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Sushruta SamhitaShrira SthanaGarbhini Vyakarana Sharira - nursing and management of pregnant women - Sushrutasamhita...

Garbhini Vyakarana Sharira – nursing and management of pregnant women – Sushrutasamhita Sharirasthana Chapter 10

दशमोऽध्यायः । अथातो गर्भिणीव्याकरणं शारीरं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः :।।१।।

Now we shall discourse on the Sharira which treats of the nursing and management, etc., of pregnant women from the day of conception till parturition (Garbhini Vyakarana-Sharira). 1

गर्भिणी प्रथमदिवसात् प्रभृति नित्यं प्रहृष्टा शुच्यलङ्कृता शुक्लवसना शान्तिमङ्गलदेवताब्राह्मणगुरुपरा च भवेत् मलिनविकृतहीनगात्राणि न स्पृशेत्, दुर्गन्धदुर्दर्शनानि परिहरेदुद्वेजनीयाश्च कथाः, शुष्कं पर्युषितं कुथितं क्लिन्नञ्चान्नं नोपभुञ्जीत, बहिर्निष्क्रमणं शून्यागारचैत्यश्मशानवृक्षाश्रयान् क्रोधभयसङ्करांश्च भावानुच्चैर्भाष्यादिकञ्च परिहरेद् यानि च गर्भं व्यापादयन्ति, न चाभीक्ष्णं तैलाभ्यङ्गोत्सादनादीनि निषेवेत, न चायासयेच्छरीरं, पूर्वोक्तानि च परिहरेत् । शयनासनं मृद्वास्तरणं नात्युच्चमपाश्रयोपेतमसम्बाधञ्च विदध्यात् । हृद्यं द्रवं मधुरप्रायं स्निग्धं दीपनीयसंस्कृतञ्च भोजनं भोजयेत्, सामान्यमेतदाप्रसवात् ।। २ ।।

General Rules: An enciente, from the first day of conception should always cherish a clear joyful spirit in a clean body. She should wear clean and white garments, ornaments etc., engage herself in the doing of peace-giving and benedictory rites and live in devotion to the gods, the Brahmins and her elders and superiors. She should not touch nor come into contact with unclean, deformed or maimed persons, and should forego the use of fetid smelling things, avoid dreadful sights and painful or agitating sounds and the use of dry, stale and putrified food as well as wet food. Long and distant walks from home, resort to cremation-grounds or to a solitary retreat, or to a Caitya¹, and sitting under the shadow of a tree should be absolutely forbidden (by her during the period of gestation). Indulgence in anger, fright or other agitating emotions of the mind should be deemed injurious. To carry a heavy load, to talk in a loud voice and all other things which might occassion injury to the foetus, (sexual intercourse, etc.) should be refrained from. The repeated practice of constant anointment and the cleansing of the body etc., (with Amalaki, Haridra etc. – lit. cosmetics) should be given up. All fatiguing exercises should be discontinued and the rules laid down for the guidance of a woman in her menses should be strictly adhered to. The couch and the bed of a pregnant woman should be low, soft and guarded on all sides by a number of soft pillows or cushions. The food should be amply sweet, palatable (Hrdya)². well-cooked, prepared with appetising drugs and abounding in fluid substances. These rules should be followed up till delivery. 2

विशेषतस्तु गर्भिणी प्रथमद्वितीयतृतीयमासेषु मधुरशीतद्रवप्रायमाहारमुपसेवेत । विशेषतस्तु तृतीये षष्टिकौदनं पयसा भोजयेत्, चतुर्थे दध्ना, पञ्चमे पयसा, षष्ठे सर्पिषा चेत्येके । चतुर्थे पयोनवनीतसंसृष्टमाहारयेज्जाङ्गलमांससहितं हृद्यमन्नं भोजयेत् । पञ्चमे क्षीरसर्पिः संसृष्टम् । षष्ठे श्वदंष्ट्रासिद्धस्य सर्पिषो मात्रां पाययेद् यवागूं वा । सप्तमे सर्पिः पृथक्पर्ण्यादिसिद्धम् एवमाप्यायते गर्भः ॥ ३ ॥

Special regimen during the period of Gestation : During the first three months of pregnancy an enciente should partake of food abounding in sweet, cool and fluid articles. Serveral medical authorities recommend a food made of Sastika rice with milk, to be given to her specially in the third month of gestation, with curd in the fourth, with milk in the fifth and with clarified butter in the sixth month of

1. Caitya is a haunted or diefied tree, or according to others a Buddhistic monastery.

2. “Hrdya” here means the diet in which there is an abundance of Ojo-producing (albuminous) properties. Food largely composed of milk and butter, as well as relishing (Hrdya) food with the soup of the flesh of Jangala (wild ) animals should be given to her in the fourth, food with milk and clarified butter in the fifth, adequate quantity of clarified butter prepared with (the decoction of) Svadamstiu, or gruel (Yavagu) in the sixth; and clarified butter prepared with (the decoction of) the Pythakparnyadi group in adequate quantities in the seventh month of gestation. 3

अष्टमे बदरोदकेन बलातिबलाशतपुष्पापललपयोदधिमस्तुतैललवणमदनफलमधुघृतमिश्रेणास्थापयेत् पुराणपुरीषशुद्धचर्थमनुलोमनार्थञ्च वायोः । ततः पयोमधुरकषायसिद्धेन तैलेनानुवासयेत्, अनूलोमे हि वायौ सुखं प्रसूयते निरुपद्रवा च भवति । अत ऊर्ध्वं स्निग्धाभिर्यवागूभिर्जाङ्गलरसैश्चोपक्रमेदाप्रसवकालात्, एवमुपक्रान्ता स्निग्धा बलवती सुखमनुपद्रवा प्रसूयते । नवमे मासि सूतिकागारमेनां प्रवेशयेत् प्रशस्ततिथ्यादौ ॥ ४॥

In the eighth month for the purpose of restoring the Vayu of her body (nervous system) to the normal course and condition and for the cleansing of the bowels. the enciente should be given an Asthapana (enema), composed of a decoction of Badara mixed with Bala, Atibala. Satapuspa, Palala (flesh), milk, cream of curd, oil, Saindhava salt, Madana fruit, honey and clarified butter. After that she should have an Anuvasana (enema) made up of oil prepared with milk and decoction of the drugs known as the Madhuradi-gana. This restores the Vayu to its normal course and condition, which brings on an easy and natural parturition unattended with any puerperal disorders. Henceforth up to the time of delivery the enciente should have liquid food (Yavagu) made up of emollient substances (fats) and soup of the flesh of Jangala animals (deer, etc.). If treated on these lines the enciente remains healthy and strong, and parturition becomes easy and unattended with evils. An enciente should be made to enter the lying-in chamber in the ninth month of her pregnancy and under the auspices of happy stars and propitious lunar conditions. 4

तत्रारिष्टं ब्राह्मणक्षत्रियवैश्यशूद्राणां श्वेतरक्तपीतकृष्णेषु भूमिप्रदेशेषु बिल्वन्यग्रोधतिन्दुकभल्लातकनिर्मितं सर्वागारं यथासङ्ख्यं तन्मय

पर्यङ्कमुपलिप्तभित्तिं सुविभक्तपरिच्छदं प्रागद्वारं दक्षिणद्वार वाऽष्टहस्तायतं चतुर्हस्तविस्तृतं रक्षामङ्गलसम्पन्नं विधेयम् ।। ५ ।।

The chamber of confinement (Sutika-grha) in respect of a Brahmin, Ksatriya, Vaisya and Sudra mother should be raised on grounds respectively possessed of white, red, yellow and black soils and made of Bilva, Vata, Tinduka and Bhallataka wood. Couches should be made of these woods respectively in cases of the different social orders. The walls of the room should be well-plastered and the furniture (necessary accessories) should be placed tidy in their proper places. The door of a lying-in chamber should be made to face the south or the east, and the inner dimensions of the room should be eight cubits in length and four in breadth. Religious rites for warding off, the visit of evil spirits and malignant stars should be undertaken at (the door of) the room. 5

