The fifteenth chapter of Chikitsasthana of Sushruta Samhita is called as Mūdhagarbha Cikitsitam Adhyaya. This chapter offers with Remedy of Dystocia.

अथातोमूढगर्भचिकित्सितंव्याख्यास्यामः।।१।।
यथोवाचभगवान्धन्वन्तरिः।।२।।

We are going to now expound Mūdhagarbha Chikitsa – therapy of adverse / obstructed supply (dystocia); as revealed by the venerable Dhañvañtari.

Kastatama Vyadhi – Very troublesome situation

गातोऽन्यत्कष्टतममस्तियथामूढगर्भशल्योद्धरणम्अत्रहियोनियकृत्प्लीहान्त्रविवरगर्भाशयानांमध्येकर्मकर्तव्यंस्पर्शन,उत्कर्षणापकर्षणस्थानापवर्तनोत्कर्तनभेदनच्छेदनपीडनर्जूकरणदारणानिचैकहस्तेनगर्भंगर्भिणीचाहिंसता,तस्मादधिपतिमापृच्छ्यपरंचयत्नमास्थायोपक्रमेत।।३।।

Mudha Garbha means obstructed foetus. Since it’s obstructed and causes troublesome signs, it’s known as Salya – a overseas physique.

There isn’t a different situation which is harder to deal with than eradicating the fetus which has been obstructed in its pathway identical to a Salya – overseas physique.

Under talked about are the explanations for this situation to be thought of as very troublesome to deal with –

On this situation, the therapy needs to be executed by hand within the house between the vagina, liver, spleen, intestines and uterus.

The beneath talked about maneuvers need to be executed with one hand solely, with out hurting the foetus and mom –

–        utkarsana – pulling ahead

–        apakarsana – flattening

–        sthana apavartana – rotating / alternative

–        utkartana – reducing,

–        bhedana – dividing / splitting,

–        chedana – excising, reducing,

–        pidana – squeezing, rubbing,

–        rujakarana – straightening,

–        darana – tearing / splitting

Subsequently any efforts on this course shall be executed solely after consulting her husband and acquiring his permission.

Mūdhagarbha Gati – Irregular presentation of the foetus

तत्रसमासेनाष्टविधामृढगर्भगतिरुद्दिष्टा;स्वभावगताअपित्रयःसङ्गाभवन्ति-शिरसोवैगुण्यादंसयोर्जघनस्यवा।।४।।

As enumerated earlier in Nidana Sthana part, chapter 8 of the identical treatise, the irregular displays of the fetus are briefly eight in quantity.

Typically the beneath talked about three sorts of obstructions of the fetus are noticed –

–        abnormality of the pinnacle,

–        abnormality of the shoulders and

–        abnormality of the hips (breech)

Garbha Nirharaṇa – Extracting the fetus

जीवतितुगर्भेसूतिकागर्भनिहरणेप्रयतेत।निर्हर्तुमशक्येच्यावनान्मन्त्रानुपशृणुयात्;तान्वक्ष्यामः।।५।।
‘इहामृतंचसोमश्चचित्रभानुश्चभामिनि।।
उच्चैःश्रवाशतुरगोमन्दिरेनिवसन्तुते।।६।।
इदममृतमपांसमुद्भुतंवैतवलघुगर्भमिमंप्रमुञ्चतुस्त्रि।।तदनलपवनार्कवासवास्तेसहलवणाम्बुधरैर्दिशन्तुशान्तिम्।।७।।
मुक्ताःपशोर्विपाशाश्चमुक्ताःसूर्येणरश्मयः।।
मुक्तःसर्वभयाद्गर्भएह्येहिविरमावितः।।८।।
औषधानिचविदध्याद्यथोक्तानि |

Makes an attempt to take away the fetus ought to be made when the fetus is alive itself. Hymns designed to expel the fetus ought to be chanted when it’s troublesome to extract / take away the fetus. The hymns ought to be chanted in a approach that they’re heard by the mom. Subsequent, this ‘fetus expelling hymns’ will probably be instructed as beneath –

