Changes

=== ''Vidhi Vimarsha'' ===

=== ''Vidhi Vimarsha'' ===

Ritukala – Ideal period in menstrual cycle for conception  

==== Ritukala – Ideal period in menstrual cycle for conception ====

 

For conception, the period after stoppage of menstruation,i.e., from the 4th day onwards to 12 days corresponding to the 16th day of the menstrual cycle is considered to be the ideal period for impregnation. During the first half of the menstrual cycle, i.e., from 1st day to 14th day, estrogen hormone is dominant, and under its influence, the cervical mucus becomes watery with a high concentration of sodium chloride. This consistency is ideal for spermatozoa to travel through the cervical canal. After ovulation on the 14th day, the formation of corpus luteum leads to the dominance of progesterone hormone, and this leads to change in a characteristic of cervical mucus from watery to viscous because of increased protein content and decrease in sodium chloride. This hampers the migration of sperm in the cervical canal. Hence the ritukala of 12 days in the first half of the cycle is justified.  

For conception, the period after stoppage of menstruation,i.e., from the 4th day onwards to 12 days corresponding to the 16th day of the menstrual cycle is considered to be the ideal period for impregnation. During the first half of the menstrual cycle, i.e., from 1st day to 14th day, estrogen hormone is dominant, and under its influence, the cervical mucus becomes watery with a high concentration of sodium chloride. This consistency is ideal for spermatozoa to travel through the cervical canal. After ovulation on the 14th day, the formation of corpus luteum leads to the dominance of progesterone hormone, and this leads to change in a characteristic of cervical mucus from watery to viscous because of increased protein content and decrease in sodium chloride. This hampers the migration of sperm in the cervical canal. Hence the ritukala of 12 days in the first half of the cycle is justified.  

==== Selection of Suitable partner for conception ====

Under effect of progesterone preventing sperm penetration                Cervical mucus under estrogenic effect

In Ayurveda classics, the preparation of procuring healthy progeny begins with the selection of a partner. For a healthy progeny with longevity and desired traits, both partners should be of reproductive age without any physical or mental disease or chronic illness. Conception in older age is associated with genetic abnormalities like Down’s syndrome and rare chromosomal abnormalities like Patau's syndrome and Edward's syndrome in the offspring. Increased maternal age may also lead to the poor outcome of pregnancy. Conception during illness may result in congenital anomalies or growth retarded fetus.  Research has shown risks of low birth weight, premature labor, anemia, and pre-eclampsia are related to the biological age.  

In Ayurveda classics, the preparation of procuring healthy progeny begins with the selection of a partner. For a healthy progeny with longevity and desired traits, both partners should be of reproductive age without any physical or mental disease or chronic illness. Conception in older age is associated with genetic abnormalities like Down’s syndrome and rare chromosomal abnormalities like Patau's syndrome and Edward's syndrome in the offspring. Increased maternal age may also lead to the poor outcome of pregnancy. Conception during illness may result in congenital anomalies or growth retarded fetus.  Research has shown risks of low birth weight, premature labor, anemia, and pre-eclampsia are related to the biological age.  

In the prone position, pressure on abdomen affects the natural movement of vata dosha, while the left-lateral position stimulates the enzyme secretions in the gut and leads to pitta prakopa. Therefore, a comfortable, supine position is recommended for coitus for conception, as all body humors are in their proper positions. A sprinkling of cold water or cold compresses of vulva after coitus is useful to prevent the reverse flow of semen from the female genital tract. Mental comfort, urge for sex and willingness for sex with the same partner are very important factors for the conception and formation of a healthy fetus. As neuro-endocrinal harmony is essential during the act of coitus, one should be free of urges or thoughts of hunger, thirst, passing flatulence, urination or bowel movements, and should be free from emotions like stress, anger, anxiety while having sexual intercourse.  

In the prone position, pressure on abdomen affects the natural movement of vata dosha, while the left-lateral position stimulates the enzyme secretions in the gut and leads to pitta prakopa. Therefore, a comfortable, supine position is recommended for coitus for conception, as all body humors are in their proper positions. A sprinkling of cold water or cold compresses of vulva after coitus is useful to prevent the reverse flow of semen from the female genital tract. Mental comfort, urge for sex and willingness for sex with the same partner are very important factors for the conception and formation of a healthy fetus. As neuro-endocrinal harmony is essential during the act of coitus, one should be free of urges or thoughts of hunger, thirst, passing flatulence, urination or bowel movements, and should be free from emotions like stress, anger, anxiety while having sexual intercourse.  

