GARBHOPACHARANIYA – Care of the pregnant woman – Ashtanga Sangraha Sharira sthana Chapter 3

Ashtanga Sangraha Sharira sthana Chapter 3 – Garbhopacharaniya – care of the foetus (vis a vis care of the pregnant woman); thus said Atreya and other great sages. ( 1 )

अथातो गर्भोपचरणीयमध्यायं व्याख्यास्यामः । इति हस्माहुरात्रेयादयो महर्षयः ॥१॥

Prathama masopachara – regimen in first month of pregnancy

प्रथमे मासि गर्भिणी क्षीरमनुपसंस्कृतं मात्रावच्छीतं काले काले पिबेत् । तस्मिन्नपि चाद्यं द्वादशरात्रं क्षीरोद्भवं सर्पिश्शालिपर्णीपलाशाभ्यां शृतं कनकरजतक्वथितं शीतोदकानुपानं पिबेत् । स्वादु शीतं द्रवप्रायं सात्म्यं च सायंप्रातराहारयेत् । न चाभ्यङ्गोद्वर्तनानि सेवेत । यथोक्तानि च दोषकराणि परिहरेदापञ्चमान्मासाद्विशेषेण ॥ २ ॥

In the first month (of pregnancy), the pregnant woman should drink unprocessed (non-medicated) and cooled milk in suitable quantity, often especially during the first twelve days, she should consume ghee prepared from milk boiled with saliparni and palasa, boiled in vessels of either gold or silver, followed by cold water as an after-drink. She should take foods which are sweet, cold and watery and accustomed ones, both in the evenings and morning; she should not indulge in anointing and massaging of the body. All such activities which have been described as harmful (to the foetus) should be avoided, especially till the fifth month. (2)

Dvitiyadi masopachara – regimen in succeeding months

द्वितीये मधुरौषधसिद्धं पयः पिबेत् । तृतीये तदेव सर्पिर्मधुभ्याम् । चतुर्थेऽक्षमात्रनवनीतयुक्तम्। पञ्चमे क्षीरसर्पिः । षष्ठे तदेव मधुरौषधसिद्धम् । सप्तमे च । तस्मिंस्तु गर्भस्य केशोत्पत्त्या मातुर्विदाहो भवतीति स्त्रियो भाषन्ते । नेति भगवानात्रेयः । गर्भोत्पीडनात्तु दोषा हृदयं प्राप्य विदहन्ति ततः कण्डूर्जायते कण्ड्वा किक्किसम् ॥३॥

During the second month, she should drink milk processed with drugs of a sweet taste.

In the third (month), the same (milk) along with ghee and honey.

In the fourth (month), the same (milk) with one aksa of fresh butter;

in the fifth, it should be milk and ghee,

in the sixth, also, the same (milk and ghee) processed with drugs of sweet taste; like wise, in the seventh also.

Women say that during this month (seventh) the mother feels heart burn due to production of hairs (on the head) of the foetus. The worshipful Atreya says it is not so, the doshas getting excited by the presence of the foetus, reach the heart and produce heartburn, causing itching and from itching follows the appearance of kikkisa (striae or short lines on the skin of the abdomen due to stretching of the skin). (3)

तत्र कोलोदकेन नवनीतस्य मधुरौषधसिद्धस्य पाणितलमात्रमस्यै दद्यात् । चन्दनमृणालकल्कैश्च स्तनोदरं मृद्गीयात् । शिरीषधातकीसर्षपमधुकचूर्णैर्वा । कुटजार्जकबीजमुस्ताहरिद्राकल्कैर्वा । निम्बकोलसुरसमञ्जिष्ठाककैर्वा । शशहरिणपृषतरुधिरयुक्तया वा त्रिफलया । करवीरकरञ्जपत्रकल्कसिद्धेन च तैलेनाभ्यङ्गः । परिषेकः पुनर्मालतीमधुकसिद्धेनाम्भसा । कण्डूयनं वर्जयेत् । त्वग्भेदवैरूप्यपरिहारार्थं स्नानोद्वर्तनं च शीलयेत् । मधुरं चाहारमल्पमल्पस्त्रेहलवणमल्पोदकानुपानं भुञ्जीत ॥४॥

Hence she should be given fresh butter processed with drugs of sweet taste, one panitala (in quantity) to eat, followed by water boiled with kola;

her breasts and abdomen should be massaged with the paste of chandana and mrinala or with a powder of sirisa, dhataki, sarsapa and madhuka; or with the paste of kutaja, seeds of arjaka, musta and haridra; or with paste of nimba, kola, manjista; or paste of triphala mixed with the blood of either sasa (rabbit) harina (antelope) or prsata (deer ).

