Stanya

Breast milk (stanya) is the nourishing fluid that is produced in the breasts (stana) forming the primary food for the infants. In Ayurveda, according to the branch ‘Kaumarabhritya’ includes the diseases in the neonates and infants. The diseases of newborn are caused by faulty nutrition, vitiated breast milk (dushta stanya or dosha) and presence of psychiatric conditions (graha dushti). (Su Sa. Sutra Sthana 1/8/5) There is emphasis on breast feeding explained through the concept of stanya vignyana. The knowledge or literature available on stanya is dispersed in various parts across different Samhita. This article deals with all the basic concepts related to stanya and breast milk in terms of pathology, physiology and therapeutics as mentioned in the Ayurveda Samhita and possible research perspectives in the field.

Contributors

Section/Chapter/topic	Concepts/Stanya
Authors	Bhojani M. K. 1, Joglekar Aishwarya 2
Reviewer	Basisht G.3,
Editor	Deole Y.S.4
Affiliations	1 Department of Sharir Kriya, All India Institute of Ayurveda, New Delhi, India 2 Department of Samhita Siddhant, All India Institute of Ayurveda, New Delhi, India 3 Rheumatologist, Orlando, Florida, U.S.A. 4 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
Correspondence emails	meera.samhita@aiia.gov.in, carakasamhita@gmail.com
Publisher	Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India
Date of publication:	September 27, 2023
DOI	10.47468/CSNE.2023.e01.s09.152

Etymology

“Stanodbhavam stanyam”- the entity produced or secreted from breast (stana) is termed as ‘stanyam’. (Dalhana on Su. Sa. Nidana Sthana 10/18) Monniere Williams dictionary mentions it as that which is drawn from the breast i.e. breast milk or mothers milk.

Synonyms

Naari ksheer, naari dugdha, stree dugdha, stree ksheera, ksheera, dugdha, manusha ksheera, manusha dudha, stanodbhava, yoshita stanya

Physiology of stanya according to ayurveda

Stanya is regarded as upadhatu (the minor structural components that stabilize and sustain the body) and prasada bhaga (essence or formed from nutrient part) of rasa dhatu metabolism, produced in the breast/mammary glands in females. [Cha. Sa. Chikitsa Samhita 15/17, Bhoja Samhita] Bhoja mentions stanya as not having any movement or physiological functions in body (gativivarjita) as it does not participate in further metabolic activities in the body. Sushruta mentions stanya as a product of digested food (pakwahara). [Su. Sa. Nidana Sthana 10/18] Like shukra, its presence is felt across the body. [Su. Sa. Nidana Sthana 10/19]
Kashyapa opines that stanya is produced from the rakta dhatu. [Kashyapa Samhita Rakta Gulma Adhyaya] This can be justified as the stanya is produced and expressed from the stana which consists of sira which are the upadhatu of rakta dhatu.
The metabolism of rasa- rakta dhatu form the major canvas for the understanding the stanya physiology. Like menstruation (artava), stanya is observed for limited time during the course of life of a female i.e. post delivery period or lactation period. Sushruta states that it is expressed within 3 of 4 days of child birth and its secretion continues till the stanyapanayana or weaning occurs. [Su. Sa. Shareera Sthana 10/14] [A.H. Uttar Tantra 1/14]
The development of breasts occurs after the menarche by physiologically accelerated growth of mammary glands during the pregnancy. [Su. Sa. Nidana Sthana 10/17] In the state of pregnancy, the rasa dhatu metabolism is directed towards stanya formation. [Cha. Sa. Shareer Sthana 6/23 ,Kashyap Samhita Sutrasthana 1]
As per Vagbhat, the gross amount of breast milk (stanya) present in an individual is 2 anjali (approximately 200ml with 1 anjali corresponding to 135ml according to a previous study). [A.H. Shareera Sthana 3/81] According to contemporary approach average breast milk production is about 500-700ml per day. It is defined to have pure white colour and becomes homologous with water when mixed. It possesses a characteristic sweet/ madhura smell when unvitiated. [Su. Sa. Shareera Sthana 8/14, Su. Sa. Nidana Sthana 10/25] Any deviation from the normal colour and consistency of stanya reflects underlying pathological condition. Sushruta has also explained the physiology of stanya.
Following factors are responsible for the appearance of breast milk in the post-natal period which also facilitates the process of labour. [Su. Sa. Nidana Sthana 10/22]-

• Apatya sparsha- Touching the child.
• Apatya darshana- Sight of the new-born.
• Apatya smarana- Thinking about the child.
• Grahanat shareerasya¬- Holding the new-born close to the mother.

