WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES, Volume 4, Issue 08, 1632-1639.
Prof. Dr. Swati Surendra Mohite
“Garbhastravi Vandhy” is a term used in Ayurvedic samhitas for recurrent habitual abortion in first trimester. Spontaneous pregnancy loss is a surprisingly common occurrence. It is physically and emotionally taxing for couples. Recurrent pregnancy loss (RPL), also referred to as recurrent miscarriage or habitual abortion, is historically defined as three consecutive pregnancy losses prior to 20 weeks from the last menstrual period & affects 1% of couples trying to conceive.. The best available data suggest that the risk of miscarriage in subsequent pregnancies is 30% after 2 losses, compared with 33% after three losses.  In this case study, interpretation of cause is done on basics of Ayurvedic diagnostic parameters & management is designed according to that. So Pachan, Panchkarma & Anti natal dilatory regimen with Ayurvedic medicines were planned. During antenatal period combination of herbs with bhasma were used. There was uneventful antenatal period except abnormal placental implantation. The patient was delivered by caesarean section. Female baby with 2900 gram birth weight was born. There was no any neonatal complication till two years of age. This follow up of baby was kept as one of the Ayurvedic formulations used contains purified mercuric sulphide (HgS).
The basic concept of diagnosis, treatment, prognosis and drug development of every disease in Ayurveda is based on Tridosha theory which includes Vata (wind), Pitta (fire) & Kapha (water).
According to Ayurveda the normal and healthy state of all the factors of rūtu, kśetra, ambu and bīja with balanced dosha , dhatu, mala are essential for conception. Rūtu implies the fertile period of the menstrual cycle and a normal and healthy menstrual cycle indicates normal functioning of the female reproductive system. The term kśetra stands for the female reproductive organs and the normal structure and physiological functioning of this system is vital for conception. Ambu implies the provision of ample nutrition which is crucial in maintaining the healthy state of the mother and fetus both. Bīja implies the seeds (~ ovum and sperm) and the health of these factors is also an indispensible component for timely conception. Abnormality in any of these may either lead to problems in conception or continuation of pregnancy till term.
Vatta is that force which maintains the balance. It is considered the most powerful dosha because it controls very basic body processes such as cell division after fertilisation, governing the vacuum creation in foetus.
Kapha is to provide nutrition to body tissues to bring about coordination of body system and regularization of all the biological processes. Kapha is keep up strength, stability and controls growth.
Vata & Kapha vitiation is observed in this patient. Acharya quotes, Vata vitiation is the main cause of infertility & Kapha vitiation for first trimester abortion.
Imbalance of Vata Kapha results in Pitta vitiation. Pitta is considered as the energy in the living organisms that helps tissue building, heat production, activities of the endocrine glands, etc. Many of these processes are thermogenic and metabolic. Pitta is said to control hormones. In this patient Pitta vitiation was not observed, so specific treatment was not arranged for it.
Dhatu is a Sanskrit word for tissues. The human body consists of seven basic tissues known as “Sapta Dhatu”. Generally Dhatu gives support to the body or maintains it. According to Ashtanga Ayurved, the seven Dhatu constitute the anatomy and physiology of the human body. They play a major role in the chain of bodily activities, ultimately ensuring a healthy body and a healthy mind. There are seven Dhatu in all which forms the different organs and different body systems. These are Rasa, Rakta, Mansa, Meda, Asthi, Majja and Shukra. One unique feature of Ayurvedic physiology is that each human tissue is derived from the previous tissue in ascending order of complexity.
In this patient Rasa & Rakta vitiation was observed. Acharya quotes that good quality of Rasa & Rakta are basically responsible for conception, implantation & nourishment of foetus up to term. Vata dosha is the leading dosha in the disease production and may be vitiated due to indulgence of Vātaj ahara vihara, due to dhatukshaya or due to margavarodh.
The patient is principal of a High school so having tremendous stress. She was having very low digestive power. Her food was very dry, contains leftover food regularly. She had disturbed sleep pattern & used to work late night.