She should be given a massage with oil processed with the paste of leaves of karavira and karanja and bath with water processed with malati and madhuka; she should avoid scratching her skin, and resort to baths and massages daily to avoid cracking and ugliness of the skin, partake foods which are sweet, small in quantity, containing little of fats and salts, and take little quantity of water as afterdrink. (4)

अष्टमे क्षीरयवागूं सर्पिष्मतीं पिबेत् । नेति खण्डकाप्य: गर्भस्य पैङ्गल्याबाधभयात् । अस्तु पैङ्गल्याबाधस्तथाप्येवं कुर्वीत । नीरुजं बलवर्णसत्वसं हननसम्पदुपेतं ज्ञातीनामग्रगण्यमपत्यं जनयतीति भगवानात्रेयः ॥५॥

During the eighth (month) she should drink kshirayavagu (gruel processed with milk) mixed with ghee. Khandakapya says that it should not be done because of the fear (risk) of getting paingalya (brown eye) But the worshipful Atreya says, that even though there be the risk of paingalya it (drinking kshirayavagu) should be done, for by doing so, she will give birth to children who are healthy, endowed with the excellence of strength, colour (and complexion), mind (intelligence), body build and foremost among his clan. (5)

बदरोदकेन पललपयोदधिमस्तुतैललवणफलघृतमधुयुक्तेनास्थापयेत् । पुराणविड्विशुध्यर्थं मधुकादिमधुरौषधसिद्धेन च तैलेनानुवासयेदनुलोमनाय वायोः । अनुलोमे हि मारुते सा सुखमनुपद्रवा प्रसूते ॥६॥

She should be administered a decoction – enema (Niruha Basti) containing water in which badara is boiled and also meat, milk, whey, oil, salt (saindhava) phala (madanaphala) ghee and honey. To remove the old faeces and to induce downward movement of Vata, an oil enema with oil processed with sweet drugs like madhuka etc. With the proper downward movement of vata she will deliver (the child) easily and without complication. ( 6 )

गर्भिणीं तु न्युब्जामास्थापयेदनुवासयेद्वा । तथास्या विवृतमार्गतया सम्यगौषधमनुप्रविशति ॥७॥

Enemas both decoction enema and oil enema should be administered to the pregnant woman after putting her in the knee – elbow position. Then all the medicine (enema material) enters inside because the channels are wide open. (7)

Notes: All other times, enemas are administered with the person lying on the left side, adoption of knee-elbow position in case of a pregnant woman is an exception to the rule-says Indu.

तत ऊर्ध्वं स्निग्धाभिर्यवागूभिर्जाङ्गलरसैश्चोपचरेदाप्रसवकालादिति भगवान् धन्वन्तरिः ॥८॥

Afterwards (after the eighth month) till the time of delivery, she should be nursed with yavagu (gruel) mixed with fats, and soup of meat of animals living in desert-like regions – says the worshipful Dhanvantari. ( 8 )

नवमे तु तत एवानुवासनतैलात् पिचुं योनौप्रणयेद्गर्भमार्गाशययोः स्नेहनार्थमिति । अनेन प्रथममासादाराभ्य क्रमेण गर्मिण्याः प्रसवकाले गर्भधारिणीकुक्षिकटीपार्श्वपृष्ठं मृदु भवति । वायुश्चानुलोमः सम्पद्यते । मूत्रपुरीषं च प्रकृतिभूतं जरायुश्च मार्गं प्रतिपद्यते । पुत्रं चेष्टं कल्यमायुष्मन्तं सुखिनं सुखेन काले बलवती प्रसूते ॥९॥

In the ninth (month) a diaper soaked in the oil prescribed for oil enema should be inserted into a vagina to lubricate the uterus and the genital tract. By this, the lower abdomen, waist, flanks and back which are bearing the (weight of) the foetus, even from the first month get softened; vayu gets the downward movement, the urine, faeces and the jarayu (covering membrane) begin to move in their routes normally. The woman (who by now) is strong, will deliver easily at the proper time, a son who is desired, healthy, endowed with long life and happiness. (9)