You, the pregnant girl, hear this hymn – “Could Amrta – the nectar, Soma – the moon, Citrabhanu – the solar and Ucchaisrava – the horse of Lord Indra (the king of Gods) reside in your stomach. The Amrta which is born from the ocean would make your fetus mild and launch it. Anala – the fireplace, Pavana – the air, Arka – the solar and Vasus – the Gods of the quarters who’re born from the salt ocean and clouds will bestow happiness (consolation) in you.  Identical to the cows are launched from their bindings, the rays of sunshine would get launched from the solar, it is best to perceive that the fetus too will probably be launched from all of the fears’.

On this situation, the remedies and medicines and many others. which have been described with regard to Apara Patana – for expelling the placenta (defined in chapter 10 of Sarira Sthana part of the identical treatise) also needs to be administered.

Garbhaāharaṇa Upāya – Bodily manipulations to extract the fetus

मृतेचोत्तानायाआभुग्नसक्थ्यावस्त्राधारकोन्नमितकट्याधन्वननगवृत्तिका-शाल्मलीमृत्स्त्रघृताभ्यांम्रक्षयित्वाहस्तंयोनौप्रवेश्यगर्भमुपहरेत्।तत्रसक्थिभ्यामा-गतमनुलोममेवाञ्छेत्,एकसक्थ्नाप्रतिपन्नस्येतरसक्थिप्रसार्यापहरेत्,स्फिग्देशेनागतस्यस्फिग्देशंप्रपीड्योर्ध्वमुत्क्षिप्यसक्थिनीप्रसार्यापहरेत्,तिर्यगागतस्यपरिघस्येवतिरश्चीनस्यपश्चादर्धमूर्ध्वमुत्क्षिप्यपूर्वार्धमपत्यपथंप्रत्यार्जवमानीयापहरेत्,पार्थापवृत्तशिरसमंसंप्रपीड्योर्ध्वमुत्क्षिप्यशिरोऽपत्यपथमानीयापहरेत्,बाहुद्वयप्रतिपन्नस्योर्ध्वमुत्पीड्यांसौशिरोऽनुलोममानीयापहरेत्,द्वावन्त्यावसाध्यौमूढगर्भी,एवमशक्येशस्त्रमवचारयेत्।।९।।

The beneath talked about measures ought to be executed when the fetus is discovered lifeless –

–        The lady ought to be positioned together with her face upwards (supine place). Her knees ought to be bent and stored vertical. Her waist ought to be elevated and supported by pads of garments stored beneath.

–        After positioning the lady, the doctor ought to smear and lubricate his hand with slimy supplies corresponding to dhanvana, nagavrttika (sallaki), salmali or ghrta (ghee).

–        The doctor ought to now introduce his lubricated hand into the vagina and attempt to pull out the fetus.

Strategies of pulling out the fetus in several types of its presentation –

The fetus which is coming by its legs ought to be pulled downwards solely.

If one leg of the fetus is prolapsing and the opposite leg is bent, the bent leg ought to be straightened and the fetus ought to be pulled out.

In case of breech presentation of the fetus i.e. if the fetus is popping out by its buttocks, the doctor ought to push the buttocks up, lengthen the legs of the fetus and pull it out.

In case of transverse presentation of the fetus i.e. if the fetus is popping out obliquely, like a door bolt, the decrease half of the physique of the fetus ought to be pushed up. The higher half of the fetus ought to be down into the supply canal after which pulled out.

The top and shoulder of the fetus ought to be pulled down and the pinnacle is introduced into the supply canal after which pulled out if the fetus is popping out by its flanks.

If the fetus is popping out by each arms, the shoulders of the fetus ought to be pushed up. The top is introduced down and pulled out.