Ambiance for coitus:

==== Ambiance for coitus ====

The importance of ambiance in stimulating desire in a couple to perform sex, and thus, conceive a healthy child, is expressly mentioned in this chapter. Articles or experiences pleasant to the sensory organs (such as using fragrant objects, pleasing or arousing music or sound, articles pleasant in taste or touch) in a stimulating environment play a very important role in arousal and act as aphrodisiacs, per Ayurvedic texts.

The importance of ambiance in stimulating desire in a couple to perform sex, and thus, conceive a healthy child, is expressly mentioned in this chapter. Articles or experiences pleasant to the sensory organs (such as using fragrant objects, pleasing or arousing music or sound, articles pleasant in taste or touch) in a stimulating environment play a very important role in arousal and act as aphrodisiacs, per Ayurvedic texts.

Effect of chanting mantras:

==== Effect of chanting mantras ====

Keeping the body and its doshas in harmony with its environment are essential to good conception, as it is with staying healthy, per Ayurvedic texts. This is consistent with the vedic concept of Yatha Pinde Tatha Brahmande (As the Body, so the Universe) – that problems occur when there is disequilibrium between the body and its surroundings.  

Keeping the body and its doshas in harmony with its environment are essential to good conception, as it is with staying healthy, per Ayurvedic texts. This is consistent with the vedic concept of Yatha Pinde Tatha Brahmande (As the Body, so the Universe) – that problems occur when there is disequilibrium between the body and its surroundings.  

Chanting and reciting mantras have an effect on neuro-endocrinal homeostasis. Hence chanting or reciting mantras or shlokas is recommended for maintenance of a psychosomatic balance of the body. In Vedic rituals, shloka (sacred hymns) to be chanted are said to invoke Lord Brahma, the creator of the universe and the progenitor of all the activities of the universe, Lord Brihaspati, the power behind every activity, Lord Vishnu, the preserver of the universe, Soma and Agni, the prime principles in all living beings, Ashvinau, the symbol of health and well-being in every creature, and Mitra and Varuna, the forces necessary to sustain life in the universe. Therefore, vedic scriptures, including Ayurvedic texts, emphasize on paying one’s obeisance to deities and forces of the universe, in the form of Gods, if one desires a healthy offspring.

Chanting and reciting mantras have an effect on neuro-endocrinal homeostasis. Hence chanting or reciting mantras or shlokas is recommended for maintenance of a psychosomatic balance of the body. In Vedic rituals, shloka (sacred hymns) to be chanted are said to invoke Lord Brahma, the creator of the universe and the progenitor of all the activities of the universe, Lord Brihaspati, the power behind every activity, Lord Vishnu, the preserver of the universe, Soma and Agni, the prime principles in all living beings, Ashvinau, the symbol of health and well-being in every creature, and Mitra and Varuna, the forces necessary to sustain life in the universe. Therefore, vedic scriptures, including Ayurvedic texts, emphasize on paying one’s obeisance to deities and forces of the universe, in the form of Gods, if one desires a healthy offspring.

Chanting of mantras is known to have physical, mental and spiritual benefits. Mantra chanting form the basis of yogic meditation practices to help calm one’s mind and ease anxieties, which could have adverse effects on one’s progeny. Ayurveda science also mentions the role of the atma, along with the union of sperm and ovum, as a prerequisite, in the formation of the garbha. For the atma (of the newborn) to be of best satva and good prior karma, the ambiance and environment of the area should be spiritual, and chanting helps in creating such an environment.

Chanting of mantras is known to have physical, mental and spiritual benefits. Mantra chanting form the basis of yogic meditation practices to help calm one’s mind and ease anxieties, which could have adverse effects on one’s progeny. Ayurveda science also mentions the role of the atma, along with the union of sperm and ovum, as a prerequisite, in the formation of the garbha. For the atma (of the newborn) to be of best satva and good prior karma, the ambiance and environment of the area should be spiritual, and chanting helps in creating such an environment.