बिल्वकार्पासीपफ्फणापाटलीपिचुमन्दाग्निमन्थमांसीवर्धमानकपत्रभङ्गक्वाथेन शीतेन सर्वगन्धोदकेन वा गर्भिण्याः प्रत्यहं स्नानमुपदिशेत् ॥ १०॥

Everyday the woman should be given a bath in cooled water, boiled with cut leaves of bilva, karpasi, papphana patali, picumanda, agnimantha, mamsi, vardhamanaka or with water scented with all kinds of perfumes. (10)

Sutikagara – maternity chamber

प्राक् चैवास्या नवमान्मासादपहृतास्थिशर्कराकपाले प्रशस्ते देशे वास्तुविद्याप्रशस्तं सर्वर्तुसुखमुपहृतसर्वोपकरणं सन्निहितज्वलनं प्राग्द्वारमुदग्द्वारं वा सूतिकागारं कारयेत् ॥११॥

Even before she reaches the ninth month a Sutikagara-(lying-in-room/maternity chamber), should be got constructed at an auspicious place after removing bones, stones etc, from that site; it should be good architecturally, and comfortable in all seasons, provided with all equipment, with fire available nearby and its entrance facing east or north. (11)

तत्रानुकूलेषु नक्षत्रादिषु पुण्याहशब्देन गोब्राह्मणवृद्धान् नत्वाऽऽवर्तमाना प्रदक्षिणं प्रविश्य बहुश: प्रसूताभिरनुरक्ताभिरविषादाभिः क्लेशक्षमाभिः परिवृता स्वस्त्ययनपर नुलोमनैराहारविहारैरनुलोमितवातमूत्रपुरीषा प्रसवकालमुदीक्षेत । स्वल्पेऽपि च विण्मूत्रविबन्धे फलवर्ती: प्रणिदद्यात् ॥१२॥

Then, on the day considered auspicious in respect of planetary position, etc, after performing punyaha (religious rite of purification of the house) and having bowed to (the feet of) the cow, brahmans and elders, going round them in the rightward direction, the pregnant woman should enter the maternity chamber; she should have, as her attendants, women who have given birth to many children, who are affectionate, who is not grief, who are capable of withstanding fatigue and knowing propitiatory rites; she should resort daily to such foods and activities which help the downward movement of flatus, urine and faeces and await the time of delivery. Even if there is a mild obstruction to faeces and urine, use of rectal supository prepared from fruits should be advised. (12)

Asannaprasava lakshana – signs of commencement of labour

तत्रासन्नप्रसवायाः क्लमो ग्लानिर्मुक्तबन्धने इवाक्षिणी निष्ठीविका मुत्रपुरीषबाहुल्यं शिथिलकुक्षिताधोगुरुत्वमन्नानभिलाषो वेदनोदरहृदयकटीबस्तिवङ्क्षणेषु तोदभेदशूलस्फुरणस्त्रवणानि च योन्यां भवन्ति । तदनन्तरमावीनां प्रादुर्भावो गर्भोदकप्रवाहश्च ॥ १३ ॥

As the time of delivery approaches near, the woman develops exertion, exhaustion, a feeling as though the eyes have lost their attachement, expectoration, increase of ( frequency) urine and faeces, looseness of the abdomen, heaviness of the lower abdomen, lack of desire for food, uneasiness in the (region of ) heart, waist, bladder and groins, pricking and tearing pain, throbbings and exudation of fluid in the vagina After these, the Avi (labour pain) commences followed by discharge of garbhodaka (amniotic fluid). (13)

Prasavopachara: management of labour

अथैनामुपस्थितगर्भं कृतकौतुकमङ्गलां पुन्नामफलहस्तां स्वभ्यक्तामुष्णोदकपरीषिक्तां सघृतां यवागूं पाययेत् । ततः सुरक्तार्षभचर्मप्रच्छदे मृदुनि भूमिशयने शयानामुत्तानामाभुग्नसक्थिपृष्ठामहतवाससोऽशङ्कनीयाः प्रियदर्शनाः परिणतवयसः प्रजननकुशलाः प्रगल्भाः कृत्तनखाः स्त्रियः सूतिकां सूनृताभिर्वाणीभिराश्वासयन्त्यः पर्युपासीरन् ॥१४॥