It’s unimaginable to handle the final two sorts of fetal obstructions. If it turns into very troublesome, use of sharp devices i.e. surgical treatment have to be thought of and resorted to.

सचेतनंचशस्त्रेणनकथञ्चनदारयेत्।।
दार्यमाणोहिजननीमात्मानंचैवघातयेत्।।१०।।
अविषह्येविकारेतुश्रेयोगर्भस्यपातनम्।।
नगर्भिण्याविपर्यासस्तस्मात्प्राप्तंनहापयेत्।।११।।

The dwelling fetus ought to by no means be lower. If executed, it’ll trigger injury to each the mom and the fetus. If the abnormality within the type of fetal obstructions is unimaginable to handle, elimination of the fetus ought to be most popular fairly than inflicting loss of life  of the mom. Therefore, time shouldn’t be wasted.

Sastra kriya – Surgical procedure

त्ततःस्न्नियमाश्र्वास्यमण्डलाग्रेणाङ्गुलीशस्न्नेणवाशिरॊविदार्य,शिरःकपालान्याहृत्य,शङ्कुनागृहीत्वोरसिकक्षायांवाऽपहरेत्;अभिन्नशिरसमक्षिकूटेगण्डेवा,अंससंसक्तस्यांसदेशेबाहूछित्त्वा,दृतिमिवाततंवातपूर्णोदरंवाविदार्यनिरस्यान्त्राणिशिथिलीभूतमाहरेत्,जघनसक्तस्यवाजघनकपालानीति।।१२।।

After this, the lady ought to be given phrases of braveness. Utilizing mandalagra sastra or anguli sastra, the pinnacle of the fetus is punctured and the cranium is squeezed. Later, it’s pulled out being held by a hook both by the chest or axilla.

The attention socket or cheek of the fetus is punctured if it isn’t potential to puncture the pinnacle after which it’s pulled out.

The arm of the fetus ought to be lower on the shoulders and the fetus pulled out if the shoulders are discovered obstructing.

The intestines of the fetus ought to be lower open, made free and the fetus is pulled out if the stomach of the fetus is bloated because of accumulation of fuel inside it.

The flat bones of the hip are lower and the fetus eliminated if the fetus is discovered obstructed by the hips.

किंबहुना –

यद्यदङ्गंहिगर्भस्यतस्यसज्जतितद्भिषक्।।
सम्यग्विनिहरेच्छित्त्वारक्षेन्नारीचयत्नतः।।१३।।
गर्भस्यगतयश्चित्राजायन्तेऽनिलकोपतः।।
तत्रानल्पमतिर्वैद्योवर्तेतविधिपूर्वकम्।।१४।।
नोपेक्षेतमृतंगर्भमुहूर्तमपिपण्डितः।।
सह्याशुजननींहन्तिनिरुच्छ्वासंपशुंयथा।।१५।।
मण्डलाओणकर्तव्यंछेद्यमन्तर्विजानता।।
वृद्धिपत्रंहितीक्ष्णाग्रंनारीहिंस्यात्कदाचन।।१६।।

As a substitute of talking elaborately, the doctor ought to utterly lower whichever a part of the fetus is discovered to trigger obstruction. Following this, the doctor / surgeon ought to pull out the fetus and shield the mom with all of the efforts.

As a result of aggravation of Vata, the actions of the fetus grow to be diverse. Subsequently it is rather a lot essential that the clever doctor ought to observe right procedures. Even for a second, the smart doctor shouldn’t neglect the lifeless fetus. If uncared for, the lifeless fetus may also kill the mom rapidly identical to absence of respiration by strangulation kills the animals.

The sharp and pointed Vriddhipatra Sastra shouldn’t be used to chop the fetus inside since it will typically harm the mom. As a substitute Mandalagra Sastra ought to be used for reducing the fetus inside.

