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

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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 

1.    The expulsion of fetus upto which month of pregnancy is termed as Garbhasrāva.

A.  2nd

B.  3rd

C.  4th

D.  5th

 

2.    Expulsion of fetus in 6th month of pregnancy is termed as……

A.  Garbhasrāva

B.  Garbhapāta

C.  Vishkambha

D.  Goodagarbha

 

3.    Why the term Garbhapāta is used to denote the expulsion of fetus after the 4thmonth of pregnancy.

A.  Because by this period the fetal parts have attained some stability

B.  Because by this period the product of conception are in liquid form

C.  Because by this period the fetus attain full maturity

D.  Because by this period the fetus attain heart.

 

4.    According to Madhukosha commentary, the period of Garbhasrāva is upto ….. months.

A.  2

B.  3

C.  4

D.  5

 

5.    Which among the following Acharya has opined that ‘Vimshati Yonidosha’ are the cause for Garbhavyapatti.

A.  Harita

B.  Bhela

C.  Kashyap

D.  Bhoja

 

6.    According to Dalhana, factors responsible for garbhāsayaadivedhana in Garbhasrāva are.

A.  Vata alone

B.  Vata and Pitta

C.  Pitta alone

D.  Tridosha

 

7.    According to Dalhana, factors responsible for Raktadarshanam in Garbhasrāva are.

A.  Pitta

B.  Garbhasramsana

C.  Opening of Ārtavavahasrotomukha

D.  Both b and c

 

 

8.    According to Charaka, what may be the cause of incurability of abortion upto 3rd month of pregnancy.

A.  Sanjātasāratva of garbha

B.  Asanjātasāratva of garbha

C.  Garbhasphurana

D.  Virudhopakrama

 

9.    Garbhapātasamutpanna Apatanaka is ……. in prognosis.

A.  Sādhyam

B.  Kricchrasādhyam

C.  Yāpyam

D.  Asādhyam

 

10.                 Which among the following properties of drugs are useful in Āmagarbhasrāva treatment.

A.  Snigdha and sheeta

B.  Snigdha and ushna

C.  Ruksha and sheeta

D.  Ruksha and ushna

 

11.                 What may be the cause of difficulty in the treatment of abortion during association of āma.

A.  Aushadha anupalabdhi

B.  Virudhopakramatva

C.  Apatyasevanam

D.  Durbalatva

 

12.                 What is the role of madya in the treatment of garbhasrāva after the expulsion of product of conception.

A.  Garbhakoshta vishuddhi

B.  Artivismaranam

C.  Vamanārtham

D.  Both a and b

 

13.                 What should be the treatment duration in garbhasrāva after the expulsion of product of conception.

A.  Two months

B.  Three months

C.  45 days

D.  Correspond to the duration of pregnancy

 

14.                 Which among the following dietetic and mode of life contraindicated for pregnant women with bleeding per vaginum.

A.  Theekshn oushadha

B.  Mrudu oushadha

C.  Vyavaya

D.  All of these

 

15.                 Which among the following is not a garbhasthāpana drug.

A.  Aindri

B.  Brāhmi

C.  Shundi

D.  Sahasraveeryā

 

16.                 Which among the following therapeutic measures are contraindicated in Akālaprasutā.

A.  Snehana

B.  Pāchana

C.  Rukshana

D.  Both b and c

 

17.                 What should be the position of bed of the women during the treatment period of garbhasrāva.

A.  Head end upper than the foot end

B.  Head end lower than the foot end

C.  Head end same as that of foot end

D.  Foot end lower than the head end

 

18.                 According to Sushruta, which among the following is suitable for the 1st  month in the month wise treatment of abortion.

A.  Vrikshadani, payasyā, priyangu

B.  Asmantaka, krishnatila, tamravalli, satāvari

C.  Madhuka, sākabeeja, payasyā, suradāru

D.  Anantā, sarivā, rasnā, madhuka

 

19.                 According to Sushruta, which among the following is suitable for the 9th month in the month wise treatment of abortion.

A.  Ksheera Pāka of anantā, sarivā, payasyā and madhuyashti

B.  Ksheera Pāka of sringātaka, bisa, kaseru and balā

C.  Ksheera Pāka of prishniparni, balā, shigru and swadamshtrā

D.  Ksheera Pāka of kapittha, bilva, brihati, patola and ikshu

 

20.                 According to Acharya Harita, the following is advised to have during 6th month of pregnancy.

A.  Ksheerasarpi

B.  Navaneeta

C.  Madhuramdadhi

D.  Ghrita Khanna

 

 

KEY to the MCQs

 1. C (Su.Ni.8/10)
 2. B (Su.Ni.8/10)
3. A (Su.Ni.8/10)
4. B (M.N.64/2.Madhu.Vyakha)
5. B (Bhe.Sa.3/4)
6. A (Su.Sa.10/57,Dalhana)
7. D (Su.Sa.10/57.Dalhana)
8. B (Ca.Sa.8/23)
9. D (Su.Ni.1/59, M.Ni.22/38, BP.Ci.24/199)
10 C (AS.Sha.4/7)
11. B (Ca. Sa 8/25)
12. D (AS.Sa.4/9)
13. D (AS.Sa.4/9)
14. D (Ca.Su.25/40)
15. C (Ca.Su. 4/18)
16. A (SS.Ci.31/48)
17. B (Ca.Sa.8/24)
18. C (Su.Sa.10/59)
19. A (Su.Sa.10/64)
20. C (Ha.Thriteeya.49/3)

 

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. 1st 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. 9th edition, Varanasi: Chaukhamba Orientalia; 2005.
  5. Pandit Sri Brahma Sankara Misra (Part II), Bhavaprakash of Sri Bhavamisra with commentaries ‘Vidyotini’, Cikitsa sthana, 11th edition, Varanasi, Chaukhambha Sanskrit Bhawan; 2009.
  6. Vaidya Jaymini Pandey (editor), Harita Samhita 1st 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.

 

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