Then, noticing the fixing of the foetus, auspicious and magical rites should be performed. Furits having masculine names should be offered to her to hold in her hands. Thin gruel, mixed with ghee and warm water should be given to drink. She should then be made to lie on a soft bed placed on the ground and covered with skin of red-coloured deer, adopt a supine position (with the face upwards) folding both her legs at the knees; a thick pad of soft cloth should be placed underneath the waist and back; elderly women who are confident, good looking, well versed in conduting delivery, dextrous in work (capable of managing any complications), having their nails cut close, should be around the pregnant woman, comforting her with pleasant talk and assuring safe delivery. (14)

अथास्यै दद्यात् कुष्ठैलालाङ्गलीवचाचव्यचित्रकचिरिबिल्वचूर्णमुपाघ्रातुं मुहुर्मुहुः । तथा भूर्जपत्रशिंशपासर्जरसान्यतमधूममन्तरान्तरा च । पार्श्वपृष्ठकटीसक्थिदेशान् कोष्णेन तैलेनाभ्यज्यानुसुखमस्या मृद्गीयात् ॥१५॥

She should then be given a powder of kustha, ela, langali, vacha chitraka, and chirabilva to be used as a snuff frequently: Likewise, inhalation of smoke of bhurjapatra, simsipa, sarjarasa and such others. her flanks, back, waist, and legs should be anointed with warm oil and massaged comfortably, in between. (15)

एवमवाक् परिवर्तते गर्भः | तस्य लक्षणम् । विमुच्य हृदयमुदरमाविशति । बस्तिशिरोऽवगृह्णाति । त्वरयन्त्येनामाव्यः । न चेदेवं परिवर्तते ततो मुहुर्मुहुजृम्भणं चङ्क्रमणं च कारयितव्यानन्तरोक्तं विधिम् ॥ १६ ॥

By these, the foetus turns downwards; its signs are-getting loosened from the (region of) the heart and descending low into the abdomen to catch up the head of the urinary bladder and the labour pains becomes more frequent. If the rotation does not take place, the woman should be told to yawn frequently, and walk a little in addition to other methods (snuffing, inhalation etc.) described above. (16)

अन्ये तु मुसलेनोलूखलं धान्यपूर्णमाहननीयमित्याहुः । तत्तु न सम्यक् । दारुणव्यायामवर्जनं हि गर्भिण्याः सततमुपदिश्यते । विशेषतश्च प्रसवकाले प्रचलितसर्वधातुदोषायाः सौकुमार्यत्वान्नार्या मुसलव्यायामेनेरितो वायुरन्तरं लब्ध्वा प्राणान् हिंस्यादिति ॥१७॥

Some others say, that she should be made to pound corn filled into a morter with a long pestle. But that is not correct, because avoidance of strenous work is advised always for the pregnant woman.

During the period of delivery, all the dhatus (tissues) and doshas are in a state of flux and the woman is very tender, so pounding with the long pestle makes for increase of vayu (vata) which invading the heart, might cause danger to life. (17)

अथ परिवृत्तगर्भां पर्यङ्कमेनामारोप्य कुशला स्त्री पादतोऽस्या निषण्णाया योनिमनुलोममनुसुखमभ्यज्य स्फिजौ पादाभ्यां पीडयेत् । योनिं च पुनः पुनः प्रसाधयेत् । ब्रूयाच्च सुभगे शनैश्शनै: प्रवाहयस्व सुप्रसन्नस्ते मुखवर्णः पुत्रं जनयिष्यतीति ॥१८॥

After noting the rotation of the foetus, the woman should be made to lie on a cot; skillful women around her should anoint oil over the region of the vaginal canal, give comfortable massage in the downward direction, and hit her buttocks softly with her own feet. The vaginal passage should be dilated frequently. She should be told – “you good lady, exert pressure slowly ( strain, make effort to expel) and cheerfuly; the colour of your face is pleasant, you will give birth to a son.’’ (18)

अन्या तु वामकर्णेऽस्या मन्त्रमिमं जपेत् ॥१९॥

Another (woman) should chant this auspicious hymn into her left ear. (19)

“क्षितिर्जलं वियत्तेजो वायुर्विष्णुः प्रजापतिः । सगर्भां त्वां सदा पातु वैशल्यं वा दधात्वपि ॥२०॥

“May ksiti (earth) jala (water), viyat (sky), teja (light, heat, fire) vayu (air), visnu, and prajapati protect you bearing a child always and grant you easy widening (of the passages of birth). (20)

प्रसूष्व त्वमविक्लिष्टमविक्लिष्टा शुभानने । कार्तिकेयद्युतिं पुत्रं कार्तिकेयादिरक्षित” मिति ॥ २१ ॥