Contemporary view also suggests that the hormonal and emotional factors play a key role in the breast milk physiology. Thus in the conditions like decreased lactation (stanya-kshaya), counselling can prove to be more beneficial.
The main function of stanya is providing the nourishment to child as explained through the jeevana karma (promoting vitality). [Su. Sa. Sutra Sthana 15/14] The entire sustainance of the child for the first six months to one year is dependent on the stanya, which also determines the health profile of the infant. Another karma of stanya is peenatvajanana i.e. providing proper structure and nourishment to the stana or breast tissue. [Su. Sa. Sutra Sthana 15/5] Kashyapa has also emphasized the same stating the breast milk as jeevana (vitalizer), pushtikara (nourishing), vriddhikara (growth promoting), balavardhana (strengthening), ojaskara (promotinig essence part of life) [Kashyap Samhita Ksheera Vigyana Adhyaya]
Ayurveda mentions that the, expression of breast milk from the right breast at first is indicative of male progeny, while that from left breast is indicative of female progeny. [Su. Sa. Shareera Sthana 3/34, Cha. Sa. Shareera Sthana 2/24]

Anatomical aspects related to stanya

Breas milk (stanya) is formed in the mammary glands (stanyavahi sira) in breasts (stana). Stanyashaya (site of breast milk) is also termed as ‘ksheerashya’ or a part of 'strotas’ comprising of stanyavaha sira present exclusively in females. [Su. Sa. Shareera Sthana 5/10] Blood vessels in chest (vakshagata sira) representing the rakta dhatu are also present in the stana comprising of stanamoola sira, which are two in number. [Su. Sa. Shareera Sthana 5/37, Su. Sa. Shareera Sthana 7/22] It is the abode of two mansa- marma namely ‘Stana-Rohita’ and ‘Stana-Moola’ injury to which can lead to number of complications. [Su. Sa. Shareera Sthana 6/35]
Structural part of stana mainly comprises of mansa dhatu and consists of about 10 peshi (muscles), which are absent in males and undergo physiological hypertrophy during youth. [Su. Sa. Shareera Sthana 5/39] Two dhamani are present in stana of female according to Sushruta. [Su. Sa. Shareera Sthana 9/5] Charak has described normal anatomical positioning, shape and size of stana. [Cha. Sa. Shareera Sthana 8/14] Normal characteristics of stana sampat are not too highly positioned (na-atiurdhwa), not too elongated (na-ati lamba), not much emaciated (anati krisha), not overly nourished (anati peenau), nipples of appropriate size (yukta pippalikau) and nipples not retracted and easy for suckling (sukha prapannau). The description of stana is identical to that given by the modern science. Nipples situated at upper side of breasts (urdhwastana) can lead to visual abnormalities in child. While nipples at elongated side of breasts (lambastana) leads to covering of face of child, which might lead to suffocation. [Su. Sa. Shareera Sthana 10/25, Cha. Sa. Shareera Sthana 8/33] Thus the prenatal and antenatal examination of breast is important to avoid such complications.

Characteristics and diagnostic aspects concerning Stanya

The stanya dushti and its presentation in different neonates can be understood by the application of objective parameters like laboratory investigations and physico-chemical analysis along with the qualitative assessment. Sushruta has thus advised to examine the stanya by putting the drops of stanya in clear water. The appearance of shankha (conch) like white colour and homogeneity of mixture, absence of effervescence (phena), thread like appearance (tantumatva), does not float on the surface (no-utplavati), does not get precipitated) (na avasidati) is considered to be the features of shuddha stanya and keeps the child healthy (aarogya), gives proper growth and development (shareeropachaya) and improves strength (bala vriddhi) in child (kumara). [Su. Sa. Shareera Sthana 10/31]
The different diagnostic parameters concerning the metabolism of stanya are explained in the figure underneath (Figure no. 1)

Figure No. 1- Development of diagnostic parameters with respect to Stanya

Pharmacological properties of breast milk

• Rasa (taste): madhura (sweet) and slight astringent (kashaya)
• Veerya (potency): sheeta (cold)
• Guna (quality): light to digest (laghu)
• Useful in nasya (nasal therapy), aschyotana (eye drops), as wholesome (pathya) and vitalizer (jeevana) [Su. Sa. Sutra Sthana 45/57]
• It shall not be boiled [Su. Sa. Sutra Sthana 45/62]
• Curd made out of breast milk possesses unctuous (snigdha), heavy to digest (guru), sweet(madhura) properties. It has balya (strengthening), santarpana (satiating), chakshushya (beneficial for eyes) and doshaghna properties. [Su. Sa. Sutra Sthana 45/73]
• Ghrita (ghee) prepared out of stanya is easy to digest, chakshushya (beneficial for eyes) and anti-toxic (vishaghna) leading to enhancement of agni and nourishing to body.