Do’s and Dont’s before coitus:

==== Do’s and Dont’s before coitus ====

This chapter provides a detailed list of Do’s and Don’ts that could help a couple conceive a healthy child. These rules or guidelines address various aspects of the couple’s lifestyle – including their diet, their environment – and their health. Traditional rituals and guidelines such as staying pious (and not indulging in immoral thoughts or actions) and being in the company of spiritual or virtuous individuals have been adviced, especially for the expecting mother.  

This chapter provides a detailed list of Do’s and Don’ts that could help a couple conceive a healthy child. These rules or guidelines address various aspects of the couple’s lifestyle – including their diet, their environment – and their health. Traditional rituals and guidelines such as staying pious (and not indulging in immoral thoughts or actions) and being in the company of spiritual or virtuous individuals have been adviced, especially for the expecting mother.  

Preparation for putreshthi yajna and its benefits:

==== Preparation for putreshthi yajna and its benefits ====

Cultures around the world, especially in the eastern countries, practice various rituals to get a healthy offspring. While these rituals and customs are considered essential, their validity from the standpoint of scientific studies have not yet been established. Cultural traditions, however, do provide some much-needed assurance during this period of anxiety and should be continued according to tradition. The physical, psychological, social and spiritual wellbeing of the couple desirous of having progeny is very important - and this is facilitated through rituals. All the regimen and rituals also favor a planned pregnancy instead of an accidental pregnancy. A planned pregnancy ensures a proper physical, psychological, financial and social status.

Cultures around the world, especially in the eastern countries, practice various rituals to get a healthy offspring. While these rituals and customs are considered essential, their validity from the standpoint of scientific studies have not yet been established. Cultural traditions, however, do provide some much-needed assurance during this period of anxiety and should be continued according to tradition. The physical, psychological, social and spiritual wellbeing of the couple desirous of having progeny is very important - and this is facilitated through rituals. All the regimen and rituals also favor a planned pregnancy instead of an accidental pregnancy. A planned pregnancy ensures a proper physical, psychological, financial and social status.

Regimens and factors affecting desired progeny:

==== Regimens and factors affecting desired progeny ====

For getting the desired result (i.e., a healthy progeny of the desired traits), one has to apply the factors either in the form of the same element (dravya samanya) or the elements having similar constitution and properties (guna samanya) or similar the effort (karma samanya), giving the similar to get similar output. All the above mentioned dietary, ritualistic practices, and do's and don'ts need to be of the desired dravya, guna and karma samanya to get the desired result, i.e., healthy and long living progeny with good complexion and intelligence. Whatever the mother sees, tastes, touches, feels, thinks and the way she behaves or thinks socially or spiritually has a deep impact on the future temperament and behavior of the child. A popular example of this ‘karma based garbha samskara’ is the mythological story of Abhimanyu, the warrior son of Arjuna, in the Mahabharata. Abhimanyu, even when he was a fetus in his mother (Subhadra)’s womb, learned the technique of entering the Chakravyuha (a special type of battle formation) from his maternal uncle Lord Krishna. If the mother takes dravya having predominant jala mahabhuta dravya, there will be an increase in the kapha dhatu of the fetus, giving it a fair complexion. Similarly, other mahabhuta-dominant dravyas contribute to other types of complexions in the baby.

For getting the desired result (i.e., a healthy progeny of the desired traits), one has to apply the factors either in the form of the same element (dravya samanya) or the elements having similar constitution and properties (guna samanya) or similar the effort (karma samanya), giving the similar to get similar output. All the above mentioned dietary, ritualistic practices, and do's and don'ts need to be of the desired dravya, guna and karma samanya to get the desired result, i.e., healthy and long living progeny with good complexion and intelligence. Whatever the mother sees, tastes, touches, feels, thinks and the way she behaves or thinks socially or spiritually has a deep impact on the future temperament and behavior of the child. A popular example of this ‘karma based garbha samskara’ is the mythological story of Abhimanyu, the warrior son of Arjuna, in the Mahabharata. Abhimanyu, even when he was a fetus in his mother (Subhadra)’s womb, learned the technique of entering the Chakravyuha (a special type of battle formation) from his maternal uncle Lord Krishna. If the mother takes dravya having predominant jala mahabhuta dravya, there will be an increase in the kapha dhatu of the fetus, giving it a fair complexion. Similarly, other mahabhuta-dominant dravyas contribute to other types of complexions in the baby.