You, the unblemished, bring out a son possessing the brilliance of Kartikeya and protected by Kartikeya himself. (21)

तथा

‘इहामृतञ्च सोमञ्च चित्रभानुश्च भामिनि । उच्चैःश्रवाश्च तुरगो मन्दिरे निवसन्तु ते ॥ २२ ॥

“May Amrita (nector), Soma, Citrabhanu, Bhamini, and the horse named Uchaisrava, reside in your house ( uterus & genital tract). (22)

इदममृतमपां समुद्घृतं वै तव लघुगर्भामिमं प्रमुञ्चतु स्त्री | तदनलपवनार्कवासवास्ते सह लवणाम्बुधरैर्दिशन्तु शान्ति मिति ॥ २३ ॥

“O lady, this water which is like nectar, protect you and initiate easy delivery, let anala (fire), pavana (air), arka (sun) vasus (lords of the quarters) and the lavanambudhara (sea of salt water) grant you happiness. (23)

तथा पराऽनुशिष्यात् अनागतायां वेदनायां मा प्रवाहिष्ठाः । अकालप्रवाहणं हि विण्मूत्रादिवेगानामिवोदीरणमनर्थकरमहितं च गर्भस्य श्वासकासशोष कुब्जतादिकारित्वात् । तथा तेषामेव विधारणमिव वेदनायामप्रवाहणमुपघाताय ततो यथोक्तं कुरुष्व ॥२४॥

She should then be instructed thus – “do not strain (bear down) if the labour pains are not clearly manifest; premature bearing down, will do harm to the foetus, just as premature straining for expulsion of faeces, urine, etc. will do (to the body); and also causes dyspnoea, cough, emaciation, hunched back etc. (to you ). So also, even dont be quiet without straining, (that also will be harmful, just as suppression of the urges (of urine, faeces etc.) So obey as instructed.” ( 24 )

शनैश्शनैश्च पूर्वं प्रवाहिष्ठाः । निर्गमे बाढं गर्भस्य योनिमुखप्रतिपत्तौ बाढतरमाप्रसवादिति । तस्यास्तु प्रवाहमानायाः स्त्रियः शब्दं कुर्युः प्रजाता प्रजाता धन्यं धन्यं पुत्रमिति । तथास्या हर्षेण प्राणा आप्यायन्ते ॥ २५ ॥

“Begin bearing down slowly and steadily at the commencement, repeatedly in the middle and quickly when the foetus comes into the vaginal orifice, continue to do so till the delivery is over.”

When she is thus bearing down, others nearby should repeat the words, ‘delivered: delivered: successful: successful: its a son: it is a son: etc; hearing these, the woman will soon gain the satisfaction (pleasure) of life (recover from the fatigue of delivery). (25)

गर्भसङ्गे तु योनिं धूपयेत् कृष्णसर्पनिर्मोकेन । पिण्डीतकेन वा । बनीयाच्च हिरण्यपुष्पीमूलं हस्तपादे धारयेच्च सुवर्चलां विशल्यां वा ॥२६॥

In case of the obstructed foetus, the vagina should be fumigated with krisnasarpa nirmoka (peel of black serpent) or with pinditaka (madanaphala); root of hiranyapuspi, (should be tied to her hands and feet; suvarchala and visalya should be worn (on the head as amulets). (26)

Aparapatana vidhi – delivery of the placenta

अथ प्रसूताया न चेदपरा पतति ततो दक्षिणेन पाणिना नाभेरुपरिष्टाद्बलवदुपपीड्य अन्येन पृष्ठत उपसड्गृह्य विधुनुयात् ॥२७॥

If, after the delivery of the child, the Apara ( placenta ) does not come out, a downward jerk should be given from above the umbilicus by placing the right hand on her abdomen and the left on her back. ( 27 )

पार्ष्या वा श्रोणीमाकोटयेत् । स्फिजौ वोपसंगृह्य सुपीडितं निपीडयेत् । वेण्याङ्गल्या वा केशवेष्टितया च कण्ठतालू परामृशेत् ॥२८॥

Or a kick given on her pelvis (waist ), buttocks squeezed hard, her palate and fauces (back of the throat inside) tickled with plait of hairs or with fingers covered with hairs. (28)