It is used in the ocular therapies (prasadana putapaaka) for purpose of rejuvenation to eyes. [A.H. Sutra Sthana 24/16] It is also used as a medium for the proper attachment of jalauka(leech) during raktamokshana. [A.H. Sutra Sthana 26/41]

Pathological aspects related to stanya

The vitiation of stanya leads to dosha vitiation in the child causing range of diseases. Dalhana mentions that the diseases occur due to consumption of vitiated stanya by the child. [Dalhana on Su. Sutra Sthana 1/7/5] The stana roga like stana-vidradhi (abscess), stana-granthi (cyst) predominantly occur after the development of stana or mammary glands according to the Sushrut Samhita. [Su. Sa. Sutra Sthana 10/17, 26, A.H. Chikitsa Sthana 13/28].

1) Dosha vaishamya (disequilibrium of dosha)

As mentioned earlier the pathology or the vitiation of normal physiology of stanya is the main reason behind the occurrence of diseases in the new-born. The basic dosha disequilibrium (vaishamya) can be understood as depletion (kshaya) and increase (vriddhi). It can be summarized in the table given below:

Table No. 1 – Types of vaishamya, its features and understanding concerning stanya

Types of Vaishamya	Features	Practical understanding
Stanya kshaya (depletion state) (Su. Sa. Sutra Sthana 15/12)	Stana mlanata: Breast appear underdeveloped or emaciated Stanya alpata: decrease in quantity of breast milk Stanya asambhava:  Lack of production of breast milk	This can be correlated with low milk supply or decrease in the quantity of milk. In some cases, complete failure of milk production can occur as well.
Stanya vriddhi (increased state) (Su. Sa. Sutra Sthana 15/6)	Stana apeenatwa: Overgrowth of stana. Stanya muhurmuhu pravritti: Intermittent, continuous production of  stanya Toda: pricking pain at stana region	This is correlated to galactorrhea Breast hypertrophy or gigantomachia can be related with this condition. Symptoms of breast abscess or carcinoma.

These conditions are often faced by the practitioners and primi mothers during day to day practice. The stanya kshaya or stanya nasha (reduction in amount of stanya- breast milk) is an important condition as it directly affects the growth and development of new born. Acharya Sushruta has provided the detailed explanation regarding the etio-pathology, clinical features and management of this condition.

• Causes of stanya nasha or stanya kshaya (absence of breast milk or low milk supply):
  Krodha (anger), shoka (depression/sorrow), avatsalya (resentment) are mentioned as the most important causes of decreased stanya production as per Sushruta. Vagbhata mentions langhana (fasting) and ayasa (over exertion) in addition to above causes. [Su. Sa. Shareera Sthana 10/30, A.H. Uttar Tantra 1/17]
• Treatment of stanya kshaya:
  It includes the application of basic concepts pertaining to stanyajanana (facilitating the production of Stanya) and stanyashodhana (alleviation of dosha vitiation in stanya). The treatment can be summarized as given below: [Su. Sa. Shareer Sthana 10/30, Cha. Sa. Shareera Sthana 8/57, A.H. Uttara Tantra 1/18]
1. Saumanasya janana: Creating and maintaining healthy blissful state of mind
2. Diet (aharaja) protocol: One suffering from depletion (stanya kshaya) should consume the dietary items like, yava (barley), godhuma (wheat), shali (rice), mansa rasa (meat soup), sura (wine). Alcoholic preparations like seedhu [Su. Sa. Sutra Sthana 45/175-176, Cha. Sa. Sutra Sthana 27/179, A.H. Sutra Sthana 5/67], sauveeraka (alcoholic preparation), peenyaka (sesame extract), lashuna (garlic, allium sativum), matsya (fish), ksheera prayoga (milk and dairy products), drava-amla- lavana pradhana ahaara (liquid diet predominantly salty and sour in taste), nishpava (flat beans) (A.H. Sutra Sthana 6/20). Sushruta also mentions masha (black gram), rajamasha (cow peas). (Su. Sa. Sutra Sthana 46/34-35)
3. Medication/aushadha protocol: Use of herbs like kasheruka (Actinoscirpus grossus (L.f.) Goetgh.), shrungataka (Trapa bispinosa Roxb.), bisa (Nelumbo nucifera Gaertn), vidarikanda (Pueraria tuberosa), madhuka (Madhuca longifolia), shatavari (Asparagus racemosus), nalika (Pergularia daemia (Forssk.)), alabu (Chenopodium album), kaalashaaka (Corchorus capsularis). veerana (Vetiveria Zizanioides), ikshu (Saccharum officinarum), darbha (Desmostachya bipinnata Stapf.), kasha (Saccharum spontaneum) , gundra (Typha angustata) , moolaka (Raphanus sativus L.). [Cha. Sa. Shareera Sthana 8/56]

