counselling courage), the head of the foetus should be cut either with a mandalagra sastra (scalpel, lancet knife) or a anguli sastra (finger knife), the foetus pulled out by holding it at its chin, palate, chest or axilla with the grabha sanku (foetal hook); if the head is not cut (it should be pulled out) by holding at its eye sockets. If it is impacted by its shoulders (it should be pulled out by cutting off the arms, if impacted with bloated abdomen resembling an inflated bag, the abdomen should be incised, the intestines pulled out making the abdomen flat and then (the foetus ) pulled out; if impacted by the pelvis, the pelvic bones should be cut and (the foetus pulled out). (40)
अपि च
यद्यद्वायुवशादङ्गं सज्जेद्गर्भस्य खण्डशः । तत्तच्छित्वा हरेत्सम्यग्रक्षन्नारीं च यत्नतः ॥४१॥
Further, whichever the part of the foetus that causes impaction should be cut into pieces and the foetus pulled out, protecting the woman all through by all the means. (41)
अथापतन्तीमपरां पातयेत् पूर्ववद्भिषक् । एवं निर्हतशल्यां तु सिञ्चेदुष्णेन वारिणा ॥४२॥
Next the apara (placenta) should be brought out by adopting the methods described earlier. In this way, the impacted foreign body should be removed and (the genital tract) washed well with warm water. (42)
दद्यादभ्यक्तदेहायै योनौ स्नेहपिचुं ततः । योनिर्मृदूर्भवेत्तेन शूलं चास्याः प्रशाम्यति ॥४३॥
दीप्यकातिविषारास्त्राहिङ्ग्वेलापञ्चकोलकात् । चूर्णं स्नेहेन कल्कं वा क्वाथं वा पाययेत्ततः ॥४४॥
The woman should then be given an oil massage, a diaper soaked in oil should be kept in the vaginal tract, by this the vagina becomes soft and the pains subside. ( 43 )
Dipyaka, ativisa, rasna, hingu, ela, and panchakola all should be made into a powder or paste, to be licked along with a fatty material (ghee) or into a decoction to be drunk (along with ghee). (44)
कटुकातिविषापाठाशाकत्वग्धिड्गुतैजनीः । तद्वच्च दोषस्यन्दार्थं वेदनोपशमाय च ॥४५॥
Likewise, katuka, ativisa, patha saka tvak, hingu and taijana, should be given to liquify the doshas and subsiding of the pain. ( 45 )
त्रिरात्रमेवं सप्ताहं स्नेहमेव ततः पिबेत् । सायं पिबेदरिष्टं च तथा सुकृतमासवम् ॥४६॥
This should be followed for three days and for the next seven days only oil should be given to drink (oleation therapy); in the evenings she should drink either arista or asava which are made aggreeble (pleasant). (46)
शिरीषककुभक्काथपिचून्योनौ च निक्षिपेत् ॥४७॥
उपद्रवाश्च येऽन्ये स्युस्तान्यथास्वमुपाचरेत् । पयो वातहरैः सिद्धं दशाहं भोजने हितम् ॥ ४८ ॥ रसो दशाहं च परं लघुपथ्याल्पभोजना ॥४९॥
Diaper soaked in the decoction of sirisa and kakubha should be kept in the vagina. Any other complication arising in the middle should be treated appropriately. For ten days, only milk processed with drugs which mitigate vata is ideal as food, juice of meat for the next ten days and later on easily digestable, healthy foods, in small quantities would be ideal. (47-49)
स्नेहाभ्यङ्गपरा स्नेहान् बलातैलादिकान् भजेत् । ऊर्ध्वं चतुर्थ्यो मासेभ्यः सा क्रमेण सुखानि च ॥५०॥ She should,then onwards, resort to oil massage and bath daily with Balataila and such others (medicated oils) for a period of four months, after that she regains happiness (health). (50)
Bala taila – Preparation – Ingredients
अथ बलातैलमुपदेक्ष्यामः ।
बलामूलकषायस्य भागाः षट् तावन्त एव पयसो यवकोलकुलत्थदशमूलकषायस्य भागो भागश्चतुर्दशस्तैलस्य तत्सर्वमैकध्यं कृत्वा श्लक्ष्णपिष्टानि चावाप्य काकोलीक्षीरकाकोलीजीवकर्षभकमुद्द्रपर्णीमाषपर्णीमेदामहामेदाक्षीरशुक्लामधुकदेवदारुमञ्जिष्ठाचन्दनसारिवातगरकुष्ठशतावर्यश्वगन्धापुनर्नवाशतपुष्पावरापत्ररससरलशैलेयैलावचागरुकालानुसारीसैन्धवानि शनैर्मृद्वग्निना साधयित्वा सुभाजनेऽनुगुप्तं निदध्यादेष भगवतो धन्वन्तरेरभिमतस्तैलराजो राज्ञां राजमात्राणां सूतिकानां कृशानां शिशूनामतीतवयसां सुकुमाराणां शूलिनां महाग्रहगृहीतानां दीर्घरोगक्षपितवपुषां मर्मविद्धपतिताभिहतभग्नविश्लिष्टदेहानां दैवोपघाताभिशप्तमनोज्वरपरीतानांपाननावनाभ्यङ्गबस्तिषु प्रयोज्यः । तेन बलपौरुषस्मृतिमतिमेधाग्निवीर्यौजांसि विवर्धन्ते पक्षाघाताक्षेपकार्दितादिविविधवातविकारगुल्महिक्काश्वासकासा निवर्तन्ते । अहरहश्चोपयुज्यमाने षण्मासादान्त्रवृद्धिः प्रशाम्यति च । वन्ध्या च पुत्रं गुणवन्तमिच्छया लभत इति । भवन्ति चात्र ॥५१॥ –
Now we will describe (the prepareation of) Bala taila; six parts of decoction of roots of bala, equal quantity of milk (cow milk), one part of decoction of yava, kola, kulattha and dashamoolas and fourteen parts of taila (oil of sesamum) are all mixed together and boiled.