भूर्जपत्रकाचमणिसर्पनिर्मोकैश्च योनिं धूपयेत् । भूर्जगुग्गुलुभ्यां वा । शालिमूलसिद्धेन वा सर्पिषा योनिमभ्यज्य कटुकालाबुजालिनीनिम्बसर्पनिर्मोकै धूपयेत् । अनभ्यक्तां वा कटुतैलमिश्रः कल्कीकृतैर्वा तैलाक्तैरालिम्पेत् । गुडनागरकल्केन वा । तदेव वा भक्षयेत् । लाङ्गलीमूलकल्केन वा पाणिमुदरं चालिम्पेत् । महावृक्षक्षीरं वा मूर्धन्यनुषेचयेत् ॥ २९॥

The vagina should be fumigated with bhurjapatra, kachamani (glass beads) and sarpa nirmoka (snake peel); or with bhurja and guggulu; the vagina should be anointed with ghee medicated with salimula and then fumigated with katuka, alabu, jalini, nimba and sarpanirmoka (snake peel); or these drugs may be made into a paste, mixed with oil processed with pungent drugs and applied to the vagina even without anointing it; or a paste of guda (jaggery/molasses) and nagara may be applied. The same paste may also be partaken; the palms and abdomen should be smeared with paste of langali or the milky sap of mahavriksha should be poured over the head. (29)

कुष्ठतालीसकल्कं बिल्वबल्वजयूषमैरेयासवसुरामण्डान्यतमेन व्योषतीक्ष्णोष्णेन वाम्लेन कुलत्थरसेन मधुकपिप्पलीसम्पाकेन वा पाययेत् । पिप्पल्येलाकोलबिडचव्यचित्रकोपकुञ्चिकाकल्कं वा । खरस्य वृषभस्य वा जीवतो दक्षिणं कर्णमुद्धृत्य बिल्वकुलत्थ — बल्वजयूषादीनामाप्लावनानामन्यतमे प्रक्षिप्य मूहूर्तस्थितमुद्धृत्य तदाप्लावनं पाययेत् ॥३०॥

Paste of kustha and talisa should be administered along with the soup of bilva and balvaja or with maireya (fermented liquid) asava (fermented infusion) suramanda (thin fluid of beer) or vyosa (trikatu) along with any sour liquid which is penetrating and hot in property; or madhuka and pippali, well cooked and taken with decoction of kulattha or paste of pippali, ela, kola, bida, chavya, chitraka and upakuncika; or a small piece of the ear of a donkey or a bull which is alive, should be cut and kept immersed for a period of one muhurta (48 minutes) in the soup of bilva, kulattha, and balvaja or any other liquid. After the stipulated time it is taken out and the liquid is given to drink. (30)

कुष्ठैलाकल्कं वा सुरया । अर्कालर्ककषायं वा प्रजातां सुरोन्मिश्रम् । कुष्ठलाङ्गलिकीमूलककल्कं वा मद्यमूत्रान्यतमेन । वत्सकादिचूर्णं वा मद्येन । शतपुष्पाकुष्ठमदनहिङ्गसिद्धस्य च तैलस्य पिचुं ग्राहयेत् । ततश्चैनामनुवासनकालेऽनुवासयेत् ॥३१॥

Paste of kustha and ela can be given along with sura or decoction of arka and alarka along with sura; or paste of kustha and roots of langali either with madya (wine), cows urine or any other (liquid) or powder of vatsakadigana (vide chapter 16 sutrasthana) along with wine; a diaper soaked in the oil prepared with satapushpa, kustha, madana, and hingu should be held (in the vagina); next on oil enema should be given at the appropriate time. (31)

बिल्वबल्बजयूषाद्याप्लावनैश्च फलजीमूतके क्ष्वाकुधामार्गवकुटजार्ककृतवेधनहस्तिपर्ण्य – भीरूपहितैरास्थापयेत् । सिद्धार्थककुष्ठलाङ्गलिकीमहावृक्षक्षीरमिश्रेण वा सुरामण्डेम । शाल्मलीवृन्तानि वा स्विन्नान्यापोथ्य पञ्चमूलकषाये विमर्दयेत् । तेन च पूतेन स्नेहवता फलादियुक्तेन ॥३२॥

Next a decoction-enema prepared with soup of bilva, balvaja, along with phala, jimutaka, iksvaku, dhamargava, kutaja, arka, krutavedhana hastiparni and abhiru; or with suramanda, mixed with siddharthaka, kustha, langalaki, mahavrkskshira (milky sap of sudha) or with decoction of panchamulas in which salmalivrnta (cotton-like material found inside the fruits) is cooked in steam, mixed, and added with oil and paste of phala (madana) etc. (32)