As mentioned earlier, extensive knowledge and research is available on the lactogenic, galactagogic potential of herbs mentioned in Ayurveda. The dravya like shatavari (Asparagus racemosus), ashwagandha (Withania somnifera), vidari (Pueraria tuberosa), musali (Chlorophytum borivilianum), durva (Cynodon dactylon), haridra (Curcuma longa Linn), musta (Cyperus rotundus), padmaka (Prunus Cerasoides D), guduchi (Tinospora cordifolia). Similarly, other drugs constituting jeevaniya (A.H. Sutra Sthana 15/5), vidarigandhadi (A.H. Sutra Sthana 15/7), padmakadi gana (A.H. Sutra Sthana 15/41), mustadi gana (A. H. Sutra Sthana 15/42, Su. Sa. Sutra Sthana 54-55), vacha-haridradi gana (A. H. Sutra Sthana 15/35-36), vacha-haridradi (Su. Sa. Sutra Sthana 38/26-28), kakolyadi gana (Su. Sa. Sutra Sthana 38/35-36) have proven potent effect in enhancing the breast milk production.
Dalhana has also mentioned few treatment modalities like sura (fermented or alcoholic preparations), shali (rice), mansa (meat), goksheer (milk), sharkara (sugar), dadhi (curd), hridya diet in the treatment of stanya kshaya [Dalhana on Su. Sa. Sutra Sthana 15/29-31]
The aparistruta stanya (improper or inadequate expression of breast milk, improper technique of breast feeding), the child can suffer from conditions like kasa (cough), shwasa (breathing difficulties), vami (vomitus) hence breast feeding should be avoided in such conditions. [Su. Sa. Shareera Sthana 10/29]

2) Treatment of stanya dushti as per Sushruta

The rasa dominant in tikta, kashaya, katu and madhura rasa are indicated for this purpose. [Cha. Sa. Shareera Sthana 8/56]

• Panchakarma: Therapeutic emesis (vamana) [A.H. Sutra Sthana 18/2], therapeutic purgation (virechana), therapeutic enema with decoction (asthapana) and unctuous enema (anuvasana).
• Aahara : Yava (barley), godhuma (wheat), shali (rice), mudga (green gram), harenu, kulattha (horse gram), sauveeraka (type of fermented preparation), maireya (type of fermented preparation) , medaka (type of fermented preparation) , lashuna (garlic) , karanja shaka (Pongamia pinnata)
• Herbs: Patha (Cissampelos pareira), mahaushadha (shunthi), suradaru (Cedrus deodara (Roxb)), musta, murva (Marsdenia tenacissima), guduchi, vatsaka (Holarrhena antidysentrica Linn. Wall.), kiratatikta (Swertia chirata), katurohini (Picorrhiza kurroa), sariva(Hemidesmus indicus) in kwatha form.

Etiological factors of stanya dushti

There is also explanation of different etiological factors pertaining to the stanya dushti in samhita which are described below [Cha. Sa. Chikitsa Sthana 30/232-236] (Table No. 2 Showing the involvement of dietary (aaharaja), lifestyle (viharaja) and psychological (manas hetu) in vitiation of stanya.

