A webinar titled “‘Role of Ayurveda in mother and child health” was hosted by Ayurveda Network, Banaras Hindu University on 22nd June 2022 as a part of the conference Janayitri -2022 on “Ayurveda and contemporary perinatal care”. This conference was jointly organized by the Department of Striroga and Prasututi Tantra, Department of Kaumarbritya, and the Department of Kriya Sharir, IMS, BHU. This national conference was held to commemorate late Prof P. V Tewari’s birth anniversary which was on 23rd June. This program was graced by six guest speakers from across the nation.
Inaugural Session:
The inaugural session was held at the webinar facility of Ayurveda Network BHU. Prof. K. N. Dwivedi (Dean, faculty of Ayurveda) Prof. Sangeeta Gehlot (former Head, Dept. of Kriya Sharir) Prof. B.M. Singh (Head of the Dept. of Kaumarbhritya) and Prof. Sunita Suman (Head of the Dept. of Stri Roga and Prasuti Tantra) were present as organizing chairpersons of the conference. Family members of Late Prof PV Tewari, Dr. Anju Singh and Mrs. Asha were also present during this event. Prof. Sangeeta Gehlot delivered the welcome address. The inaugural address was delivered by Prof. K.N Dwivedi.
‘Postpartum issues and their impact on neonates’ – Prof. Seema Shukla
The first lecture was delivered by guest speaker Prof. Seema Shukla on the topic ‘Postpartum issues and their impact on neonates”. The postpartum period is important for the prevention, early detection, and treatment of complications or diseases. Early complication includes mastitis/ breast engorgement. Mastitis is a parenchymal infection of the mammary gland and the source of infection is the throat and nose of neonates. Treatment includes the use of antibiotics and analgesics along with the continuation of breastfeeding or the expression of breast milk. ‘Sutika Unmad’ is also one of the complications that can be observed during the postpartum period. Charaka explained it under Agantuja Unamada. She briefed about the causes, types, and symptoms of Sutika Unamad. Psychological support is an important aspect of the treatment of Unamada. It has been mentioned in Charaka Samhita that by improving mental strength and by avoiding alcoholic preparation one can prevent Unmada.
She also explained about psychological changes that occur during the postpartum period and certain conditions like postpartum blues, postpartum psychosis, and postnatal depression. Sudden fall in estrogen and progesterone, sodium imbalance, and psychological factors could be the causes of postpartum blues. Spontaneous recovery is possible but may require only emotional and social support. Postpartum psychosis is rarely seen but it is always an emergency. Symptoms include hallucinations and or delusions usually within 90 days of postpartum period. A family history of psychosis increases the risk associated with postpartum psychosis by 50%. Risk assessment is associated with infanticide or maternal suicide even after the mother is seemingly improved. Etiological factors may be hormonal, immunological, or genetic. The median remission period of postpartum psychosis is about 6 weeks. Other causes like delirium due to infection and acute thyroid dysfunction should be ruled out before making the diagnosis of postpartum psychosis. Breastfeeding may need to be suspended.
‘An Ayurvedic approach to postpartum depression’ – Vd. Vandana Baranwal
The second lecture was delivered by Vd. Vandana Baranwal on the topic of “An Ayurvedic approach to postpartum depression”. She explained her perspective on possible causes of postpartum depression and the nourishment aspect of Sootika Paricharya for the formation of good quality Rasa Dhatu and its role in preventing postpartum depression. Postpartum depression is a major depressive disorder that can cast an impact on childbearing mothers from 6.5% to 30%, affecting personal, professional, and social aspects of life. According to previous research, it is also one of the reasons for developing depressive disorders in the mother later in life. Signs and symptoms include depressed mood, fatigue, insomnia, fatigue, anxiety, irritability, insomnia, loss of interest, etc. In severe cases, obsessive behaviour and thoughts of causing harm to oneself may be present. Causes and pathogenesis ‘Sootika Vishad’ have not been described in the Ayurveda texts. According to Chandogya Upanishad, 1/3 of Rasa Dhatu nourishes Manas. In her view Rasa become ‘Kshina’ due to Garbhini Avastha. Therefore Rasakshaya would not able to nourish Manas during Sootika Avastha. Rasa Kshaya along with Alpa Satwa and the imbalanced status of Tridoshas in Sootika Avastha altogether leads to the development of ‘Sootika Vishad’.