यथोक्तास्थापनद्रव्यसिद्धेन कटुतैलेनोत्तरबस्तिं दद्यात् । शिग्रुसुमुखमरिचाजाजीचित्रककल्कक्षीरगोमूत्रसिद्धेन वा कटुतैलेनानुवासयेत् । उमाशाल्मलीपिच्छया वा सघृता योनिं पूरयित्वा विधुनुयात् । स्निग्धेन वा कृत्तनखेन पाणिना नालानुसारतोऽपहरेत् ॥३३॥

Or an vaginal enema (douche) should be given with decoction of drugs mentioned above for decoction-enema and mixed with katu taila; paste of sigru, sumukha, maricha, ajaji, chitraka processed with cows milk and cows urine and added with katutaila should be used as an oil-enema; a thick paste of uma and salmali piccha (cotton like material present inside the fruits) mixed with ghee should be placed inside the vaginal tract and the woman shaken ( a little ). Or it ( placenta) should be pulled out by the hand which is lubricated and nails closely cut, (the hand) following the umbilical cord upward. (33)

Makkalla – post-partum pain

प्रजातायां चेद्वस्तिमूर्धोदरेषु शूलं मक्कलाख्यं स्यात्तत्र यवक्षारचूर्णं सर्पिषा सुखोष्णोदकेन वा पिबेत् । वरणादिं वा सपञ्चकोलमेलाप्रतीवापम् ॥ ३४ ॥

अथवा वीरतरादिमूषरादिप्रतीवापम् । लवणचूर्णं वा वत्सकादिनिर्यूहेण । वत्सकादिं वा मदिरया । अंशुमतीद्वयक्वाथेन वा मरिचभद्रदारुकल्कम् । भाङ्गनागरदेवदारुकल्कं वोष्णाम्भसा । पुराणगुडं वा त्रिकटुत्रिजातक धनिकाचूर्णसंसृष्टं भक्षयेत् ॥ ३५ ॥

If, after delivery, the woman develops pain in the region of the head of the bladder and abdomen which is known as Makkalla, she should be made to drink warm water added with powder of yavakshara and ghee; or decoction of drugs of varanadi group of drugs (videchapter 16 of sutrasthana) mixed with (powder of) panchakola; or of virataradi group of drugs with usaradi group of drugs; or vatsakadi group of drugs mixed with madira (fermented liquor); or paste of maricha and bhadradaru with decoction of the two amsumatis; or paste of bharigi, nagara and devadaru, mixed with hot water; or old jaggery (treacle) mixed with powder of trikatu, trijataka and dhanika should be given to her to eat. (34-35)

तस्याश्चेत् स्वस्थानतो योनिर्भश्येत् ततो यस्य कस्यचिच्छोणितेनाभ्यज्य योनिं यथास्थानं कुशला स्त्री निवेशयेत् । निविष्टां चाशोकरोहिणीबर्हिषोशीरप्रियङ्गुदेवदारुकल्कविपक्वेन तैलेन बहुश: स्वेदयेत् पूरयेत् ब्रूयाच्च गच्छ सुभगे स्वस्थानमिति ॥३६॥

If there happens a prolapse of the vagina from its normal place, then it should be anointed with some kind of blood and put in its normal place by another skilled woman; an oil prepared by boiling the paste of asoka rohini, barhisa, usira, priyangu and devadaru should be used for fomentation of the part and filling into it.

Then the words, “you, the good (beautiful) one, please get back to your original place” should be uttered. (36) 6

Sutikopachara – management of puerperium

तद्वच्चान्यतमा स्त्री जातमात्रमेव बालं बालोपचरणीयेन विधिनोपपादयेत् । तमुपदेक्ष्यते तूत्तरेषु । अथ सूतिकां बलातैलेनाभ्यज्यात् । बुभुक्षितां चपञ्चकोलचूर्णेन यवान्युपकुञ्चिकाचव्यचित्रकव्योषसैन्धवचूर्णेन वा युक्तामहः परिणामिनीं यथासात्म्यं स्नेहमात्रां पाययेत् । स्नेहायोग्यां वातहरौषधक्काथं ह्रस्वपञ्चमूलक्काथं वा ॥३७॥