Researchers have been studying the effect of external sensory experiences on the brain activities of infants. In one instance, researchers found enhanced brain activity in infants exposed to “novel word sounds” played everyday during the third trimester.  

Researchers have been studying the effect of external sensory experiences on the brain activities of infants. In one instance, researchers found enhanced brain activity in infants exposed to “novel word sounds” played everyday during the third trimester.  

Effects of karma of the progeny’s prior birth:

==== Effects of karma of the progeny’s prior birth ====

 

As explained in this chapter, with the effect of karma samanya there is garbha sanskara on the fetus inside the mother’s womb. Therefore, the birth of an individual in any race depends on the karma of the parents and the karma from the child’s previous life. According to Charaka, an individual goes through the cycle of birth and death according to Karma Siddhanta. In fact, the birth of an individual has multiple facets like poorvakarma, matrija karma, pitrija karma, garbhadhana, garbhini paricharya and much more. One should not forget the effect of, i.e., karma on the fetus, the mother, and the father. Therefore, in spite of following of all do’s and don’ts strictly, there can be bad progeny because of it's (and the parent's) karma.

As explained in this chapter, with the effect of karma samanya there is garbha sanskara on the fetus inside the mother’s womb. Therefore, the birth of an individual in any race depends on the karma of the parents and the karma from the child’s previous life. According to Charaka, an individual goes through the cycle of birth and death according to Karma Siddhanta. In fact, the birth of an individual has multiple facets like poorvakarma, matrija karma, pitrija karma, garbhadhana, garbhini paricharya and much more. One should not forget the effect of, i.e., karma on the fetus, the mother, and the father. Therefore, in spite of following of all do’s and don’ts strictly, there can be bad progeny because of it's (and the parent's) karma.

Factors for healthy progeny:

==== Factors for healthy progeny ====

 

As explained earlier, according to yukti pramana, the formation of garbha is multidimensional and requires normalcy of all components i.e. fertile period, healthy uterus, sufficient and healthy nutrients, and most importantly, healthy gametes.  

As explained earlier, according to yukti pramana, the formation of garbha is multidimensional and requires normalcy of all components i.e. fertile period, healthy uterus, sufficient and healthy nutrients, and most importantly, healthy gametes.  

Maintenance of products of conception:

==== Maintenance of products of conception ====

 

Stha or tishthati means to stay or remain in position. For sustaining a pregnancy, proper nourishment with adequate hormone status is essential. As mentioned in verse 20 of this chapter, herbs such as aindra, brahmi, satavirya, etc. help nourish the fetus, while Jivaniya herbs used regularly by the mother help achieve a healthy outcome of pregnancy.   

Stha or tishthati means to stay or remain in position. For sustaining a pregnancy, proper nourishment with adequate hormone status is essential. As mentioned in verse 20 of this chapter, herbs such as aindra, brahmi, satavirya, etc. help nourish the fetus, while Jivaniya herbs used regularly by the mother help achieve a healthy outcome of pregnancy.   

Factors causing harm to the embryo:

==== Factors causing harm to the embryo ====

Numerous factors that may hamper sustaining the pregnancy or cause abnormalities in the progeny have been described in this chapter. These factors can be classified as dietary, lifestyle, traumatic, psychological and spiritual factors.  Observance of these avoidable factors leads to growth retardation, the death of the fetus, premature birth, illness or congenital malformations to the offspring. Research seems to indicate that emotional stress to the mother can lead to prenatal or postnatal complications of various types . Dietary habits and lifestyle may lead to neurohormonal changes which affect pregnancy and its outcome . Similar faulty habits by the father can also cause abnormalities of spermatozoa which in turn leads to congenital anomalies in offspring.