Table 2: Causes of vitiation of breast milk

Aaharaja hetu (dietary factors)	viharaja hetu (lifestyle related factors)	manas hetu (psychological factors)
Ajeerna bhojana (eating despite the food is undigested)	Jagarana (night awakenness)	Mana santapa (mental disturbance)
Asatmya ahara (eating unwholesome food)	Atichinta (over thinking)	Krodha (anger)
Vishama ashana (eating in inappropriate amount and time)	Vegavidharana (suppression of urges )
Viruddha ahara (eating incompatible food)	Vega udeerana (over expression fof urges)
Atibhojana (over-eating)	Diwaswapna (daytime sleeping)
Amla / ksharayukta/ lavanayukta bhojana (eating food i.e. sour, alkaline and spicy in nature)	Abhighata (injury or accident)
Guda (Jaggery) , krishara (gruel), dadhi (curd) , mandaka (preparation of curd), gramya- udaka- anupa mansa (meat of different animals)

Ashtang Hridaya has also mentioned viruddha ahara (incompatible diet), kshudha (excessive hunger) , vichetasa (abnormal lifestyle), dhatu dushti as cause of stanya dushti. (A.H. Uttar Tantra 1/19)
Thus all the diet related, lifestyle related and psychological factors are involved in the pathogenesis of stanya dushti (vitiation of breast milk). These can be considered as risk factors for various disorders related to breast milk and breast feeding.

Understanding the clinical features of stanya dushti

Dalhana has pondered over the vitiation of stanya due to various dosha where the stanya vitiated by pitta dosha can lead to pungent and bitter taste instead of sweet. It also leads to occurrence of pita (yellowish discolouration), neela (bluish discolouration), lohita raji (reddish discolouration) in stanya. (Dalhana on Su. Sa. Nidana Sthana 10/25) Atipandutva (excess whitishness) and ati-madhurya (excess sweet taste) is depictive of kapha dushta stanya as well. [Dalhana on Su. Sa. Nidana Sthana 10/25]
Charak Samhita [Cha. Sa. Shareera Sthana 8/56] and Ashtang Hridaya (A.H. Uttar Tantra 2/2-5) also mentions the features of stanya dushti based on dosha prominence as below-

Table No. 3 Characteristics of dosha dushta stanya

Stanya dushti	Colour of stanya	Taste (rasa) of stanya	Nature of stanya	Effect of stanya
Vataja	Shyava-aruna varna (Reddish black in colour)	Kashaya Anurasa (slightly astringent)	Vishada (clear) Agandha (odourless) Ruksha (devoid of unctousness) Drava (excessive liquid in consistency) Phenila (with bubbles or effervescence)	Atriptikara (not nourishing or satiating) Karshana (emaciating) Vata vikarakara (causing Vata diseases) Vibandhakrita (causing constipation) (A.H. Uttar Tantra 2/2)
Pittaja	Krishna (blackish) neela (bluish) peeta (yellowish) tamra (reddish)	Tikta (bitter), amla (sour), katu (pungent) taste (rasa)	Kunapa gandha (foul smelling) ushna (warm)	Pitta vikara kara (causing pitta diseases) Daha (causing burning sensation when ingested) (A. H. Uttar Tantra 2/3) Charmadala (skin disease)(Ka. S Khila Sthana 15/8) Amlapitta (Hyperacidity), (Ka.S Khila Sthana 15/8) Vamana (Ka.S Khila Sthana 15/8) Kasa (Cough)A . S .U 2/14 Shwasa (Dyspnea), A. S .U 2/14 Jwara (Fever) A. S.U 2/14
Kapha	Ati-Shukla (excessively white)	Ati-madhura (sweet), lavana (salty) anurasa	Ghrita- taila- vasa gandhi (smelling like ghee, oils) Picchila (with sticky consistency) Tantumada (thread like consistency) Jala Nimajjan (sedimenting in water) (A.H.Uttar Tantra 2/4)	Shleshma vikara kara Phakka (Breast milk induced marasmus) (K.S.Chi.17/4) Visarpa (erysipelas), Kotha (erythematous rash), Kandu (itching), Swasa (breathing abnormality) , Kasa (cough), Shaitya (cold body), Pratishyaya (coryza), Kshiralasaka (A.S.U.2/16)

Sushruta has stated that breast feeding is contraindicated in mother who is kshudhita (hungry), shokarta (depressed), shranta (exhausted), pradushta dhatu (having dosha and dhatu vitiation), garbhini (pregnant), atiksheena (excessively weak), atisthula (obese), vidagdha bhakta (one consuming spicy food), viruddha ahara (consuming incompatible diet). [Su. Sa. Shareera Sthana 10/31]
Charak explains 8 types of abnormalities in breast milk (ksheera dosha) based on the dosha prominence. [Cha. Sa. Sutra Sthana 19/4/1] The dosha accumulate in mammary glands and ducts (ksheeravaha sira) leading to abnormalities in breast milk. [Cha. Sa. Chikits Sthana 30/236]
The clinical features along with the treatment protocol of these stanya dosha can be summarized as below: [Cha. Sa. Chikitsa Sthana 30/232-235] Treatment of stanya dushti according to Ashtang Hridaya (A.H. Uttar Tantra 2/9-14) is also explained (Table No. 4 treatment of breast milk abnormalities as per Charaka Samhita and Ashtang Hridaya)-

