Module on “Garbhasrāva and Garbhapāta” By- Dr. Anuradha Roy

“Garbhasrāva and Garbhapāta”

Dr. Anuradha Roy

Department of Prasuti Tantra, Faculty of Ayurveda, IMS; BHU, Varanasi.

The terminologies Garbhasrāva/ Garbhapāta has be mentioned by Ācharyas under the heading of Garbhavyāpada (disorders pertaining to fetus).

The expulsion of fetus upto fourth month of pregnancy is termed as Garbhasrāva. Where the fetus being expelled more in liquid form. And expulsion of fetus in fifth and sixth month of pregnancy is termed as Garbhapāta, where the fetus attains stability.

With an exception Madhukosa commentary quotes Bhoja’s openion as the period of Garbhasrāva upto third month.

Factors responsible:

1. Acharya Caraka has mentioned that all the seven factors are responsible for the normal delivery of a mature foetus at term. So as any abnormalities in the above mentioned factors may lead to immature growth and expulsion before term (Garbhasrāva/ Garbhapāta).
2. Maharshi Bhela quoted that all the twenty yonirogas being responsible for garbha vyāpada.
3. After fourth month of pregnancy anger, grief, jealousy, fear, terror, excessive coitus and exercise, irritation, suppression of natural urges, sitting or standing and sleeping on uneven place or in abnormal postures, excessive suppression of thirst and hunger etc cause bleeding per vaginum or abortion.
4. Acharya Sushruta mentioned coitus, travelling in carriage, riding on horse, journey on foot, staggering or stumbling, falling from height as palace etc, compression, running, trauma by weapon, stone or whips, sleeping or sitting in uneven place, fasting, suppression of natural urges, consumption of excessive dry, hot or pungent diet, grief, diarrhea, excessive use of ksara (alkali), emetics and purgatives, swinging, indigestion and use of abortifacient drugs the fetus gets detached from its bonds in the same way as a fruit gets detached form its stalk duet to trauma.
5. As a fruit falls down untimely due to the effect of krimi (insect or parasite), vāta (wind) and āghāta (trauma) similarly fetus gets detached due to the influence of all these factors.
6. Physical and psychological disorders of mother and disorders of fetus are also said to be responsible for producing fetal complication as abortion.
7. Also the conception occurring in the third day of menstrual cycle.
8. Acharya Vagbhatas say that if the woman does not give up contraindicated things.
9. Aggravated vāyu, located in sukra causes abortion.

Pathogenesis (Samprapti):

The fetus getting detached from its bonds, exceeding normal limits within the uterus, descending downwards from the hollow space between liver, spleen and bowels produces irritation in the abdominal cavity. The apāna vāyu getting aggravated due to this irritation causes pain in flanks, kukshi (lower abdomen), bastisira (neck of bladder), abdomen and vagina, along with flatulence or distention of abdomen, retention of urine etc, several other symptoms and troubles the young fetus with bleeding.

Clinical features (Lakshana):

1. Due to the causes mentioned earlier abortion starts, there is pain in uterus, sacral and groin region and over the urinary bladder along with bleeding. The pain is due to vitiation of vāyu and bleeding is due to expulsion of āma garbha and opening of the orifices of ārtavavaha srotasas.
2. There are two main features –Shoola (pain) and pushpa darshanam (bleeding).

Complications: Though not mentioned in classics but in treatment some complications are listed as sotha (oedema/inflammation), apatānaka (tetanus), arsha (piles) and others.

Cause of incurability of abortion upto third month of pregnancy:

As because during second and third month of bleeding during pregnancy fetus is not retained because upto this period it is asanjātasāra (does not have proper development) and is in āmāwasthā.

Cause of difficulty in the treatment of abortion during association of Āma:

Upto third month or beyond that when the fetus has association of āma and bleeding starts, then it is difficult to treat due to opposite character of treatment. For stopping the bleeding and retaining the fetus shita (cold), mridu (soft) and madhura (sweet) drugs had to be prescribed which will increase āma due to similarity in properties, also these drugs are opposite to qualities of ārtava which is hot and āgneya in character.

Management:

1. Caraka says that the method for stability of fetus is being told, by this her abortion is prevented. The treatment should be started immediately after evidence of bleeding per vaginum.
2. She should be treated with unctuous and cold things.
3. Treatment prescribed for raktapitta (bleeding diathesis) except purifying measures can be used.
4. Milk is beneficial
5. Use of garbhasthāpana aushadhi, utpaladi gana drugs
6. Woman having abortion should avoid anger, grief, tiredness, coitus and exercise.
7. Should listen to pleasing and desired stories and be cheerful.
8. Once the condition is stable cow’s milk medicated with unripe young fruit of udumbara should be prescribed.
9. Head low position.
10. Month wise treatment of garbhasrava, the regimen prescribed under this category specially aimed at treatment of women with habitual and recurrent abortions. Thus by using month wise medicine the pregnancy continues naturally upto full term.
11. Varana Bandha
12. Monthwise garbhacalan cikitsa probably for the threatened abortion to be prescribed.

MCQs 

KEY to the MCQs

Supplementary Resources 

1. Yadavaji Trikamaji (editor). Charaka Samhitā of Agnivesha with ‘Ayurveda-Dipikā’ commentary by Chakrapānidatta, Siddhisāsthāna, chapter 9. Reprint edition, Varanasi: Chaukhamba Surbharati Prakashan;2000.
2. Yadavaji Trikamaji & Narayan Ram (editor). Sushruta Samhitā of Sushruta with ‘Nibandhasangraha’ commentary by Dalhana. Chikitsasthana, chapter 37. Reprint edition, Varanasi: Chaukhamba Surbharati Prakashan;2003.
3. Shivprasad Sharma (editor). Ashtānga Samgraha of Vriddha Vāgbhata with ‘Shashilekhā’ commentary by Indu. Sutrasthana, chapter 28. 1^st edition, Varanasi: Chowkhamba Sanskrit Series Office; 2006.
4. Harishastri Paradakara (editor). Ashtānga Hridayam of Vāgbhata with commentaries ‘Sarvāngasundarā’ of Arunadatta & ‘Ayurvedarasāyana’ of Hemādri. Sutrasthana, chapter 19. 9^th edition, Varanasi: Chaukhamba Orientalia; 2005.
5. Pandit Sri Brahma Sankara Misra (Part II), Bhavaprakash of Sri Bhavamisra with commentaries ‘Vidyotini’, Cikitsa sthana, 11^th edition, Varanasi, Chaukhambha Sanskrit Bhawan; 2009.
6. Vaidya Jaymini Pandey (editor), Harita Samhita 1^st edition, Varanasi, Chaukhambha Visvabharati, 2010.
7. Priya Vrat Sharma (editor), Bhela Samhita, with English translation, commentary and critical notes, Dr.K.H. Krishnamurthy, Reprint 2008, Varanasi, Chaukhambha Visvabharati 2008.