Next a thin paste of kakoli, kshirakakoli, jivaka, rsabhaka, mudgaprni, masaparni, meda, mahameda, kshirasukla, madhuka, devadaru, manjista, chandana, sariva, tagara, kustha, satavari, ashwagandha, punarnava, satapushpa, vara (tripala) patra, rasa (bola),. sarala, saileya, ela, vaci, aguru, kalanusari (usira) and saindhava is then added and the whole thing cooked over mild fire to the required level, (filtered) and poured into a clean container and kept hidden (inside a heap of husk ).
This, king of oils (medicated oils) approved by Lord Dhanvantari, is ideal for kings, courtiers, women in parturition, the emaciated, children, those advanced in age, the tender ones, those having pains, those possessed by powerful evil spirits, whose body has become wasted by chronic diseases, who had injury on vital parts, who have fallen from great heights, who have been assaulted, who have broken bones and torn parts, who have been afflicted by wrath of gods, cursed by others of divine status, and those sufferings for mental diseases; to be used in the form of pana (internal drink for oleation therapy) navana (nasal drops), abhyanga (external application and massage) and basti (enema). It increases strength, valour, memory, intelligence, ingenuity, digestion, vitality and capacity to withstand exertion; cures hemiplegia, convulsions, facial palsy, and many other kinds of Vata diseases (nervous disorders), abdominal tumor, hiccup, difficult/increased breathing and cough. Used daily for six months, it relieves antra vruddhi (inguinal and scrotal hernias) and a barren woman will get a good son of her liking. (51)
बस्तिद्वारे विपन्नायाः कुक्षिः प्रस्पन्दते यदि । जन्मकाले ततः शीघ्रं पाटयित्वोद्धरेच्छिशुम् ॥५२॥
Further, some more verses
If during the course of delivery, the woman is dying but her lower abdomen makes throbbings, then the living child should be immediately removed out by cutting the abdomen near the orifice of the urinary bladder. (52)
मधुकं शाकबीजं च पयस्या सुरदारू च । अश्मन्तकः कृष्णतिलास्ताम्रवल्ली शतावरी ॥५३॥
वृक्षादनी पयस्या च लता चोत्पलसारिवा । अनन्ता सारिवा रास्त्रा पद्मा च मधुयष्टिका ॥५४॥
बृहतीद्वयकाश्मर्यक्षीरिशुङ्गत्वचो घृतम् । पृश्निपर्णी बला शिग्रुः श्वदंष्ट्रा मधुपर्णिका ॥ ५५ ॥
शृङ्गाटकं बिसं द्राक्षा कशेरुमधुकं बला । सप्तैतान् पयसा योगानर्धश्लोकसमापनान् ॥५६॥
क्रमात् सप्तसु मासेषु गर्भे स्रवति योजयेत् । कपित्थबिल्वबृहतीपटोलेक्षुनिदिग्धिकात् मूलैः शृतं प्रयुञ्जीत क्षीरं मासे तथाष्टमे । नवमे सारिवानन्तापयस्यामधुयष्टिभिः योजयेद्दशमे मासि सिद्धं क्षीरं पयस्यया । अथवा यष्टिमधुकनागरामरदारूभिः ॥ ५९॥ ॥५७॥ ॥५८ ॥
The following seven groups of drugs (mentioned in each half verse) should be boiled in milk and given as medicine, if garbhasrava (abortion) occurs in the first seven months of pregnancy, in their respective order. –
1) madhuka, sakabija, payasya, and suradaru,
2) asmantaka, krsnatila, tamravalli, and satavari
3) vrikshadani, payasya, lata (priyangu ),
4) utpala, sariva ananta, sariva, rasna, padma, and madhuyasti,
5) the two brihati, kasmarya, tender sprouts of trees yeilding milky sap and ghee.
6) prsniparni, bala, sigru, svadamstra and madhuparni
7)Srngataka, bisa, draksa, kaseru, madhuka, and bala in the eighth month,
8) she should be given milk boiled with the roots of kapittha, patola, bilva, brihati, iksu, and nidhigdhika
9) during the ninth month, milk boiled with sariva, ananta, payasya and madhuyasthi.
10) during the tenth month, milk boiled with payasya or with yastimadhuka, nagara, and amaradaru. (53-59)
॥ इति चतुर्थोऽध्यायः ॥
Thus ends Ashtanga Sangraha Sharira sthana Fourth chapter.