Sooitka Paricharya is playing a very important role in the prevention of ‘Sootika Vishad’. The first stage of Sooitka Paricharya is for Agni Deepan and Vatanulomana which is for the first five days. Phase second of Sootika Paricharya is intended for Dhatu Poshan and Vardhan which is from day 5 to day 12. Phase third of Sootika Paricharya is for Brihan and rejuvenation that starts from 12 days onwards. The use of Trikatu or Panchakola with warm water or Ghrita reinforces Agnideepan and suppression of Vata. Improved Agni function produces good quality Rasa Dhatu and further, it nourishes Manas. Also, the Vata Niyaman pacifies Manodosha. Research shows that Trikatu promotes cognitive function and Panchakola helps to maintain myelination function.
During the second phase of Sootika Paricharya, enhancement of Agni can be perceived in the form of increased appetite. Ahara Dravya like Yava, Kola, Kulattha, Amla Dravya, Yusha, and Mamsa Rasa promotes Dhatu Poshana and Vardhan in this phase. A sufficient amount of Sneha and the use of Lavan Rasa, Hridya Dravya contribute to the nourishment of Rasa and successive Dhatu formation and also nourishment of Ojas. In this way, Sootika Paricharya helps in the management of Sootika Vishad.
In phase three, the use of Rasayan Dravya has been advised. Rason, Shatavari, Ashwagandha, and Kushmanda can be given along with honey or in the form of cooked milk. These Rasayan Dravya helps in the rejuvenation of various Dhatus and helps to improve physical and mental functions as well. Also, local therapy like Abhyanga with Bala Taila in a hunchback position has been advised in the classics of Ayurveda. Abhyanga to be followed by Parisechan with warm Kwatha prepared with Vatahar Dravyas. Use of Udarpatta Bandhana and Dhoopan with Rakshoghna Dravyas has also been advised. Udarpatta Bandhana is wrapping the abdomen with a cotton cloth or use of an abdominal binder to help the abdomen back to its original position. By following all these regimens physical and mental strength can be regained and that can further prevent the occurrence of postpartum depression.
‘Ayurveda approach to understanding and uses of Uttarabasti’-Prof. Mamatha K.V:
The title of this lecture was “Ayurveda approach to understanding and uses of Uttarabasti”. She started her lecture with an explanation of the vaginal route of drug administration. Advantages of vaginal route drug administration being very specific is explained in Ayurveda for a long back. Modern science come to know about the advantage of this route very recently when a publication in the year1993 shows a new route for drug delivery in the form of intrauterine delivery of insulin and calcitonin. Precipitation of vasovagal attacks is very commonly associated with the procedure of Uttarbasti. She shared her experiences with the administration of Uttarbasti. The chances of vasovagal shock become less if Uttarbasti is followed after the administration of Anuvasan and Niruha Basti as Poorvakarma. When Uttarbasti is performed as independent procedure without administration of Anuvasan and Niruha Basti and use of Snehan and Swedan alone then the chance of vasovagal attacks cannot be neglected. Therefore it is advised to administer Anuvasana and Niruha before administration of Uttarbasti. The position for Uttarbasti should be lithotomy but after completion of the act of drug instillation is over, a pillow can be kept below the buttock helps in the retention of a drug for more time or Pavan Muktasana can be also advised.