==== Precaution for the treatment of disorders in pregnant females ====

As explained by Charaka, a pregnant woman is like a vessel full of oil and should be treated with care, meaning that all doshas, dhatu, mala and ojas of the pregnant woman are at such a critical physiological stage that if one does not attend to her in a timely and proper way it may lead to damage to the foetus or the mother or both. Hence the disorders which may occur during pregnancy are to be treated with special care. For the antenatal mother, the diet or medications which should be used for curing any ailment should be mild and effective. Panchakarma treatment, because of its use of invasive and strong medicines, is to be avoided. Basti and abhyanga to kati are advocated in the eighth month of pregnancy, and these are comparatively safer procedures and may also help in a normal labor. During the eighth month, the fetus is sufficiently developed and viable, and even if the mother gets labor pain while undergoing treatment (mild to aggressive courses, as the need may be), the fetus can be preserved, and there are fewer chances of compromising fetal life.  

As explained by Charaka, a pregnant woman is like a vessel full of oil and should be treated with care, meaning that all doshas, dhatu, mala and ojas of the pregnant woman are at such a critical physiological stage that if one does not attend to her in a timely and proper way it may lead to damage to the foetus or the mother or both. Hence the disorders which may occur during pregnancy are to be treated with special care. For the antenatal mother, the diet or medications which should be used for curing any ailment should be mild and effective. Panchakarma treatment, because of its use of invasive and strong medicines, is to be avoided. Basti and abhyanga to kati are advocated in the eighth month of pregnancy, and these are comparatively safer procedures and may also help in a normal labor. During the eighth month, the fetus is sufficiently developed and viable, and even if the mother gets labor pain while undergoing treatment (mild to aggressive courses, as the need may be), the fetus can be preserved, and there are fewer chances of compromising fetal life.  

The effects of drug use during pregnancy on the fetus has been researched and documented. The mother as well the fetus, if subjected to certain drugs /treatment, can lead to side-effects on either or both.  FDA has specified a certain list of drugs (X category) which are contraindicated during pregnancy . In Ayurveda, the principles of antenatal treatment are given for shamana as well as shodhana, other drugs and treatment are contraindicated. In practice, for any ailments occurring during pregnancy, herbal medicines are preferred over herbo mineral medicines.

The effects of drug use during pregnancy on the fetus has been researched and documented. The mother as well the fetus, if subjected to certain drugs /treatment, can lead to side-effects on either or both.  FDA has specified a certain list of drugs (X category) which are contraindicated during pregnancy . In Ayurveda, the principles of antenatal treatment are given for shamana as well as shodhana, other drugs and treatment are contraindicated. In practice, for any ailments occurring during pregnancy, herbal medicines are preferred over herbo mineral medicines.

Disorders of the fetus and its treatment.

==== Disorders of the fetus and its treatment ====

Following are the common disorder of fetus, abortion, followed by intrauterine growth retardation and intrauterine death.

Following are the common disorder of fetus, abortion, followed by intrauterine growth retardation and intrauterine death:

Factors responsible for abortion and its treatment:

===== Factors responsible for abortion and its treatment =====

First-trimester abortion is seen in about 80% of total abortions. Any bleeding during the first trimester (up to 12 weeks) may either end in inevitable abortion, preterm labor and in rare cases may proceed to full term. Emotional factors like severe anger, stress, jealousy all are suspected to cause the high release of CRH (Corticotropin-releasing hormone) which may trigger uterine contractions.   

First-trimester abortion is seen in about 80% of total abortions. Any bleeding during the first trimester (up to 12 weeks) may either end in inevitable abortion, preterm labor and in rare cases may proceed to full term. Emotional factors like severe anger, stress, jealousy all are suspected to cause the high release of CRH (Corticotropin-releasing hormone) which may trigger uterine contractions.   

As explained earlier, garbhapata (abortion) due to ama dosha (during the first trimester) is very critical to treat. Treatment of ama dosha is apatarpana while that of garbha and garbhini needs santarpana, which are antagonistic and hence very tedious to treat. In practice, Madhura varga dravyas such as shatavari (Asparagus racemosus) and medicated ghee phalaghrita are used in case of threatened abortion. These promote proper nourishment and growth and stop bleeding.

As explained earlier, garbhapata (abortion) due to ama dosha (during the first trimester) is very critical to treat. Treatment of ama dosha is apatarpana while that of garbha and garbhini needs santarpana, which are antagonistic and hence very tedious to treat. In practice, Madhura varga dravyas such as shatavari (Asparagus racemosus) and medicated ghee phalaghrita are used in case of threatened abortion. These promote proper nourishment and growth and stop bleeding.