जाते हि शिथिले कुक्षौ मुक्ते हृदयबन्धने सशूले जघने नारी ज्ञेया सा तु प्रजायिनी तत्रोपस्थितप्रसवायाः कटीपृष्ठं प्रति समन्ताद्वेदना भवत्यभीक्ष्णं पुरीषप्रवृत्तिर्मूत्रं प्रसिच्यते योनिमुखात् श्लेष्मा च ।। ७ ।।

Signs of imminent parturition : (M.T.) : A looseness of the sides of the abdomen and untying of the umbilical cord of the child (from the cardiac cord of its mother) and a perception of the characteristic pain at the waist would indicate the approach of the time of delivery. A constant and severe pain at the waist and the back, constant (involutary) motions of the bowels and micturition and mucous discharge from the vagina are the symptoms which mainifest at the time (i.e., a little before) of parturition. 6-7

प्रजनयिष्यमाणां कृतमङ्गलस्वस्तिवाचनां कुमारपरिवृतां पुन्नामफलहस्तां स्वभ्यक्तामुष्णोदकपरिषिक्तामथैनां सम्भृतां यवागूमाकण्ठात् पाययेत् ततः कृतोपपधाने मृदुनि विस्तीर्णे शयने स्थितामाभुग्नसक्थीमुत्तानामशङ्कनीयाश्चतस्त्रः स्त्रिया: परिणतवयसः प्रजननकुशलाः कर्त्तितनखाः परिचरेयुरिति । । ८ ॥

Preliminary Measures : Rites of benediction should be performed for the safety of the enciente in her travel and she should be made to pronounce benedictory Mantras surrounded by male babies on all sides. A fruit with a masculine name should be given in her hand. Her body should be anointed with oil and washed with warm water and she should be made to drink largely a gruel (Yavagu) made of articles (which exert a beneficial virtue at the time). Then she should be laid on her back on a soft and sufficiently spacious bed, her head being placed on a pillow and her legs slightly flexed and drawn up. Four elderly ladies with impaired finger-nails and skilled in the art of accouchement and with whom she feels no delicacy, should attend and nurse her at the time. 8

अथास्या विशिखान्तरमनुलोममनुसुखमभ्यज्यादनुब्रूयाच्चेनामेकासुभगे ! प्रवाहस्वेति, नचाप्राप्तावी प्रवाहस्व, ततो विमुक्ते गर्भनाडीप्रबन्धे सशूलेषु श्रोणिवङ्क्षणबस्तिशिरःसु च प्रवाहेथाः शनैः शनैः । ततो गर्भनिर्गमे प्रगाढम्। ततो गर्भे योनिमुखं प्रपन्ने गाढतरमाविशल्यभावात् ।। ९ ।।

Then after having gently lubricated the mouth of the parturient canal along the natural direction of the pubic hairs (Anuloma) (so as not to create any discomfort in the part) one of them (elderly ladies) should address the enciente as follows : “O fortunate damsel, try to bear down the child, but do not make such an attempt in the absence of real pain” On experiencing an untying of the umbilical cord of the child, the enciente should gently make such urgings, whenever she will experience pain in the pelvic, pudendal and pubic regions and in the region between the neck of the bladder and the pelvis. Deep urgings should be made on the exit of the foetus out of the uterus, and after that deeper urgings should be made during the passage of the child through the canal until delivery. 9

अकालप्रवाहणाद् बधिरं मूकं कुब्जं व्यस्तहनुमूर्ध्वाभिघातिनं कासश्वासशोषोपद्रुतं विकटं वा जनयति ।

तत्र प्रतिलोममनुलोमयेत् ।। १० ।।

An urging (made by the enciente) in the absence of any real pain may lead to deafness, dumbness, haunch-backed and deformity of the jaw-bones of the child or subject is to attacks of cough, asthma. consumption etc., or lead to the diseases of its head, or to the birth of a defromed child. A case of abnormal presentation (Pratiloma) should

be converted into the normal or cephalic one (Anuloma) by version¹. 10

गर्भसङ्गे तु योनिं धूपयेत् कृष्णसर्पनिर्मोकेण पिण्डीतकेन वा । बध्नीयाद् हिरण्यपुष्पीमूलं हस्तपादयोः, धारयेत् सुवर्चलां विशल्यां वा ।। ११ ।।

In the case of protracted delivery, e.g., and obstruction of the child at the vagina, – the vagina should be fumigated with the fumes of the slough (cast-off skin) of a cobra ( snake) or with the fumes of Pinditaka (Madana) or the roots of Hiranyapuspi (Kantakari) should be tied (round the hand and the leg) or Suvarcala (Atasi) or Visalya (Patala) should be tied round the neck (wrist) and wast of the parturient woman. 11

अथ जातस्योल्वमपनीय मुखञ्च सैन्धवसर्पिषा विशोध्य, घृताक्तं मूर्ध्नि पिचुं दद्यात् ।

ततो नाभिनाडीमष्टाङ्गुलमायम्य सूत्रेण बद्धवा छेदयेत्, तत्सूत्रैकदेशञ्च कुमारस्य ग्रीवायां सम्यग्बध्नीयात् ।। १२ । ।

Post-parturient Measures : The shreds or membranes lying on the body of the child should be removed immediately after its birth and its mouth should be cleansed with clarified butter and rock-salt. Then a linen pad soaked in clarified butter² should be applied on the head of the new-born baby. Then the umbilical cord, after having been slightly drawn out, should be ligatured one end of a string at a point eight fingers apart from its navel, the other end of the string being tied round its neck; then the umbilical cord should be severed immediately above the ligature. 12

अथ कुमारं शीताभिरद्भिराश्वास्य जातकर्मणि कृते मधुसर्पिरनन्तचूर्णमङ्गुल्याऽनामिकया लेहयेत् । ततो बलातैलेनाभ्यज्य, क्षीरवृक्षकषायेण सर्वगन्धोदकेन वा रुप्यहेमप्रतप्तेन वा वारिणा स्नापयेदेनं कपित्थपत्रकषायेण वा कोष्णेन यथाकालं यथादोषं यथाविभवञ्च ।। १३ ।।

1. The various forms of (Pratiloma) abnormal presentations have been described under Mudha-Garbha Nidana (Nidana-Sthana-Chap. IX) and their treatment is to be found in Chikitsa-Sthana – Chap. XV.

Brahmadeva recommends Bala-Taila instead of clarified butter.

Natal Rites : Then having sprayed (the face of) the baby with cold water, the post-natal rites should be performed unto it. After that the baby should be made to lick an electuary composed of honey, clarified butter and the expressed juice of Brahmi leaves and Ananta, mixed with (half a Ratti weight of) gold dust and given with the ringfinger of the feeder. Then the body of the child should be anointed with Bala-taila and it should be bathed in an infusion of the barks of Ksiri trees, or in the washings (decoctions) of drugs known as the Sarvagandha (Eladi group), or in water in which red-hot gold or silver bar has been immersed, or in a tepid decoction of Kapittha leaves, according to the nature of the season, the preponderance of the deranged Dosas in its body and according to its physical conditions. 13

हृदिस्थानां धमनीनां विवृतत्वादनन्तरम् । चतूरात्रात् त्रिरात्राद् वा स्त्रीणां स्तन्यं प्रवर्त्तते ॥ १४ ॥

तस्मात् प्रथमेऽह्नि मधुसर्पिरनन्तामिश्रं मन्त्रपूतं त्रिकालं पाययेद, द्वितीये लक्ष्मणासिद्धं सर्पिस्तृतीये च।

ततः प्रानिवारितस्तन्यं मधुसर्पि: स्वपाणितलसंमितं द्विकालं पाययेत् ।। १५ ।।

Diet for the Child – (M.-T.): The milk in the brests of a newly parturient woman sets in three or four days after parturition owing to the dilatation of the orifices of the milk ducts (galactoferous ducts). Hence the baby should be fed thrice daily (morning, noon and evening) on a handful (child’s own hand) of clarified butter and honey mixed with (a Ratti weight of) pulverized Ananta roots sanctified with Mantras on the first day; and on the second and third days the child should be fed on clarified butter prepared with the Laksana (root). On the following (fourth) day the child should be fed on its handful of honey and clarified butter only twice (i.e., in the morning and at noon). (From the evening of fourth day) the mother should first squeeze off a quantity of her milk and then give the child her breast. (This rule should be observed at the time of tending the child every day ). 14-15