Table No. 4- Treatment of breast milk abnormalities as per Charak Samhita and Ashtang Hridaya

Type of stanya dushti	Clinical features	Treatment as per Charak Samhita	Chikitsa of Stanya Dushti as per Ashtang Hridaya
Vataja Stanya Dushti
Vairasya	Karshya (emaciation) in child, Swadate na- Stanya breast milk does not taste good, aversion towards breast milk Kruchhrena Vardhate – The growth of child is delayed.	Draksha (vitis vinifera), Madhuka (Madhuka indica), Sariva Siddha Ksheera (medicated milk). Lepa of Panchakola over the Stana region of mother.	Dashamoola kwatha – 3 times a day Decoction of Chitraka (Plumbago zeylanica), Patha, Katuka, Kushtha, Deepyaka (Trachyspermum ammi) Bharangi (Clerodendron Serratum), Devdaru, Saral, Vrishchikali, Pippali (Piper longum) Ghritapana with Ghrita mentioned in Vaatavyadhi Accha Surapana Mridu Virechana Basti Swedana Rasnadi Ghrita
Phena-Sanghata	Kricchra Pravartana (difficulty in expression of breast milk) , Kshamaswarata (dull voice) , Purisha-Mutra Graha (retention of faeces and urine) ,causes Vataja Shiroroga (headache), peenasa (sinusitis)	Administration of decoction of Patha (Cissampelos pareira), Shunthi (Zingiber officinale), Murva Lepa of Anjana (collyrium), Shunthi (dry ginger), Devadaru (cedrus deodara), Bilvamoola (aegle marmelos), Priyangu over the stana region.
Raukshya	Balahrasa (Weakness)	Use of Siddha Ghrita or Ksheera prepared using Virechanopaga Dravya (herbs used for purpose of virechana) Use of Jeevaniya Panchamoola Lepa.
Pittaja Stanya Dushti
Vaivarnya	Discolouration of Stanya , Gatravaivarnaya (discolouration of body parts) , Swedana-Adhikya (excessive perspiration) , Trishna-Adhikya (excessive thirst)	Use of Kalka infused with Yashtimadhu (Glycerrhiza glabra), Mrudwika, Payasya (Fritillaria roylei Hook.) etc. Lepa of Draksha, Madhuka Kalka over the Stana region.	Amrita (guduchi), Abhiru (shatavari), Patoli (Stereospermum colais (Dillwyn) Mabb.), Nimba (Azadirachta indica), Chandan (Santalum album), Sariva Kwath Triphaladi Kwath Sarivadi, Patoladi, Padmakadi Gana Dravya Siddha Kwath Pittaghna Ghrita Paana Virechana
Vaigandhya	Occurrence of Pandu and Kamala in the child.	Use of Vishanika (Aristolochia bracteolata), Triphala (polyherbal medicine consisting of Haritaki, Bibhitka, Amalaki), Rajani (Turmeric/Haridra) Siddha Ksheera. Lehana of Abhaya (Terminalia chebula) choorna along with Trikatu and Madhu. Lepa of Sariva, Ushira etc. Dravya over the Stana region.
Kaphaja Sthanya Dushti
Sneha	Chardana (vomitus), Kunthana (discomfort or pain), Lalastrava (excessive salivation), Strotas Rodha (obstruction of body channels), Nidra (sleepiness), Klama (lethargy).	Consumption of decoction infused with Devdaru , Musta , Patha etc.	Yashti- Saindhava / Pippali-Saindhava Siddha Ghrita Madanphala Pushpa  (Randia dumetorum) – Lepa over stana Vamana Mustadi, Tagaradi, Ativishadi Gana Siddha Kwatha Sevana
Paichillya	Lalastrava , Vaktra-Shotha (Inflammation in the buccal cavity)	Consumption of decoction infused with Abhaya, Vacha (Acorus calamus), Musta, Shunthi, Patha. Use of Takra-Arishta (Cha. Sa. Chikitsa Sthana 15) Lepa of Vidari, Pueraria tuberosa (Roxb. ex Willd.) Bilwa (Aeges Marmelos), Madhuka etc. over Stana region.
Gaurava	Hridroga (Heart disorders)	Consumption of Panchakola decoction. Lepa of Bala (Sida cordifolia), Shunthi, Murva etc. Dravya over the Stana region.
Tridoshaja Stanya Dushti
Tridoshaja		Can be treated depending on the presence of any of the Stanya Dushti as above.	Pathadi Kwath (consisting of Patha, Shunthi, Guduchi, Kiratatikta, Katuka, Deodar, Sariva, Moorva, Indrayava) Murvadi Kwath (Moorva , Vyosha , Vara , Kola (Jijiphus Jujuba) , Jambu (Syzygium cumini) , Darvi (Beberis aristata) ,Sarshapa (Brassica juncea (Linn.)), Patha with Madhu