For this presentation, the term Uttarbasti was restricted only as an intrauterine route of drug administration. She shared her experience of use of lipid-based drugs in the form of Tail, Ghitra, and Kshar Basti for intrauterine administration but she never attempted to instill Kashaya. A light diet should be advised for this procedure. Drugs instilled in the uterine cavity might act on uterine mucosa or uterine tubes. Her experience with the use of Kshar Taila in tubal blockage suggests a 50% positive outcome. In severe, blockage recanalization could not be achieved. Mode of action Uttarbasti in case of cervical and vaginal factors of infertility acts by causing dilatation. Thick viscid cervical mucus may become loose to allow easy penetration of spermatozoa. pH in the vagina and uterine cavity may get changed due to Uttarbasti and this change can influence symbiosis in the vaginal canal thereby it might be helping in conception. Taila or Ghrita may act with immunological factors. Some Tailas and Ghritas are having an antioxidant, anti-inflammatory, or antimicrobial activity that might be overcoming the local infections.
Uterine receptivity is an important factor, Taila or Ghrita may act on endometrial receptors to enhance the receptivity. Intrauterine prostaglandin levels are one of the concerns in infertility, the anti-inflammatory nature of Taila or Ghrita may act on prostaglandin levels. Immunological factors might be converted to a favorable turn by the administration of Uttarbasti. The decidual reaction which is taken in the early phase may get improved due to increasing vascularity or bringing adequate endometrial thickness or hormonal effect which brings sensitivity or receptivity despite no change in hormonal level. Hyperexcitability of nerve ending in myometrium to cause contraction and expulsion of in vitro fertilization may get decreased due to Uttarbasti. In cases after receiving Panchakarma like Snehan, Swedan, Vamana etc and patients opting for in vitro fertilization show a higher success rate.
The volume of drugs to be instilled into uterine cavity should not enter into the peritoneum. In her experience, even 3 ml quantity can also enter the peritoneal cavity. She also shared her experience of oil embolism and its management. She mentioned about few cases of hypoplastic uterus found to have good triggers after Uttarbasti. She further explained the possible mechanism of action of Uttarbasti in dysmenorrhea and Asrikdar
She discussed the reasons to use lipid bases in Uttarbasti. Lipids are better vehicles for carrying nanoparticles, lipid forms a microemulsion, and liposomes can be easily absorbed. Lipids being mucoadhesive can stay over the endometrial lining for a longer period. Also, they carry peptides and these peptides can act directly on the uterine wall. Possible side effects associated with the procedure of Uttarbasti were also briefed by her. For instance, severe cramps, the possibility of infection, and injury-induced inflammation can phagocyte the sperm that is deposited at that site, and rarely vasovagal shock.
‘Experiences in policy-making pertaining to health care’- Ms. Shailaja Chandra:
She delivered a lecture on “Experiences in policy-making pertaining to health care ”
She explained how the policies are made either at the state level or central level. One must understand that there is a need for policy making done correctly. She also shared why policy making does take a long duration and why it is unnecessary to push and pull of policy in all directions with no result. Policy making is generally associated with the government sector but it can be also observed in the private sector and corporate sector. Policies are either top-down or bottom-up. In the case of bottom-up policy in the medical field, the model comprising effectiveness and low risk first has to go through a pilot study. Based on results obtained from the pilot study strategies should have to be decided further. An incidence study or prevalence study is required for policy making. For instance, in the year 1992 prevalence rate of cataracts was more in many states. World Bank has suggested mandatory use of intraocular lenses that nowadays are routinely used. In those days cataract patients get operated on without intraocular lens placement. Bringing IOL into national programs was a big policy. Making that policy requires approvals that would justify certain claims like safety, efficacy, and use of IOL in various parts of the world on satisfactory levels. In this background, 11 million surgeries with IOL were performed in seven states, and transported villagers to the district hospital where equipment was installed to perform cataracts with IOL. She explained the top-down approach of policy making with an example. In a top-down policy, certain issues are taken into consideration as an essential one to bring out policy. If such issues are not taken into account sufficiently then it would get backfired, these are the drawback of such kind of approach. This kind of approach can harm the reputation of institutes or people doing studies and making policies on that basis causing high disrepute.