अथ सूतिकां बलातैलाभ्यक्तां वातहरौषधिनिष्क्वाथेनोपचरेत् । सशेषदोषान्तु तदहः पिप्पली- पिप्पलीमूल-हस्तिपिप्पलीचित्रकशृङ्गवेरचूर्णं गुडोदकेनोष्णेन पाययेत् । एवं द्विरात्रं त्रिरात्रं वा कुर्यादा दुष्टशोणितात् । विशुद्धे ततो विदारिगन्धादिसिद्धां स्नेहयवागूं क्षीरयवागूं वा पाययेत् त्रिरात्रम् । ततो यवकोलकुलत्थसिद्धेन जाङ्गलरसेन शाल्योदनं भोजयेद् बलमग्निबलञ्चावेक्ष्य । अनेन विधिनाऽध्यर्धमासमुपसंस्कृता विमुक्ताहाराचारा विगतसूतिकाभिधाना स्यात्, पुनरार्त्तवदर्शनादित्येके ।। १६ ।।

Treatment of the mother: The body of the mother should be anointed (after parturition) with the Bala- Taila and treated (both internally and externally) with a decoction of Vayu-subduing drugs (such as the Bhadra-Darvadi group, etc.). If still there be any abnormality in the condition of the Dosas (the discharge of vitiated blood i.e., lochia), the mother should be given to drink a luke-warm solution of treacle mixed with powders of Pippali, Pippali roots, Hasti-pippali, Citraka and Srngavera, and the medicine should be continued for two or three days or longer, (if necessary), till the disappearance of the vitiated blood (lochia). When the discharge gets normal (i.e., on the appearance of healthy lochia), the mother should be made to take for three days a gruel (Yavagu) prepared with the decoction of the drugs constituting the Vidari-Gandhadi Gana and mixed with (a good quantity of) clarified butter or a Yavagu prepared in milk. After that a meal of boiled Sali-rice and a broth made from the meats of Jangala animals boiled with barley, Kola and Kulattha pulse, should be prescribed for her, taking into consideration the strength and the condition of her appetite (Agni or digesting power). The mother should observe this regimen of diet and conduct for one month and a half (after delivery). After this period she may be at liberty to choose any food to her liking and revert to her natural mode of living. According to several authorities, however, a woman does not regain her natural temperament of body till the reappearance of the healthy menstruation (after parturition). 16

धन्वभूमिजातां तु सूतिकां घृततैलयोरन्यतरस्य मात्रां पाययेत् पिप्पल्यादिकषायानुपानं स्नेहनित्या च स्यात् त्रिरात्रं पञ्चरात्रं वा बलवतीमबलां यवागूं पाययेत् त्रिरात्र पञ्चरात्रं वा । अत ऊर्ध्वं स्निग्धेनान्नसंसर्गेणोपचरेत् । प्रायशश्चैनां प्रभूतेनोष्णोदकेन परिषिञ्चेत् । क्रोधायासमैथुनादीन् परिहरेत् ।। १७ ।।

A strong but newly delivered woman, born and bred up in a Jangala country should be given to drink, for three or five nights, either oil or clarified butter in an adequate quantity with an after-potion consisting of the decoction of drugs constituting the group known as the Pippalyadi Gana. She should be daily anointed with oil, etc. If, however, of strong health, she should be made to take, for three or five nights in succession, a medicated Yavagu (gruel) as described in the last para. Thenceforth a diet of demulcent properties should be prescribed for her and her body should be regularly washed with a copious quantity of tepid water. A mother, after parturition, should forego (for a considerable time) sexual intercourse, physical labour and indulgence in irascible emotions¹, etc. 17

भवतश्चात्र ।

मिथ्याचारात् सूतिकाया यो व्याधिरुपजायते 1 स कृच्छ्रसाध्योऽसाध्यो वा भवेदत्यपतर्पणात् ।। १८ ।।

तस्मात् तां देशकालौ च व्याधिसात्म्येन कर्मणा । परीक्ष्योपचरेन्नित्यमेवं नात्ययमाप्नुयात् ।। १९ । ।

Memorable Verses: Any disease acquired by a newly delivered mother (Sutika) by her injudicious conduct of life soon lapses into one of a difficult type (hard to cure); and it becomes incurable if it be due to too much fasting. Hence a wise physician should treat her with such measures as are natural and congenial to her temperament, the time, the place and the nature of the disease, so that she may not be afflicted with any evil effect. 18-19

अथापराऽपतन्त्यानाहाध्मानौ कुरुते, तस्मात् कण्ठमस्याः केशवेष्टितयाऽङ्गुल्या प्रमुजेत्, कटुकालाबुकृतवेधनसर्षपसर्पनिर्मोकैर्वा कटुतैलविमिश्रैर्योनिमुखं धूपयेत् लाङ्गलीमूलकल्केन वाऽस्याः पाणिपादतलमालिम्पेत् मूर्ध्नि वाऽस्याः महावृक्षक्षीरमनुसेचयेत्, कुष्ठलागलीमूलकल्कं वा मद्यमूत्रयोरन्यतरेण पाययेत्, शालमूलकल्क वा पिप्पल्यादिं वा मद्येन, सिद्धार्थककुष्ठलागलीमहावृक्षक्षीरमिश्रेण सुरामण्डेन वाऽऽस्थापयेत्, एतैरैव सिद्धेन सिद्धार्थकतैलेनोत्तरबस्तिं दद्यात्, स्निग्धेन वा कृत्तनखेन हस्तेनापहरेत् ।। २० ।।

1. Fifteen kinds of emotions as described in the thirty-ninth chapter of the Chikitsa-sthana.

A placenta retained in the uterus causes constipation (Anaha) of the bowels and distension of the abdomen (tympanitis). Hence in such a case her throat should be tickled with a finger covered with hair; or the exterior orifice of the vagina should be fumigated with the fumes of the cast-off skin of a snake, Katuka, Alabu, Krtavedhana and mustard seeds mixed with mustard oil. In the alternative, a plaster of Langali roots should be applied to the palms and soles of her hands and feet; or the milky juice of Snuhi tree should be applied over her scalp, or a compound made of pasted Langali roots and Kustha mixed with either wine or the cow’s urine should be given her for drink. A Kalka either of Sala roots or of the drugs constituting the Pippalyadi Gana mixed with wine (Sura) should be given her for the purpose. In the alternative an Asthapana (enerna) of white mustard seeds Kustha (Kuda), Langali and the milky juice of Mahavrksa mixed with Suramanda should be prescribed. (If the above measures fail) an UttaraBasti (uterine douche) prepared with the aforesaid drugs and boiled in mustard oil should be applied; or else the placenta should be removed by the hand lubricated with an oleaginous substance and with the nails clipped off. 20

प्रजातायाश्च नार्या रुक्षशरीरायास्तीक्ष्णैरविशोधितं रक्तं वायुना तद्देशगतेनातिसंरुद्धं नाभेरधः पाश्र्वयोर्बस्तौ बस्तिशिरसि वा ग्रन्थिं करोति । ततश्च नाभिबस्त्युदरशूलानि भवन्ति, सूचीभिरिव निस्तुद्यते भिद्यते दीर्यत इव च पक्वाशयः । समन्तादाध्मानमुदरे मूत्रसङ्गश्च भवतीति मक्कल्ललक्षणम् ।। २१ ।।

Makkalla and its Treatment: The lochia of a newly delivered woman whose organism has become excessively dry on account of profuse use of absorbants or deranged by any other causes, – the lochia being obstructed in its exit by the local Vayu, – gives rise to Granthis (nodules) which may appear below the navel, on the sides of the pelvis about the region of the bladder or of the pubis. Severe piercing pain (Sula) is felt about the region of the navel, the stomach and the bladder and a sensation of pricking with needle and cutting pain in the intestines. At the same time the abdomen becomes distended with the retention of urine. These are the symptoms of Makkalla. 21