It can be observed that the treatment protocol of each abnormality involves use of internal medicine with the external application of different drugs over the breast region of lactating mothers.

Diseases in neonates due to abnormal breast milk

• Sushruta mentions the consumption of heavy to digest food, inappropriate quantity and untimely food intake leads to abnormal breast milk. This causes diseases in neonate. [Su. Sa. Shareera Sthana 10/33]
• Ashtang Sangraha explains the variety of diseases like jwara (fever), kasa (cough), chhardi (nausea, vomiting, gastric disturbance) commonly observed in the paediatric population. (A. S. Uttar Tantra 1/22)
• Ksheeralasaka and Parigarbhika are two most common diseases observed in neonates. These conditions are explained by focusing on the growth and development of new-born. Ksheeralasaka (A.S. Uttar Tantra 2/20-22) is a condition involving the vitiation of all the three dosha resulting in symptoms like diarrhoea, malaise, fever, vomiting, nausea etc. in the child. This is comparable to the chronic indigestion and disturbed gastro-intestinal functioning, which is commonly observed in breast fed infants.
• Parigarbhika is popularly understood as the failure to thrive or malnutrition related disorders. It has been explained as an important factor resulting from the abnormal breast milk. [A.S. Uttar Tantra 1/23]
• Deepana treatment mentioned in this condition has significant practical application. Similarly, other conditions like kukunaka (opthalmia neonatarum) and ahiputana (napkin rash), [Su. Sa. Chikitsa Sthana 20/57] charmadala (skin disorders) (K. S. Khila Sthana 15/10), utfullika (H. S .3.54.9-13), visarpa (herpetic rash) (K.S Khila Sthana 14/10-15) also result from vitiated stanya leading to the occurrence of range of disorders in the paediatric population.
• Aversion of the infant towards breast feeding (stanya dwesha) is considered a sign of graha dushti e.g. skanda, skandapasmara, andhaputana. [Su. Sa. Shareera Sthana 10/51, A.H. Uttar Tantra 3/5]. It is also observed in conditions like mukha roga (pathologies in buccal cavity), kantha roga (pathologies in throat), trishna (morbid thirst), udarashool (pain in abdomen). The abnormalities in breast milk should be managed by administrating the snehapana in the form of ghrita followed by vamana with water processed with neem (nimba-udaka). [Su. Sa. Chikitsa Sthana 17/42] Stanya pravritti (expression of breast milk) can also be pathologically observed in conditions like rakta gulma without the evidence of pregnancy. [Cha. Sa. Nidana Sthana 3/13, A.H. Sutra Sthana 11/51]

Herbs used in treatment of abnormalities of breast milk

Charaka Samhita dedicates two groups to summarize the treatment protocol of stanya related disorders. These include stanyashodhana (purifiers) and stanyajanana (galactogogues) gana. [Cha.Sa. Sutra Sthana 4/12] The former involves the study of drugs that help to pacify the stanya-dushti and later represents the drugs that help to increase the production and quantity of stanya. (Figure No. 2- Stanya shodhana and Stanyajanana Gana)