Growth retardation of fetus and its treatment  

===== Growth retardation of fetus and its treatment =====

 

Intrauterine growth retardation of the fetus occurs due to malnourishment of mother as well as pregnancy disorders which cause vaginal discharge and bleeding. According to severity, they are categorized as garbhashosha (mentioned in Charaka Sharirsthana 2nd chapter) upavishtaka, nagodara, lina garbha (not directly mentioned but clinical features with the absence of movements of fetus suggest this condition).  These conditions occur either because of improper nourishment of mother with vata and pitta dominant diet or because of decreased transfer of nutrients from mother to fetus as a consequence of fetal metabolic disorder or placental abnormality. The treatment principle applicable here is brimhana supplying nourishment to mother and fetus.  

Intrauterine growth retardation of the fetus occurs due to malnourishment of mother as well as pregnancy disorders which cause vaginal discharge and bleeding. According to severity, they are categorized as garbhashosha (mentioned in Charaka Sharirsthana 2nd chapter) upavishtaka, nagodara, lina garbha (not directly mentioned but clinical features with the absence of movements of fetus suggest this condition).  These conditions occur either because of improper nourishment of mother with vata and pitta dominant diet or because of decreased transfer of nutrients from mother to fetus as a consequence of fetal metabolic disorder or placental abnormality. The treatment principle applicable here is brimhana supplying nourishment to mother and fetus.  

All the dietary articles mentioned in the management have vatahara and dhatupushtikara properties, as there are vataprakopa and dhatukshya in these conditions. In the case of lina garbha, there is the absence of fetal movements, to expel such fetus, treatments which increase uterine contractions and induce labor are indicated because such fetus resembles fetus papyraceous or mummified fetus.

All the dietary articles mentioned in the management have vatahara and dhatupushtikara properties, as there are vataprakopa and dhatukshya in these conditions. In the case of lina garbha, there is the absence of fetal movements, to expel such fetus, treatments which increase uterine contractions and induce labor are indicated because such fetus resembles fetus papyraceous or mummified fetus.

Practically the herbs used in fetal growth restriction are yashtimadhu, shatavari, gambhari and preparations like phalghrita, laghumalinivasanta. These herbs and preparations are rasayana and improve dhatvagni and rasa dhatu nirmana. They also help in clearing any obstruction in the channels (srotas) which are supplying nourishment to the fetus through the mother.  As mentioned in classics, ksheer basti given to the mother in severe IUGR conditions stimulates fetal growth.   

Practically the herbs used in fetal growth restriction are yashtimadhu, shatavari, gambhari and preparations like phalghrita, laghumalinivasanta. These herbs and preparations are rasayana and improve dhatvagni and rasa dhatu nirmana. They also help in clearing any obstruction in the channels (srotas) which are supplying nourishment to the fetus through the mother.  As mentioned in classics, ksheer basti given to the mother in severe IUGR conditions stimulates fetal growth.   

Garbhini Udavarta and its management:

===== Garbhini Udavarta and its management =====

 

As a result of progesterone hormone which relaxes all the smooth muscles, there is decreased bowel and intestinal movements. Especially during the later months of pregnancy, along with progesterone, the pressure of the uterus on intestines and rectum leads to decreased peristalsis. This is observed most commonly during the 8th month. Garbhini udavarta is a similar condition with constipation and gaseous distention. This condition is to be relieved as straining for defecation may lead to hemorrhoids, bleeding hemorrhoids and leaking of membranes. Medicated enema of decoction is to be administered to clear the bowel as oral medications may aggravate uterine contractions. Enema with oil should be administered afterward for oleation of the tract, and this may further help in the formation of canal/pathway for parturition.   

As a result of progesterone hormone which relaxes all the smooth muscles, there is decreased bowel and intestinal movements. Especially during the later months of pregnancy, along with progesterone, the pressure of the uterus on intestines and rectum leads to decreased peristalsis. This is observed most commonly during the 8th month. Garbhini udavarta is a similar condition with constipation and gaseous distention. This condition is to be relieved as straining for defecation may lead to hemorrhoids, bleeding hemorrhoids and leaking of membranes. Medicated enema of decoction is to be administered to clear the bowel as oral medications may aggravate uterine contractions. Enema with oil should be administered afterward for oleation of the tract, and this may further help in the formation of canal/pathway for parturition.   