तत्र (सर्पिषा सुखोदकेन वा लवणचूर्णेन) वीरतर्वादिसिद्धं जलमुषकादिप्रतीवापं पाययेत्, यवक्षारचूर्णं वा पिप्पल्यादिक्वाथेन वा, पिप्पल्यादिचूर्णं वा सुरामण्डेन, वरुणादिक्वाथं वा पञ्चकोलैलाप्रतीवापं, पृथक्पर्ण्यादिक्वाथं वा भद्रदारुमरिचसंसृष्टं, पुराणगुडं वा त्रिकटुकचतुर्जातककुस्तुम्बुरुमिश्रं खादेदच्छं वा पिबेदरिष्टमिति ।। २२ ।।

In such a case, a decoction of the drugs of the Viratarvadi Gana mixed with a powdered compound of the Usakadi Gana should be given to her. In the alternative, a potion of carbonate of potash (Yavaksara) dissolved in tepid water or dissolved in the decoction of the Pippalyadi Gana; or a compound made of the powdered drugs of the latter Gana with Sura-manda; of the powders of cardamom and Pancha-kolas dissolved in the decoction of the drugs of the Varunadi Gana; of the powders of pepper and Bhadradaru dissolved in the decoction of the Prthakparnyadi Gana; or of pulverized Trikatu. Caturjataka and Kustumburu mixed with old treacle; or of simple Arista, should be prescribed 22

अथ बालं क्षौमपरिवृतं क्षौमवस्त्रास्तृतायां शय्यायां शाययेत् । पीलुबदरीनिम्बपरूषकशाखाभिश्चैनं परिवीजयेत् । मूर्ध्नि चास्याहरहस्तैलपिचुमवचारयेत् । धूपयेच्चैनं रक्षोघ्नैर्धूपैः । रक्षोध्नानि चास्य पाणिपादशिरोग्रीवास्ववसृजेत् । तिलातसीसर्षपकणांश्चात्र प्रकिरेत् । अधिष्ठाने चाग्निं प्रज्वालयेत् व्रणितोपासनीयञ्चावेक्षेत ।। २३ ।।

Management of the Child: The baby being wrapped up in silk should be laid on a bed covered with a silken sheet; it should be fanned with the branches of a Pilu, Nimba, Badari or Parusaka tree. A (thin) pad Picu) soaked in oil should be constantly kept on the head of the child, and its body should be fumigated with the fumes of drugs (e.g. Vaca, mustard, etc.) potent enough to keep off the (evil) influences of demons and evil spirits. The same drugs should be tied round the neck, hands, legs and head of the infant and the floor of the lying-in-room should be kept strewn over with pounded sesamum, mustard, linseed (Atasi). A fire should also be kept kindled in the chamber. Measures laid down in the chapter on the nursing of an Ulcer-patient (chapter IX Sutra) should be observed in the present case as well. 23

ततो दशमेऽहनि मातापितरौकृतमङ्गलकौतुकौ स्वस्तिवाचनं कृत्वा नाम कुर्यातां यदभिप्रेतं नक्षत्रनाम वा ॥ २४ ॥

Then on the tenth day of its birth the parents having performed the necessary rites of benediction and celebrated the occasion with suitable festivities, shall give the child a name of their own choice or one determined by its natal astrism, etc. 24

ततो यथावर्णं धात्रीमुपेयान्मध्यमप्रमाणां मध्यमवयस्कामरोगां शीलवतीम् अचपलामलोलुपामकृशामस्थूलां प्रसन्नक्षीरामलम्बौष्ठीमलम्बोर्ध्वंस्तनीमव्यङ्गामव्यसनिनीं जीवद्वत्सां दोग्ध्रीं वत्सलामक्षुद्रकर्मिणीं कुले जातामतो भूयिष्ठैश्च गुणैरन्वितां श्यामामारोग्यबलवृद्धये बालस्य । तत्रोर्ध्वस्तनी करालं कुर्यात् । लम्बस्तनी नासिकामुखं छादयित्वा मरणमापादयेत् ॥ २५ ॥

Lactation and selection of a wetnurse: For the healthy growth of the child a wet-nurse should be selected from among the matrons of its own caste (Varna) and possessed of the following necessary qualifications. She should be of middle stature, neither too old nor too young (middle-aged), of sound health, of good character (not irascible or easily excitable), not fickle, ungreedy, neither too thin. nor too corpulent with lips unprotruded, and with healthy and pure milk in her breasts which should neither be too much pendulent nor drawn up. It should be carefully observed that her skin in healthy and unmarked by any moles or stains, she being free from any sort of crime (such as gambling, day-sleep, debauchery etc.). She should be of an affectionate heart, and with all her children living. She should be of respectable parentage and consequently possessed of many good qualities, with an exuberance of milk in her breasts, and not in the habit of doing anything that degrades woman in life. A “syama” girl possessed of the aforesaid qualities makes a good wet-nurse. A child nursed at the breast of a woman with upturned or unprominent nipples is apt to be deformed (Karala) in features, while extremely pendulous (large and flabby) breasts may suffocate the child by covering its mouth and nostrils. 25

ततः प्रशस्तायां तिथौ शिरः स्नातमहतवाससमुदङ्मुखं शिशुमुपवेश्य धात्रीं प्राङ्मुखींमुपवेश्य दक्षिणं स्तनं धौतमीषत्परिस्त्रुतमभिमन्त्र्य मन्त्रेणानेन पाययेत् ।। २६ ।।

Having chosen a wet-nurse of the commendable type, the child with its head well-washed should, on an auspicious day, be laid on her lap wrapped in a clean and untorn linen. The face of the child should be turned towards the north, while the nurse should look to the east at the time. Then, after first having a small quantity of the milk pressed out and the breast washed and consecrated with the following Mantras (incantations) the child should be made to suck her right breast. 26

चत्वारः सागरास्तुभ्यं स्तनयोः क्षीरवाहिनः । भवन्तु सुभगे नित्यं बालस्य बलवृद्धये ॥ २७ ॥

पयोऽमृतरसं पीत्वा कुमारस्ते शुभानने । दीर्घमायुरवाप्नोतु देवाः प्राश्यामृतं यथा ॥ २८ ॥

Metrical Texts : “O, thou beautiful damsel, may the four oceans of the earth contribute to the secretion of milk in thy breasts for the purpose of improving the bodily strength of the child. O, thou with a beautiful face, may the child, reared on your milk, attain a long life. like the gods made immortal with drinks of ambrosia’. 27-28

अतोऽन्यथा नानास्तन्योपयोगस्यासात्म्याद् व्याधिजन्म भवति । अपरिस्स्रुतेऽप्यतिस्तब्धस्तन्यपूर्ण स्तनपानात् उत्सुहितस्त्रोतसः शिशोः कासश्वासवमीप्रादुर्भावः । तस्मादेिवंविधानां स्तन्यं न पाययेत् ।। २९ ।।

A child nursed at the breast of any and every woman for want of a nurse of the commendable type, may fall an easy prey to disease, owing to the fact of the promiscuous nature of the milk proving incongenial to its physical temperament. The milk of a nurse not being pressed out and spelled off at the outset may produce cough, difficulty of breathing, or vomiting of the child, owing to the sudden rush of the accumulated milk into its throat choking up the channels. Hence a child should not be allowed to suck in such milk. 29

क्रोधशोकावात्सल्यादिभिश्च स्त्रियाः स्तन्यनाशो भवति । अथास्याः क्षीरजननार्थं सौमनस्यमुत्पाद्य यवगोधूमशालिषष्टिकमांसरससुरासौवीरकपिण्याकलशुनमत्स्यकशेरुक श्रृङ्गाटकबिसविदारिकन्दमधुकशतावरीनलिकालाबूकालशाक प्रभृतीनि विदध्यात् ।। ३० ॥

The loss or suppression of the milk in the breasts of a woman is usually due to anger, grief and the absence of natural affection for her child, etc. For the purpose of establishing a flow in her breast, her equanimity should be first restored, and diets consisting of Sali-rice, barley, wheat, Sastika, meat-soup, wine (Sura), Sauviraka, sesamumpaste, garlic, fish, Kaseruka, Srngataka lotus-stalk, Vidari-kanda, Madhuka flower. Satavari, Nalika, Alabu and Kala-Saka, etc., should be prescribed. 30

