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* Murvadi Kwath (Moorva , Vyosha , Vara , Kola (Jijiphus Jujuba) , Jambu (Syzygium cumini) , Darvi (Beberis aristata) ,Sarshapa (Brassica juncea (Linn.)), Patha with Madhu
* Murvadi Kwath (Moorva , Vyosha , Vara , Kola (Jijiphus Jujuba) , Jambu (Syzygium cumini) , Darvi (Beberis aristata) ,Sarshapa (Brassica juncea (Linn.)), Patha with Madhu
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<p style="text-align:justify;">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. </p>
== Diseases in neonates due to abnormal breast milk ==
<ul><li>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]</li>
<li>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) </li>
<li>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. </li>
<li>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]</li>
<li>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.</li>
<li>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]</li></ul>
== Herbs used in treatment of abnormalities of breast milk ==
<p style="text-align:justify;">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)</p>
[[File:Stanyashodhana and stanyajanana gana.jpg|center]]
<center>Figure No. 2- Stanyashodhana and stanyajanana gana</center>
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) <br/>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) <br/>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) <br/>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. </p>
== 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]
<ol style="text-align:justify;"><li style="font-weight:bold">Chhaga paya (goats milk): <span style="font-weight:normal">It is considered to be best when breast milk is not available. [Cha. Sa. Sutra Sthana 25/42]</span></li>
<li style="font-weight:bold">Gavya paya (cow milk) : <span style="font-weight:normal">It is also mentioned to be one of the best substitute for breast milk [A.H. Sutra Sthana 5/22]</span></li>
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.<ref name="ref14"></ref> 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.<ref name="ref15"></ref>
<li style="font-weight:bold">Laghu- panchamula siddha ksheera with sitopala or sthiradi varga siddha kshira with sitopala - <span style="font-weight:normal">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<ref name="ref16"></ref> 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. </span></li></ol>
== Contra-indications to breast feeding ==
<p style="text-align:justify;">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. </p>
== Concept of dhatri or wet nurse ==