The position in pregnancy to administer basti is nyubja sthithi – hunchback /flexed posture. Conventionally, the left-lateral position is used. In nyubja sthithi, the fetus moves in a ventral position relieving the pressure on colon and rectum, making it easy for basti to be administered and reach descending colon easily.  

The position in pregnancy to administer basti is nyubja sthithi – hunchback /flexed posture. Conventionally, the left-lateral position is used. In nyubja sthithi, the fetus moves in a ventral position relieving the pressure on colon and rectum, making it easy for basti to be administered and reach descending colon easily.  

Mrita garbha (intrauterine death) and its management: 

 

===== Mrita garbha (intrauterine death) and its management =====

 

All the factors which are contraindicated during pregnancy and are known to cause harm to the fetus, if continued by the mother can cause upavishtaka, nagodara, garbhashosa. If left untreated, excessive accumulation of doshas with maternal illness may lead to placental insufficiency and fetal disorders where it fails to metabolize nutrients and causes fetal death.  The symptoms of mritagarbha (fetal death) also signify causes as antepartum hemorrhage, hypovolemia and its complications in the mother.   

All the factors which are contraindicated during pregnancy and are known to cause harm to the fetus, if continued by the mother can cause upavishtaka, nagodara, garbhashosa. If left untreated, excessive accumulation of doshas with maternal illness may lead to placental insufficiency and fetal disorders where it fails to metabolize nutrients and causes fetal death.  The symptoms of mritagarbha (fetal death) also signify causes as antepartum hemorrhage, hypovolemia and its complications in the mother.   

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To expel the dead fetus, the treatments to be administered are to initiate uterine contractions and induce labor. If necessary surgical treatment for removal of a dead fetus is also believed to save the mother from serious complications like DIC (disseminated intravascular coagulopathy) may occur if fetal fibrin is absorbed in maternal circulation.  After the removal of the dead fetus, the physician should administer sura varga (alcoholic preparations) for the relief of pain and purification of the gut and genito-urinary system and also for the sense of exhilaration. Loss of fetus in such a later stage can be very stressful for mother and anxiety, depression and other psychotic complications may arise if proper care is not taken. Once there is complete shuddhi of koshtha and garbhashaya, one should give brimhana treatment to promote tissue bulk and nutrition. As there is the removal of the kleda from all dhatus during the management and shuddhi, santarpana is very essential.

To expel the dead fetus, the treatments to be administered are to initiate uterine contractions and induce labor. If necessary surgical treatment for removal of a dead fetus is also believed to save the mother from serious complications like DIC (disseminated intravascular coagulopathy) may occur if fetal fibrin is absorbed in maternal circulation.  After the removal of the dead fetus, the physician should administer sura varga (alcoholic preparations) for the relief of pain and purification of the gut and genito-urinary system and also for the sense of exhilaration. Loss of fetus in such a later stage can be very stressful for mother and anxiety, depression and other psychotic complications may arise if proper care is not taken. Once there is complete shuddhi of koshtha and garbhashaya, one should give brimhana treatment to promote tissue bulk and nutrition. As there is the removal of the kleda from all dhatus during the management and shuddhi, santarpana is very essential.

The upbringing of the child:

The upbringing of the child:

According to Artha Shastra of Chanakya (Vishnugupta), a child till the age of five years needs a lot of care and affection, while the next ten years require inculcating him/her with discipline and education and once he/she reaches 16 years of age, he/she should be treated as a friend. Children of 16 years of age are mature, physically and sexually, and by then are ready to acquire skills of work for earning.

According to Artha Shastra of Chanakya (Vishnugupta), a child till the age of five years needs a lot of care and affection, while the next ten years require inculcating him/her with discipline and education and once he/she reaches 16 years of age, he/she should be treated as a friend. Children of 16 years of age are mature, physically and sexually, and by then are ready to acquire skills of work for earning.

=== BIBLIOGRAPHY ===

=== BIBLIOGRAPHY ===