अथास्याः स्तन्यमप्सु परीक्षेत; तच्चेच्छीततलममलं तनु शङ्खावभासमप्सु न्यस्तमेकीभावं गच्छत्यफेनिलमतन्तुमन्नोत्प्लवतेऽवसीदति वा तच्छुद्धमिति विद्यात्, तेन कुमारस्यारोग्यं शरीरोपचयो बलवृद्धिश्च भवति । न च क्षुधितशोकार्त्तश्रान्तप्रदुष्टधातुगर्भिणीज्वरितातिक्षीणातिस्थूलविदग्धभक्ष्यविरुद्धाहारतर्पितायाः स्तन्यं पाययेन्नाजीर्णौषधञ्च बालं, दोषौषधमलानां तीव्रवेगोत्पत्तिभयात् ।। ३१ ।।

Examination of milk etc. : The breast-milk of a nurse or a mother should be tested by casting it in water. The milk which is thin, cold, clear and tinged like the hue of a conch-shell, is found to be easily miscible with water, does not give rise to froths and shreds and neither floats nor sinks in water, should be regarded as pure and healthy. A child fed on such milk is sure to thrive and gain in strength and health. A child should not be allowed to take the breast of a hungry, aggrieved, fatigued, too thin, too corpulent, fevered, or a pregnant woman, nor of one in whom the assimilated food is followed by an acid reaction, or of one who is found of incongenial and unhealthy dietrary, or whose fundamental elements are vitiated. A child should not be given the breast milk until an administered medicine is assimilated in its organism, lest this should give rise to a violent aggravation of the pharmacological action of the medicine, well as of the deranged Dosas (Vayu, Pitta etc.), and the refuse matters (Malas) of its body. 31

भवन्ति चात्र |

धात्र्यास्तु गुरुभिर्भोज्यैर्विषमैर्दोषलैस्तथा । दोषा देहे प्रकुप्यन्ति ततः स्तन्यं प्रदुष्यति ।। ३२ ।।

मिथ्याऽऽहारविहारिण्या दुष्टा वातादयः स्त्रियाः । दूषयन्ति पायस्तेन शारीरा व्याधयः शिशोः ।

भवन्ति कुशलस्तांश्च भिषक् सम्यग्विभावयेत् ॥ ३३ ॥

Memorable Verses : The dosas ( Vayu, Pitta and Kapha) of a wet-nurse are aggravated by ingestion of indigestible or incompatible food, or of those articles which tend to derange the Dosas of the body, and hence her milk may be vitiated. A child, fed on the vitiated milk of a woman, vitiated by the deranged Dosas owing to injudicious and intemperate eating and living, falls an easy prey to physical disease. An intelligent physician in such a case should devise means for the purification of the milk as well as of the deranged Dosas which account for such vitiation (inasmuch as the medication of the child along will not produce any satisfactory effect). 32-33

अङ्गप्रत्यङ्गदेशे तु रुजा यत्रास्य मुहुर्मुहुः स्पृशति तं स्पृश्यमाने च निमीलिताक्षो मूर्धस्थे शिरो रोगे न बस्तिस्थे मूत्रसङ्गार्त्तो रुजा तृष्यति मूर्च्छति ।। ३५ ।।

विण्मूत्रसङ्गवैवर्ण्यच्छर्द्याध्मानान्त्रकूजनैः जायते । रोदिति ॥ ३४ ॥

धारयेत् । । कोष्ठे दोषान् विजानीयात् सर्वत्रस्थांश्च रोदनैः ।। ३६ ।।

Infantile diseases and their Diagnosis: A child constantly touches its diseased part or organ and cries for the least touch (by another of that part of its body). If the seat of disease be its head, the child cannot raise nor move that organ and remains with its eyes closely shut. A disease seated in its bladder gives rise to retention of urine, thirst, pain and occasional fainting fits. A retention of urine and stool discolouring of complexion, vomiting, distension of the abdomen, and gurgling in the intestines indicate the seat of the disease to be its Kostha (colon ). A constant crying ( and the child’s refusal to be consoled) would signify that diseased principle (morbiferous diathesis) extends all through its organism. 34-36

तेषु च यथाऽभिहितं मृद्वच्छेदनीयमौषधं मात्रया क्षीरपस्य क्षीरसर्पिषा संयुक्त विदध्यात्, धात्र्याश्च केवलं, क्षीरान्नादस्यात्मनि धात्र्याश्च पूर्ववत्, अन्नादस्य कषायादीनात्मन्येव न धात्र्याः । तत्र मासादूर्ध्वं क्षीरपायाङ्गुलिपर्वद्वय ग्रहणसम्मितामौषधमात्रां विदध्यात्, कोलास्थिसम्मितां कल्कमात्रां क्षीरान्नादाय, कोलसम्मितामन्नादायेति ।। ३७ ।।

Treatment of Infants : Medicines laid down under the head of a particular disease should like-wise be prescribed in the case of its appearance in a child or an infant; but then only the remedies of mild potency and those which do not tend to disintegrate the bodily fat and Kapha should be given in adequate dose (according to age, etc.) as mentioned hereafter and administered through the vehicle of milk and clarified butter, to a child living on milk alone, while the nurse also is to take the same medicines as well. In the case of a child fed both on milk and (boiled) rice (Ksirannada i.e., living on both solid and liquid food) the medicine should be administered both to the child and its wet-nurse. In the case of a child living on solid food only, decoctions (Kasaya) etc. should be given to the child and not to the nurse. Medicines to the quantity of a small pinchful may be prescribed for a suckling who has completed its first month of life. Kalkas (medicated pastes) should be given to a child fed on milk and rice to the size of a stone of a plum-fruit (Kola), and the dose for a child fed on rice (solid food) only being to the size of a plum (Kola)². 37

येषां गदानां ये योगाः प्रवक्ष्यन्तेऽगदङ्कराः । तेषु तत्कल्कसंलिप्तौ पाययेत शिशुं स्तनौ ।। ३८ ।।

एकं द्वे त्रीणि चाहानि वातपित्तकफज्वरे । स्तन्यपायाहितं सर्पिरितराभ्यां यथार्थतः ।। ३९ ।।

Metrical Texts : In the case of any disease of a child nursed at the breast, the breasts of the nurse should be plastered with the pastes of drugs recommended by physicians for the particular malady (instead of giving the drugs to the child), and the child made to suck the same. The use of clarified butter is not beneficial to a child on the first day of an attack of Vatajvara (fever due to the derangement of the bodily Vayu), within the first two days of an attack of Pittaja fevr, and within

1. Milk and clarified butter being congenial to the constitution of infants should be used as vehicles for drugs in their cases but, these are not necessary in the case of the nurse.

2. According to several other authorities, the dosage in the case of children is to be regulated as follows:

In the case of a child, one month old, drugs should be given in the form of an electuary through the vehicle of milk, honey, syrup, clarified butter, etc. – the dose being one Ratti (about two grains) at first and gradually increased by a Ratti a month, till it completes one year. After this time the dose is to be one Masa (about twenty grains) for each year of age till he is fifteen. This dosage, however, does not apply in the present age.

the first three days of that of Kaphaja fever. But the use of clarified butter may be prescribed for an infant fed on milk and boiled rice, or on boiled rice alone, according to requirements. 38-39

न च तृष्णाभयादत्र पापयेत शिशुं स्तनौ । विरेकबस्तिवमनान्यते कुर्याच्च नात्ययात् ॥ ४० ॥

In case of fever a child should be given no suck at all, least the symptoms of thirst might develop. Purgatives, Bastis or emetics are forbidden in the disease of children, unless the disease threatens to take a fatal course. 40

मस्तुलुङ्गक्षयाद्यस्य वायुस्ताल्वस्थि नामयेत् । तस्य तृड्दैन्ययुक्तस्य सर्पिर्मधुरकैः शृतम् । पानाभ्यञ्जनयोर्योज्यं शीताम्बुद्वेजनं तथा ।। ४१ ।। वातेनाध्मापितां नाभिं सरुजां तुण्डिसंज्ञिताम् । मारुतघ्नैः प्रशमयेत् स्नेहस्वेदोपनाहनैः ॥ ४२ ॥