Mala are the substances or waste matter to be thrown out of the body. Mala are excretory byproducts formed as a result of various physiological activities going on in the living body. Ayurveda lists two main types of Mala (waste products), Ahar Mala (waste products derived from food) and Dhatu Mala.
Raja (menstrual bleeding) is Mala of Rasa dhatu. In this patient Raja was vitiated by Vata, as the colour of bleeding was blackish red. Patient had dysmenorrhoea & scanty menses which is predominant symptom of Vata vitiation.
At first step digestive power was improved. Vata is the first disease manifestation so it was treated first. Kapha vitiation was managed after treatment of Vata. The antenatal period was managed by Ayurvedic proteins, antioxidants, Zinc, Calcium, Vitamin C, Iron, anticoagulants & immunomodulatory herbs & bhasma. The only allopathic preparation used was Iron.
Medical History Female patient with age 41, married at the age of 28, 13 years back, visited hospital on 10 December 2012 for secondary infertility for 2 years, with history of 6 times missed abortion, occupation high school principal, 8 years primary infertility & in last 3 years conceived for 6 times but had missed abortions & not conceiving for last 2 years.
Past History Patient had menarche at 13 yrs, regular monthly, normal quantity, with undergarment satins, difficult to remove, blackish brown colour, Primary infertility for first 8 years, & then for two years, six first trimester abortions, seventh after starting Ayurvedic treatment, ovulation induction for three times, normal parental & concepts karyotyping, TORCH positive (Rubella, CMV Ig G positive), normal reproductive system evaluated by laproscope, negative antiphospholipids, treated with aspirin, HCG, progesterone, low molecular weight heparin in previous conceptions.
Diagnosis and assessment
Prakruti (constitution) Kapha Pradhan Vatanubandhi
The examination was carried out using Ayurvedic clinical methods including pulse examination and abdominal examination using percussion. Abnormality in Raja 6 (menstrual flow) was assessed & is found to be vata & kapha vitiation.
Therapeutic focus The ayurvedic line of treatment was divided into three parts, Vata kapha vitiation correction before conception with Pachan (digestion of undigested elements), Pancakarma therapy (specialized treatments mentioned in the texts for elimination of anomalous impurities out of the body) Vata kapha balance in first trimester, Tridosha balance in second & third trimester
Ayurvedic medicines arranged accordingly
Pachan – Haridra khanda- 10 gm /twice / day -15 days, Dashmularishta – 20 ml/twice / day /after both meals/ 1 month, Arogyavardhini – 250 mg/ twice / day /15 days, Shankh Vati – 250 mg/ twice / day /15 days, Patient conceived seventh time after 45 days of treatment & aborted.
Panchkarma therapy – Basti (abnormal elements removed by rectal route) was given before menstrual cycle. Alternate Nirooha basti & Anuvasana basti were given. Dashmoola decoction for Nirooha & Bala tail for Anuvasana were used . Vaman was given after one month of Basti. Phalasarpi , medicine used for improvement of fertility was used for internal oliation.
Outcomes Elective Caesarean Section done at 39 weeks of pregnancy & female baby weighing 2.9 kg was delivered. Apgar score at, ten minutes was ten. Mild icterus on third day. Patient discharged on eighth day.
Pre conception Ayurvedic treatment played major roll in continuing pregnancy beyond first trimester. So the treatment started with detoxification with Haridra (Turmeric). As the Raja was Vata Kapha vitiated Dashmoolarishta, Tab Shankhvati & Tab Arogyavardhini started. This combination brought Vata Kapha & Rasa Rakta dhatu to its normal phase. Further Shodhana pacified dosha. So dosha , dhatu & mala balancing elements of body achieved its balance. Acharya stated, Vata vitiation is major cause of abnormality in reproductive organs. So shodhan treatment started with Basti. Vamana was given after Basti to achieve balance of Kapha before conception. Kapha is the main dosha governing first trimester. Stability to the foetus is given by Kapha.