In her lecture, she further briefed regarding policy-making at the state level on their own and some policies that need central government approval. Policies that need central government approval like cataract blindness because it requires medical intervention that could have very serious repercussions unless it had been thought through and looked at from all angles. She quoted an example of the use of some Tailam in Siddha medicine. She had visited a PHC at Tamilnadu where she saw the use of medicated oils to reduce tears in case of primigravida and multiple pregnancies. The results were quite astounding. Afterward health secretary Sheelarani Chungad introduced it on a voluntary basis at PHC. Women opted for it voluntarily and liked it.
The second example she presented was from a chapter dedicated to practicing from ‘Report on the status of Indian medicine and folk healing-with a focus on the benefits that the systems have given the public’ She visited Pandit clinic Dr. Sucharita in Bengaluru where infertility was being attended. Also, Swarnabindu Prashana was administered to newborns up to age 16 years every month on Pushyanakshtra day. Dr. Pandit stated that she has obtained results in 10 cases of infertility out of 80 cases where all other measures from allopath medicine failed to treat infertility. She maintained the height and weight records of infants and children and provided compulsory immunization as part of the Ayurveda immunization program.
As policy policy-making or evidence, she advised Ayurveda community people to collaborate with statisticians and multidisciplinary group who can observe and keep records and comes out with risks and benefits. She shared data on antenatal care of Siddha medicine from the year2005 to 2010. Out of 1020 deliveries conducted those done with Siddha medicine ANC, none of them had a second-degree perineal tear and 116 had a first-degree tear. This kind of documentation on large numbers is required. It is not possible to bring out enough documentation from a single hospital. There should be an understanding between practice, research, and the adoption of policies. Otherwise public would not get the benefit from good things coming out of practice and research.
‘Role of Samskaras in child development’- Prof. Romesh Dutta Sharma:
Prof. Romesh Dutta Sharma has delivered a lecture on the topic “Role of Samskaras in child development’’ Among Samskaras 18 have been mentioned that can be further categorized as per prenatal, perinatal, and postnatal phases. Prenatal Samskar includes Garbhadhan, Punsavana, and Simmantonayan. In the prenatal phase, Garbhadhan being the foundation for a future child is an important one. It is a known fact that Tulya Gotriya marriages (consanguineous marriages) are associated with congenital malformation, genetic disorders, and many more. Therefore consanguineous marriages have to be avoided. In Ayurveda classics, Atulya Gotra marriage has been advised thousand years back. Symptoms of early pregnancy under the term ‘Sadyogarbha Lakshana’ have been mentioned in Ayurveda classics. By knowing pregnancy in its early stage and implementing a suitable diet and behavioural pattern one can be able to prevent defects associated with the early stages of organogenesis. He enlisted the diseases of genetic disorders, multifactorial disorders of genes, and monogenic disorders. He cited a paper published in the year 2020 suggesting a high mortality rate in comparison to non-consanguineous marriages. Consanguineous marriage was associated with the incidence of several single gene and multifactorial diseases and congenital malformation like bronchial asthma, hearing defect, heart diseases, and sickle cell anaemia. He advised genetic counselling to avoid consanguineous marriages.
‘My experiences with Prof. P.V Tewari’-Prof. G.N Tiwari
Prof. G.N Tiwari shared his experiences with Prof. P.V Tewari. He shared one incident when he joined BHU. Prof. P. V Tiwari advised him to follow the path of truth while pursuing research. He shared his experience of research work that he had performed at BHU. She encouraged him by saying, don’t bother about the results whatever they may be, and complete the work honestly. He also shared a few more memories that reflected sincerity, honesty, simplicity, and disciplined nature of late. Prof. P. V Tewari.