गुदपाके तु बालानां पित्तघ्नीं कारयेत् क्रियाम् । रसाञ्जनं विशेषेण पानालेपनयोर्हितम् ।। ४३ ।।

If the local Vayu aggravated by the waste of brain-materials (Mastulunga), bends down the palate bone of a child attended with an excessive thirst and agony, clarified butter boiled with (the decoction and Kalka of) the drugs of the Madhura Gana, should be used both internally and externally and the patient should as well be treated with spray of cold water (to stimulate him). The disease in which the navel of a child becomes swollen and painful, is called Tundi. It should be remedied by applying fomentations, medicated oils, Upanahas, etc.. possessed of the virtue of subduing the Vayu. A suppuration of the anal region (Guda-paka) of a child should be treated with Pittaghna (Pittadestroying) measures and medicines. Rasanjana used internally and externally (as an unguent) proves very efficacious in these cases. 41-43

क्षीराहारय सर्पि पाययेत् सिद्धार्थकवचामांसीपयस्यापामार्गशतावरीसारिवाब्राह्मीपिप्पलीहरिद्राकुष्ठसैन्धवसिद्धं, क्षीरान्नादाय मधुकवचापिप्पलीचित्रकत्रिफलासिद्धम्, अन्नादाय द्विपञ्चमूलीक्षीरतगरभद्रदारुमरिचमधुविडङ्गद्राक्षर्धिब्राह्मीसिद्धम् । तेनारोग्यबलमेधायूंषि शिशोर्भवन्ति ।। ४४ ।।

Infantile Elixirs : Clarified butter cooked with (the decoction and Kalka of) white mustard seeds (Siddharthaka), Vaca, Jatamamsi. Payasya, Apamarga, Satavari, Sariva, Brahmi, Pippali, Haridra. Kustha and Saindhava salt should be given to an infant fed exclusively on milk. Clarified butter prepared with (the decoction and Kalka of) Madhuka (Yastimadhu), Vaca, Citraka, Pippali and Triphala should be given to an infant fed both on milk and (boiled) rice (solid and liquid food). Clarified butter boiled with (the decoction and Kalka of) Dasamula, milk, Tagara, Bhadradaru, Marica, honey Vidanga, Draksa, Ridhi and Brahmi should be given to an infant fed on (boiled) rice (solid food). By these the health, strength, intellect and longivity of the child is improved. 44

बालं पुनर्गात्रसुखं गृह्णीयात्; न चैनं तर्जयेत्, सहसा न प्रतिबोधयेत् वित्रासभयात्, सहसा नापहरेदुत्क्षिपेद् वा वातादिविघातभयात्, नोपवेशयेत् कौब्ज्यभयात्, नित्यञ्चैनमनुवर्त्तेत प्रियशतैरजिघांसुः । एवमनभिहतमनास्त्वभिवर्धते नित्यमुदग्रसत्त्वसम्पन्नो नीरोग: सुप्रसन्नमनाश्च भवति । वातातपविद्युत्प्रभापादपलताशून्यागारनिम्नस्थानग्रहच्छायादिभ्यो दुर्ग्रहोपसर्गतश्च बालं रक्षेत् ।। ४५ ।।

A child should be so handled or lifted as not to cause any discomfort. A baby should not be scolded, nor suddenly roused up ( from sleep), lest it might get awfully frightened. It should not be suddenly drawn up nor suddenly laid down, lest this should result in the derangement of its bodily Vayu. An attempt to seat it (before it has learnt to sit steadily), may lead to haunch-back (Kyphosis). Lovingly should a child be fondled and amused with toys and play-things. A child unruffled by any of the above ways becomes healthy, cheerful and intelligent as it grows older. An infant should be guarded against any exposure to the wind, the sun, or the glare of lightning. He should not be placed under a tree or a creeper, in low lands, and in lonely houses or in their shades (caves); and it should be protected from the malignant influences of evil stars and occult powers. 45

नाशुचौ विसृजेद् बालं नाकाशे विषमे न च । नोष्ममारुतवर्षेष रजोधूमोदकेषु क्षीरसात्म्यतया क्षीरमाजं गव्यमथापि वा । दद्यादास्तन्यपर्याप्तेर्बालानां वीक्ष्य मात्रया ।। ४७॥ च ॥ ४६ ॥

Metrical Texts : A child should not be left (alone) in an unclean and unholy place, nor under the sky (uncovered place), nor over an undulating ground, nor should it be exposed to heat, storm, rain, dust, smoke and water. Milk is congeinal of the organism of a child, i.e., it is its proper food. Hence in the absence of sufficient breast-milk, the child should be given the milk of a cow or of a she-goat in adequate quantities. 46-47

षण्मासञ्चैनमन्नं प्राशयेल्लघु हितञ्च । नित्यमवरोधरतश्च स्यात् कृतरक्ष उपसर्गभयात् ।

प्रयत्नतश्च ग्रहोपसर्गेभ्यो रक्ष्या बाला भवन्ति ।। ४८ ॥

In the six month of its birth the child should be fed on light and wholesome boiled rice. A child should always be kept in an inner apartment of the house and religious rites should be performed on its behalf for the propitiation of evil deities, and it should be carefully guarded against the influences of evil stars. 48

अथ कुमार उद्विजते त्रस्यति रोदिति नष्टसंज्ञो भवति नखदशनैर्धात्रीमात्मानञ्च परिणुदति दन्तान् खादति कूजति जृम्भते ध्रुवौ विक्षिपत्यूर्ध्वं निरीक्षते फेनमुद्रमति सन्दष्टौष्ठ: क्रूरो भिन्नामवर्चा दीनार्त्तस्वरो निशि जागर्ति दुर्बलो म्लानाङ्गो मत्स्यच्छृछुन्दरिमत्कुणगन्धो यथा पुरा धात्र्याः स्तनमभिलति तथा नाभिलषतीति सामान्येन ग्रहोपसृष्टलक्षणमुक्तं, विस्तरेणोत्तरे वक्ष्यामः।। ४९।।

Symptoms when a malignant star, etc., strikes : The child looks frightened and agitated, cries, becomes unconscious at times, wounds himself or its nurse with its teeth and finger-nails, gnashes its teeth, crooks, yawns or moves its eye-brows with upturned eyes, vomits frothy matter, bites its lips, becomes cruel, passes loose stool mixed with shreds of mucus, cries in an agonised voice, becomes dull in complexion, becomes weak, does not sleep in the night, does not suck the breast as before, or emits a fishy, fish like, bug-like or molelike smell from its body-these are the general symptoms exhibited by a child under the influence of a malignant star or planet which will be specifically described later on in the Uttara-Tantra. 49

शक्तिमन्तञ्चैनं ज्ञात्वा यथावर्णं विद्यां ग्राहयेत् । अथास्मै

पञ्चविंशतिवर्षाय द्वादशवर्षां पत्नीमावहेत् पित्र्यधर्मार्थकामप्रजाः प्राप्स्यतीति।। ५०।।

Education and Marriage: The education of a child should be commenced at a suitable age and with subjects proper to the particular social Varna or order it belongs to. On attaining the twenty-fifth year he should marry a girl of twelve. A conformity to these rules, is sure to crown him with health, satisfaction progeny and a capacityfor fully discharging the religious rites and paying off his parental debts. 50

ऊनषोडशवर्षायामप्राप्तः पञ्चविंशतिम् । यद्याधत्ते पुमान् गर्मं कुक्षिस्थः स विपद्यते ।। ५१ ।।

जातो वा न चिरं जीवेज्जीवेद् वा दुर्बलेन्द्रियः । तस्मादत्यन्तबालायां गर्भाधानं न कारयेत् ॥ ५२ ।।

अतिवृद्धायां दीर्घरोगिण्यामन्येन वा विकारेणोपसृष्टायां गर्भाधानं नैव कुर्वीत । पुरुषस्याप्येवंविधस्य त एव दोषाः सम्भवन्ति ।। ५३ ।।

Metrical Texts: An offspring of a girl below the age of sixteen by a man below twenty-five is usually found to die in the womb. Such a child, in the event of its being born alive, dies a premature death or else becomes weak in organs (Indriyas). Hence a girl of extremely tender age should not be fecundated at all. An extremely old woman, or one suffering from a chronic affection (of the generative organ), or afflicted with any other disease. should not be likewise impregnated. A man with similar disabilities should be held likewise unfit. 51-53