Figure No. 2- Stanyashodhana and stanyajanana gana

It can be observed that the dravya representing the stanyashodhana gana are of katu-tikta rasa pradhanya (dominance of pungent and bitter taste) and ushna veerya (having hot potency) while those in the stanyajanana gana (promoting breast milk production) possess madhura rasa and vipaka. The tikta rasa is explained to have stanya-shodhana (A. H. Sutra Sthana 10/14) and while the madhura rasa possesses stanyakrita (enhancing production of stanya) or stanya-prasadana (enhancing quality of stanya) properties. (A.H. Sutra Sthana 10/8) The excessive consumption of katu rasa on the other hand leads to Ssanya nasha or diminution in production of stanya (Cha. Sa. Sutra Sthana 26/43/5, Su. Sa. Sutra Sthana 42/9/1,4)
Stanya also acts as a medium for the administration of medication i.e. Anupana for the child in ksheerapa state (exclusively breast feeding) and ksheerannada stage (intermittent breast feeding) (Su. Sa. Shareera Sthana 10/37). Ashtang Hridaya suggests the navaneet (butter) with stanya as anupana for 2 kaala (two times per day) during the first few days after birth of new-born (A.H. Uttar Tantra 1/14)
Stanyajanana gana is also indicated as a part of rasayana kalpa (rejuvenating herbs). Hence proper rasayana can be advised for the purpose of stanya vriddhi (increased production of breast milk) (Cha. Sa. Chikitsa Sthana 1/3/3)
There is explanation of dosha dependant treatment protocol with respect to the stanya especially the stanya dushti(vitiation of breast milk) in Charak Samhita. Charak has indicated ksheeravanti madhura dravya (sweet substances processed in milk)(Cha. Sa. Chikitsa Sthana 30/298) as a form of medicine in the children. There is indication of providing the treatment to mother in order to correct the breast milk vitiation. Thus the indicated medication can be delivered by mixing it with the mother’s milk to achieve better results.

Stanyapana vignyana (breast feeding techniques) and substitutes to breast feeding

The substitutes for breast milk are described as below: [Su. Sa. Shareera Sthana 10/47, A.H. Uttar Tantra 1/20]

1. Chhaga paya (goats milk): It is considered to be best when breast milk is not available. [Cha. Sa. Sutra Sthana 25/42]
2. Gavya paya (cow milk) : It is also mentioned to be one of the best substitute for breast milk [A.H. Sutra Sthana 5/22]
Contemporary science states that raw and unpasteurised cows milk is difficult to digest and contain more protein content like casein as compared to human milk. The infant formula milk is however treated bovine milk making it a appropriate substitute for breast milk. The goats milk based infant formula can also be administered as a substitute in case of cow milk allergy but can result in nutrient deficiency.
3. Laghu- panchamula siddha ksheera with sitopala or sthiradi varga siddha kshira with sitopala - Laghu Panchamula consists of roots of 5 herbs namely , Shalaparni (Desmodium gangeticum), Prishniparni (Uraria picta) , Brihati (Solanum indicum), Kantakari (Solanum virginianum) and Gokshura (Tribulus Terrestris). Research proves that these herbs have proven galactogogue activity These can be used as substitutes for formula milk or breast feeding in the circumstances where breast feeding is not possible. The evidence based scientific preclinical study and clinical trials should be carried out to prove the effectiveness of the mentioned options.

Contra-indications to breast feeding

Breast feeding is contraindicated in the conditions like atikshudha (excessive hunger), shoka (depression), shranta (tiredness), in the illnesses like jwara, kshaya, sthoulya, in individuals consuming the vidagdha and viruddha ahara. [Su. Sa. Shareera Sthana 10/30] It is also not indicated in the child who is suffering from ajeerna . Here the digestive power (agni) also plays a vital role in determining the outcomes. Thus a study can be carried out to assess the effect of enlisted factors on the stanya and the child. These could be achieved through robust cohort, case control or cross-sectional observational studies.

Concept of dhatri or wet nurse

Breast feeding is started as soon as lactation starts or at least within the 3 to 4 days of post-natal period. [Su. Sa. Shareera Sthana 10/14] Dhatri or wet nurse feeds the infant in case of the inability of breast feeding by the mother. The dhatri should be in the state of optimum health and conduct in order to provide best nutrition to the baby. This can be understood as the application of concept of formula feed or breast milk storage or obtaining the same from the milk banks to ensure the nutrition of child. According to Sushruta, the dhatri must be of sama varna (of same ethnicity), madhyama pramana (medium built), madhya vaya (middle aged), aroga (disease free), sheelavati (with good character), achapala (not impatient), alolupa (satisfied), akrisha (not too thin), asthula (not too fat), avyanga (not having any disability), avyasani (devoid of any addictions), prasanna ksheera (breast milk is not vitiated), vatsala (caring and loving), jeevatvatsa (whose infant is alive). [Su. Sa. Shareera Sthana 10/25, Cha. Sa. Shareera Sthana 8/52] Ashtang Hridaya advises two dhatri or nursing mothers. [A. H. Uttar Tantra 1/15-16] Sushruta mentions to commence the breast feeding from right breast first after proper mantroccharana (chanting of mantra). [Su. Sa. Shareera Sthana 10/25-27]

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