Rasa & Rakta are responsible factors for foetal nutrition in first trimester. 12] So Rasayana started immediately after conception.
Ayurvedic medicine, namely Laghu Malini Vasant ras (Contents – Rasaka Bhasma – (Calx of Zinc Sulphide) 20 mg, Maricha ( Piper nigrum) 10 mg,Butter and lemon juice) is the potent drug acting on Rasa Raktadi Dhatu. It stabilises & sustains foetus & helps in reducing tendency of abortion. Useful in strengthening women by its Balya, Rasayan properties. Rasayana is thought to improve metabolic processes which result in the best possible biotransformation & produce the best quality body tissue. Zinc (Zn) from it, is essential for synthesis of coenzymes that mediate biogenic-amine synthesis and metabolism. It is helpful for healthy brain development.  Lemon juice is a source of Vitamin C. Researches state that it reduces oxidative stress & minimise the chances of preeclampsia.  Butter is the source of lactobacilli which improves absorption of micronutrients. Piper nigrum is antioxidant, antithyroid, anticoagulant & antihypertensive. 
Shatavari (Asperagus racemosus) is from Madhuraskandh. It has predominance of madhura rasa. It nourishes rasa dhatu, which nourishes mother & foetus in pregnancy. Shatavari has anti thrombolytic action so it improves circulation of foetus & thus improving nourishment. Shatavari is antioxidant so it will reduce oxidative stress during pregnancy thus pregnancy induced complications will be minimized. (Potduang et al., Afr. J. Trad. CAM (2008) 5 (3): 230 – 237). Shatavari is having Rasayana activity, thus improving total body circulation with maternal & foetal nutrition.
Yashtimadhu (Gycerrhiza glabra) is from Madhura gana. Its attributes are madhur rasa, madhur vipaka, sheeta virya with guru & snigdha guna. It is pittaghna, vataghna but kaphakarak. It is shonitsthapana & raktapittaghna, thus giving strength to muscle fiber of blood vessels & improves circulation. As it improves liver enzymes facilitates micronutrients absorption. Yashtimadhu is rasayana for prevention of repeated respiratory tract infection in children, as having immunomodulator activity.  So thus if it is given during pregnancy it will strengthen the respiratory system. It is immunostimulatory, antioxidant, anticoagulant thus improving maternal circulation & nourishment of foetus leads to improved birth weight. These properties of Shatavari & Yashtimadhu improved the birth outcome & there was minimum respiratory distress at birth.
Madhumalini vasant contains, Shudha Hingula (HgS) which is Rasayana, Balya, Yogavahi, Krumihara, Kukutanda which is Bhruhana, Balya, Garbhaposhaka, Kachora, which is Sugandhi, Deepaka, Pachaka Maricha which is Katu, Ushna, Deepak, Pachak, Strotoshodhaka, Priyangu which is Sheeta, Pittashamaka & Bhavana Dravya Dadima Swarasa Nimbu Swaras which are Hrudya, Tridoshashamaka with Amla which is Deepak, Pachak, Anulomak. It is reach source of natural calcium, antioxidants. Madhumalini Vasant helps in improving weight of foetus due to presence of Amagarbha i.e. egg. 
Praval pishti Prvala pishti greatly increases the oxygen level in the body, thereby allowing the body to rid itself of toxic waste that continues to build up. As it has sheeta virya, it stopped vaginal bleeding, by its stambhan action.
Amagarbha basti(egg enema) was given for Upavishtaka (intrauterine growth retardation) as a natural protein source. Matra basti of Bala tail is to achieve softening of birth canal.
Ayurveda is a science of life. Peculiar feature of this science is tailor made treatment for each disease. This treatment may need some variation according to prakruti of patient. But the way of treatment pillar might be same. Ayurveda has potential to diagnose & treat cases in its own way.
ACKNOWLEDGMENT: Dr Anamita Sing.
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