तत्र पूर्वोक्तैः कारणैः पतिष्यति गर्भे गर्भाशयकटीवङ्क्षणबस्तिशूलानि रक्तदर्शनञ्च । तत्र शीतैः परिषेकावगाहप्रदेहादिभिरुपचरेज्जीवनीयशृतक्षीरपानैश्च । गर्भस्फुरणे मुहुर्मुहुस्तत्सन्धारणार्थं क्षीरमुत्पलादिसिद्धं पाययेत् ॥ ५४॥

A foetus, on the point of being miscarried on account of the above-mentioned causes, produces pain in the uterus, bladder, waist (Kati) and the inguinal regions (Vamksana) and bleeding. In such a case, the patient should be treated with cold baths, sprays of cold water and medicated plaster (Pradeha) at the time etc. and milk boiled with

1. Jivaniya drugs two Tolas, milk sixteen Tolas and water sixty-four Tolas, to be boiled and reduced to sixteen Tolas, i.e., to weight of the milk.

drugs constituting the Jivaniya group, should be given to her for drink. In case of unusual movements of the foetus in the womb, the enciente should be given a drink of milk boiled with the drugs of Utpaladi Gana, for soothing and making it steady in its place. 54

प्रस्त्रंसमाने सदाहपार्श्व पृष्ठ-शूलासग्दरानाह-मूत्रसङगाः, स्थानात् स्थानं च प्रक्रामति गर्भ कोष्ठे संरम्भः, तत्र स्निग्धशीताः क्रियाः ।। ५५ ।।

A foetus being displaced from its normal position produces the following symptoms, viz., pain or spasms in the back and the sides (Parsva), burning sensation, intense pain, excessive discharge of blood and retention of urine and faeces. A foetus changing place or shifting from one place to another, swells up the abdomen ( Kostha). Cooling and soothing measures should be adopted in such cases. 55

वेदनायां महासहाक्षुद्रसहामधुकश्वदंष्ट्राकण्टकारिकासिद्धं पयः शर्कराक्षौद्र मिश्रं पाययेत्; मूत्रसङ्गे दर्भादिसिद्धम्; आनाहे हिङ्गुसौवर्चललशुनवचासिद्धम् । अत्यर्थं स्रवति रक्ते कोष्ठागारिकागारमृत्पिण्डसमङ्ङ्गाधातकीकुसुमनवमालिकागैरिकसर्जरसरसाञ्जनचूर्णं मधुनाऽवलिह्याद्, यथालाभम् न्यग्रोधादित्वक्प्रवालकल्कं वा पयसा पाययेदुत्पलादिकल्कं वा कशेरुश्रृङ्गाटकशालूककल्कं वा शृतेन पयसा, उदुम्बरफलौदककन्दक्वाथेन वा शर्करामधुमधुरेण शालिपिष्टम् । न्यग्रोधादिस्वरसपरिपीतं वा वस्त्रावयवं योन्यां धारयेत् । । । ५६ ।।

Medical Treatment: In a case of pain under the circumstances, the enciente should be made to drink a potion consisting of milk boiled with Mahasaha, Ksudrasaha, Madhuka flower, Svadainstra and Kantakari, mixed with sugar and honey. In the case of retention of urine, the patient should be made to drink a potion of milk boiled with drugs known as the Darbhadi Gana (mixed with sugar and honey). In the case of Anaha (retention of stool attended with distension of the abdomen), a potion consisting of milk boiled with asafetida, Sauvarcala salt, garlic and Vaca (mixed with honey and sugar) should be given. In cases of excessive bleeding, linctus made of the powdered chamber of Kosthagarika insect, Samanga, Dhataki flowers, Navamalika, Gairika, resin and Rasanjana, or of as many of them as would be

1. There is a kind of insect which makes its chamber with earth generally under the ceiling or on the walls. This earth should be used.

available, mixed with honey, should be licked. In the alternative, the bark and sprouts of the drugs known as the Nyagrodhadi Gana mixed with boiled milk should be administered, or a Kalka of the Pravala mixed with boiled milk should be used, or a Kalka of Utapladi group mixed with boiled milk should be used or pulp of Saluka, Srngataka and Kaseru mixed with boiled milk should be given. As a furher alternative, the enciente may be made to eat cakes made of powdered Sali rice with the decoction of Udumbara fruit and Audaka-kanda, mixed with honey and sugar. A piece of linen or a plug soaked in the expressed juice of the drugs of the Nyagrodhadi group should be inserted into the passage of the vagina. 56

अथादृष्टशोणितवेदनायां मधुकदेवदारुमञ्जिष्ठापयस्यासिद्धं पयः पाययेत्, तदेवाश्मन्तकशतावरीपयस्यासिद्धं विदारिगन्धादिसिद्धं वा, बृहतीद्वयोत्पलशतावरीसारिवापयस्यामधुकसिद्धं वा, एवं क्षिप्रमुपक्रान्ताया उपावर्त्तन्ते रुजो गर्भश्चाप्यायते ।। ५७ ।।

In a case of pain unattended with bleeding, the enciente should be made to drink a potion composed of milk-boiled with Madhuka (Yastimadhu), Devadaru and Payasya; or with Asmantaka, Satavari and Payasya; or with the drugs of the group of Vidarigandhadi Gana; or with Brhafi, Kantakari, Utpala, Satavari. Sariva, Payasya and Madhuka (Yastimadhu). These remedies speedily applied tend to alleviate the pain and make the foetus growth steady in the womb. 57

व्यवस्थिते च गर्भे गव्येनोदुम्बरशलाटुसिद्धेन पयसा भोजयेत् । अतीते लवणस्नेहवर्ज्याभिर्यवागूभिरुद्दालकादीनां पाचनीयोपसंस्कृताभिरुपक्रमेत यावन्तो मासा गर्भस्य तावन्त्यहानि | बस्त्युदरशूलेषु पुराणगुडं दीपनीयसंयुक्तं पाययेदरिष्टं वा ।। ५८ ।।

After the foetus has been steadied by the aforesaid measures, a diet consisting of boiled rice and cow’s milk, boiled with the dried tender fruits of Udumbara, should be prescribed for the patient. In the event of miscarriage, the patient should be made to drink a Yavagu ( gruel) of the Uddalaka rice etc., cooked with the decoction of the Pacaniya group (Pippalyadi)and devoid of all saline and fatty matter, for a number of days corresponding to that of the month of gestation. Old treacle mixed with the powdered drugs of the Dipaniya group (Pancha-kola), or simply some Arista (Abhayarista, etc.), should be given, in the event of there being pain in the pelvis, bladder and abdomen. 58

वातोपद्रवगृहीतत्वात् स्त्रोतसां लीयते गर्भः; सोऽतिकालमवतिष्ठमानो व्यापद्यते, तां मृदुना स्नेहादिक्रमेणोपचरेत् । उत्क्रोशरससंसिद्धामनल्पस्नेहां यवागूं पाययेत् । माषतिलबिल्वशलाटुसिद्धान् वा कुल्माषान् भक्षयेत्, मधु माध्वीकञ्चानुपिबेत् सप्तरात्रम् । कालातीतस्थायिनि गर्भे विशेषतः सधान्यमुदूखलं मुसलेनाभिहन्याद् विषमे वा यानासने सेवेत ।। ५९ ।।

The internal ducts and channels (Srotas) stuffed with aggravated Vayu lead to the weakening (Laya) of the foetus and, if the state continues, it leads even to its death. Hence the case should be treated with milk anointing measures, etc.. (Sneha-karma, etc.), and gruels made of the flesh of the birds of the Utkrosa species and mixed with a sufficient quantity of clarified butter, should be given to her. As an alternative, Kulmasa¹ boiled with Masa, sesamum and pieces of dried (tender) Bilva fruit should be given to her, after which she should be made to drink, for a week, honey and Madhvika (a kind of weak wine). At the non-delivery of the child even after the lapse of the full term of gestation, the enciente should be made to thrash corn with a pestle in an Udukhala or mortar (husking apparatus) or should be made to sit or move (on legs or by conveyance), on an uneven ground. 59

वाताभिपन्न एव शुष्यति गर्भः । स मातुः कुक्षि न पूरयति मन्दं स्पन्दते च तं बृंहणीयैः पयोभिर्मांसरसैश्चोपचरेत् ।। ६० ।। }

Atrophy of a foetus in the womb should be ascribed to the action of the deranged Vayu. This is detected by the comparatively lesser fulness of the abdomen of the enciente and slow movement of the foetus in the womb. In such a case, the enciente should be treated with milk, with the Vrmhaniya (of restorative and constructive properties) drugs, and with meatsoup. 60

शुक्रशोणितं वायुनाऽभिप्रपन्नमवक्रान्तजीवमाध्मापयत्युदरम् । तत्

1. “Kulmasa” may mean either Kulattha pulse or halt boiled wheat, harley. etc. 2. The particle “Ca” in the text signifies the use of any other constructive tonic.