Meanwhile another woman should attend to the new born baby as per the regimen of care of the infant, which will be described further on. (vide, chapter 1 of uttarasthana) Next, the woman who has delivered should be anointed with Balataila (vide. next chapter); when she feels hungry she should be given a drink of accustomed fatty material (oil or ghee) processed with either the powder of panchakola or of yavani, upakunchika, chavya, chitraka, vyosa and saindhava, only that much quantity as can be digested within the day time, for the woman who is eligible (fit) for oleation therapy, a decoction of drugs which mitigate vata or that of hrasva panchamula can be given. (37)

पीतवत्याश्च यमकेनाभ्यज्य वेष्टयेदुदरं वस्त्रेण । तथा न वायुरुदरविकृतिमुत्पादयेदनवकाशत्वात् । जीर्णे तु स्नेहे पूर्वौषधैरेव सिद्धां विदार्यादिगणक्वाथेन क्षीरेण वा यवागूं सुस्विन्नां द्रवां मात्रया पाययेत् । प्राक् स्नेहयवागूपानाभ्यां चोभयकालमुष्णोदकेन परिषेचयेत् ॥ ३८ ॥

After she has taken the drink (decoction), her abdomen is to be anointed with yamaka (mixture of two fats-oil and ghee) and tied with a band of cloth, so that vata, not finding a place, will not create any disorder of the abdomen.

After the drink of fat has been digested, she should be given thin watery yavagu (gruel) as food, processed with drugs mentioned earlier or with decoction of drugs of vidarayadigana, mixed with milk, in suitable quantity. The woman should be given a bath in hot water both the times, once before the drink of oil, and again before the drink of yavagu (gruel). (38)

एवं त्रिरात्रं पञ्चरात्रं सप्तरात्रं वानुपाल्य ततो यवकोलकुलत्थयूषेण लघुना चान्नपानेन । द्वादशरात्रात् परं जाङ्गलरसादिभिश्च क्रमादाप्याययेदग्निबलादीन्यवेक्ष्य पाययेत् । तथा जीवनीयबृंहणीयमधुरवातहरसिद्धैरभ्यङ्गोद्वर्तनपरिषेकावगाहैरन्नपानैश्च रुपाचरेत् । एवं हि गर्भवृद्धिक्षपितशिथिलसर्वशरीरधातुप्रवाहणवेदनाक्लेदरक्तनिस्स्स्रुतिविशेषशून्यशरीराच्च पुनर्नवीभवति ॥३९॥ । क्वथितशीतं च तोयं हृद्यै-

In this way she should be fed for three, five or seven days, later on with soup of either yava, kola, or kulattha, and such other foods and drinks which are easily digestible. From the twelvth day onwards, she should be given nourishing foods such as soup of meat of animals of desert-like regions, gradually, in accordance with her capacity of digestion; water which is boiled and cooled should be allowed for drinking. She should also be treated with oil massage, shower bath and immersion bath, using oil and water medicated with drugs possessing jivaniya (invigourating), brimhaniya (nourishing) madhura (sweet in taste) and vatahara (mitigaring vata) properties, and with foods and drinks which are agreeable and pleasing. By these measures, the body (of the woman) which has become emaciated and weak due to the development of the foetus, all the dhatus (tissues) becoming depleted and loose, the fatigue caused by straining during delivery, and loss of large quantities of water and blood etc, will become new, once again. (39)

अत एव च सूतिकाया व्याधिः कृच्छ्रसाध्यो भवत्यसाध्यो वा तस्मात्तां यथोक्तेन विधिना प्रयत्नेनोपचरेत् । एवं साध्यर्धमासमुपसंस्कृता क्रमेण विमुक्ताहारविहारयन्त्रणा विगतसूतिकाभिधाना स्यात् पुनरार्तवदर्शनादित्येके ॥४०॥

As the diseases which affect the woman who has delivered will be either difficult to treat or incurable, the measures suggested above should be adhered to, at all costs.

After following this regimen strictly for one and half months, change over to other foods and activities should be gradual; the woman will remain to be called as a ‘‘delivered lady’’ till the artava (menstrual flow) reappears; so say some authorities. (40)

इत्याद्यं मासमादाय यावद्गर्भक्षमा पुनः । स्त्रीस्यात्तावद्विधिः सर्वः सर्वथा साधु दर्शितः ॥४१॥

Thus all the regimen to be followed by the woman commencing from her first month (of pregnancy) till she becomes fit to conceive again have been clearly described so far. (41)

॥ इति तृतीयोऽध्यायः ॥

Thus ends Ashtanga Sangraha Sharira sthana third Chapter.