कदाचिद यदृच्छयोपशान्तं नैगमेषापहृतमिति भाषन्ते । तमेव कदाचित् प्रलीयमानं नागोदरमित्याहुः; तत्रापि लीनवत् प्रतीकारः ।। ६१ ।।

A combination of ovum and semen affected by the deranged Vayu in the womb, may not give rise to a successful fecundation (living impregnated matter), but leads of a distension of the abdomen (as in pregnancy ), which again, at any time, may disappear of itself. And this is ascribed by the ignorant to the malignant influence of Naigamesa (spirits ). Such an impregnated matter, sometimes lying concealed in the uterus, is called Nagodara, which should be treated with the remedies laid down under the head of Lina-Garbha (weak foetus). 61

अत ऊर्ध्वं मासानुमासिकं वक्ष्यामः मधुकं शाकबीजञ्च पयस्या सुरदारु च। अश्मन्तकस्तिलाः कृष्णास्ताम्रवल्ली शतावरी ॥ ६२ ॥

वृक्षादनी पयस्या लता सोत्पलसारिवा। अनन्ता सारिवा रास्ना पद्मा मधुकमेव च ॥ ६३ ॥

बृहत्यौ काश्मरी चापि क्षीरिशुङ्गास्त्वचो घृतम् । पृश्निपर्णी बला शिगु श्वदंष्ट्रा मधुपर्णिका | श्रृङ्गाटकं बिसं द्राक्षा कशेरु मधुकं सिता ॥ ६४ ॥ वत्सैते सप्त योगाः स्युरर्धश्लोकसमापनाः । यथासंख्यं प्रयोक्तव्या गर्भस्त्रावे पयोयुताः || ६५ ॥

Now we shall discourse on the management of pregnancy according to the months (period) of gestation.

Metrical Texts: The following receipes, such as, (1) Madhuka (Yastimadhu), Sakabija, Payasya and Devadaru; (2) Asmantaka, black sesamuin, pippali, Manjistha, Tamra-valli and Satavari; (3) Vrksadani, Payasya, Lata (Durva), Utpala and Saariva; (4) Ananta. Sariva, Rasna, Padma and Madhuka ( Yastimadhu); (5) Brhati, Kantakari, KAshmari, sprouts (Sunga) and barks of milk-exuding trees (as, Vata, etc.) and clarified butter, (6) Prsni-pari, Bala, Sigru, Svadaiistra and madhuparnika; and (7) Srngataka, Bisa (stalks of

1. Cakradatta reads “Bisa” (stalks of lotus ) instead of “Ghrta” (clarified butter).

lotus), Draksa, Kaseru, Madhuka ( Yastimadhu) and sugar; should successively be given with milk¹ to an enciente, from the first to the seventh month of her gestation, in the case of a threatened miscarriage or abortion. 62-65

कपित्थबृहतीबिल्वपटोलेक्षुनिदिग्धिकामूलानि क्षीरसिद्धानि पाययेद् भिषगष्टमे ।। ६६ ।।

नवमे मधुकानन्तापयस्यासारिवाः पिबेत् । क्षीरं शुण्ठीपयस्याभ्यां सिद्धं स्याद् दशमे हितम् ॥ ६७ ॥

सक्षीरा वा हिता शुण्ठी मधुकं सुरदारु च। एवमाप्यायते गर्भस्तीव्रा रुक् चोपशाम्यति ।। ६८ ॥

An enciente should be made to drink milk boiled with the roots of Kapittha, Brhati, Bilva, Patola, Iksu and Kantakari ( in case of impending or threatened miscarraige) in the eighth month of her pregnancy. In the ninth month ( and under similar conditions), the potion should be made up of Madhuka ( Yastimadhu), Ananta-mula, Payasya and Sariva. IN the tenth month (and under similar conditions), a potion consisting of milk boiled with Sunthi and Payasya is beneficial, or in the alternative, may be given a potion made up of milk with Sunthi, Madhuka (Liquorice) and Devadaru. The severe pain would vanish and the foetus would continue to develop safely in the womb, under the aforesaid mode of treatment. 66-68

निवृत्तप्रसवायास्तु पुनः षड्भ्यो वर्षेभ्य ऊर्ध्वं प्रसवमानाया नार्याः कुमारोऽल्पायुर्भवति ।। ६९ । ।

A child born of a woman, who had remained sterile ( notconceived) for a period of six years ( Nivrtta-prasava ) 2 after previous child-birth, becomes a short-lived one. 69

अथ गर्भिणीं व्याघ्युत्पत्तावत्यये छर्दयेत्, मधुराम्लेनान्नोपहितेनानुलोमयेच्च, संशमनीयञ्च मृदु विदध्यादन्नपानयोः अश्नीयाच्च मृदुवीर्यं मधुरप्रायं गर्भाविरुद्धञ्च, गर्भाविरुद्धाश्च क्रिया यथायोगं विदधीत मृदुप्रायाः।। ७०।।

1. Sivadasa also says that powders of these drugs should be given with boiled milk but he adds that some authorities recommend these drugs to be boiled in milk according to Ksira-Paka-Vidhi.

2. If a conception does not occur in a woman for a period of more than five years after child-birth, she is called Nivrtta-prasava.

Application of mild emetic medicines (though forbidden in the case of a pregnant woman), may be resorted to, in the case of a pregnant woman), may be resorted to, in the case of a fatal disease (even in that stage). A diet consisting of sweet and acid things should be prescribed for her, so as to bring the deranged Dosas to the normal state; mild Samsamaniya (soothing and pacifying) medicines should be applied and food and drink consisting of articles mild in their potency, predominently sweet-tasting and not injurious to the foetus, should be advised and mild (external) measures not baneful to the foetus should be resorted to, according to the requirements of the case. 70

। सौवर्णं सुकृतं चूर्णं कुष्ठं मधु घृतं वचा। मत्स्याक्षकः शङ्खपुष्पी मधुसर्पिः सकाञ्चनम् ॥ ७९ ॥

अर्कपुष्पी मधु घृतं चूर्णितं कनकं वचा | हेमचूर्णानि कैडर्यः श्वेता दूर्वा घृतं मधु।।७२।।

चत्वारोऽभिहिताः प्राशा: श्लोकार्थेषु चतुर्ष्वपि । कुमाराणां वपुर्मेधाबलबुद्धिविवर्धनाः ॥ ७३ ॥

भवन्ति चात्र

Memorable Verses : The growth, memory, strength and intellect of a child are improved by the use of the four following medicinal compounds, used as linctus (Prasa) viz., (1) well-powdered gold, Kustha, honey clarified butter and Vaca (2) Matsyaksaka (Brahmi), Sankha-puspi,powdered gold, clarified butter and honey; (3) Arkapuspi, honey, clarified butter powdered gold and Vaca; and (4) powdered gold, Kaidarya (Maha- Nimba), white Durva, clarified butter and honey. 71-73

इति सुश्रुतसंहितायां शारीरस्थाने गर्भिणीव्याकरणशारीरं नाम दशमोध्यायः ।

Thus ends the tenth Chapter of the Sharira Sthana in the Susruta Samhita, which treats of the nursing and management etc. of pregnant women.

शारीरस्थानं समाप्तम् ।

Here ends the Sharira Sthana.

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