Aparā Pātana – Removing of the placenta

अथापतन्तीमपरांपातयेत्पूर्ववद्भिषक्।।
हस्तेनापहरेद्वाऽपिपार्श्वभ्यांपरिपीड्यव।।१७।।
धुनुयाच्चमुहुर्नारीपीडयेद्वांऽसपिण्डिकाम्।।
तैलाक्तयोनेरेवंतांपातयेन्मतिमान्भिषक्।।१८।।
एवंनिहतशल्यांतुसिञ्चेदुष्णेनवारिणा।।
ततोऽभ्यक्तशरीरायायोनौस्नेहंनिधापयेत्।।१९।।
एवंमृद्वीभवेद्योनिस्तच्छूलंचोपशाम्यति।।

Makes an attempt to take away the Apara – placenta ought to be made as described in chapter 10 of Sarira Sthana part of the identical treatise if it isn’t popping out by itself.

Apara ought to be pulled out both by –

–        by the hand,

–        by squeezing the flanks of the mom,

–        by shaking her violently,

–        by squeezing or hitting onerous on her shoulder or

–        by anointing the vagina of the mom with oil

The lady ought to be sprinkled with heat water after eradicating the overseas physique i.e. retained placenta as defined above. Following this, her complete physique ought to be anointed and likewise instil medicated oil into her vagina. The vagina would grow to be mushy and the ache additionally would subside by these measures.

कृष्णातन्मूलशुण्ठ्येलाहिङ्गुभार्गीःसदीप्यकाः।।२०।।
वचामतिविषांरास्त्रांचव्यंसंचूर्ण्यपाययेत्।।
स्नेहेनदोषस्यन्दार्थवेदनोपशमायच।।२१।।
क्वाथंचैषांतथाकल्कंचूर्णंवास्नेहवर्जितम्।।
शाकत्वग्घिङ्ग्वतिविषापाठाकटुकरोहिणीः।।२२।।
तथातेजोवतींचापिपाययेत्पूर्ववद्भिषक्।।
त्रिरात्रंपञ्चसप्ताहंततःस्नेहंपुनःपिबेत्।।२३।।
पाययेतासवंनक्तमरिष्टंवासुसंस्कृतम्।।
शिरीषककुभाभ्यांचतोयमाचमनेहितम्।।२४।।
उपद्रवाश्चयेऽन्येस्युस्तान्यथास्वमुपाचरेत्।।

The beneath talked about herbs are properly powdered –

–        Krsna (pippali),

–        Pippalimula

–        Sunthi

–        Ela

–        Hingu

–        Bharngi

–        Dipyaka

–        Vaca

–        Ativisa

–        Rasna and

–        Cavya

This powder is combined with any fats i.e. oil or ghee. This recipe is run to the mom. This recipe wouldn’t solely liquify the doshas but additionally would relieve the ache.

Decoction or paste or powder ready with the above talked about herbs can also be administered with out including ghee or oil (sneha – fat).

Alternatively, the powder of the beneath talked about herbs can also be administered within the above stated method –

–        Saka Tvak

–        Hingu

–        Ativisa

–        Patha

–        Katukarohini and

–        Tejovati

She ought to as soon as once more drink this oil after a lapse of three, 5 or seven days. She ought to be administered with properly processed asava (fermented infusion) or arista (fermented decoction) at evening. For consuming and bathing functions, she ought to use the water handled and ready from Sirisa and Kakubha. These medicated waters are perfect for these functions. If any complication arises within the center, they need to be appropriately handled.

सर्वतःपरिशुद्धाचस्निग्धपथ्याल्पभोजना।।२५।।
स्वेदाभ्यङ्गपरानित्यंभवेत्क्रोधविवर्जिता।।
पयोवातहरैःसिद्धंदशाहंभोजनेहितम्।।२६।।
रसंदशाहंशेषेतुयथायोगमुपाचरेत्।।
व्युपद्रवांविशुद्धांचज्ञात्वाचवरवर्णिनीम्।।२७।।
ऊर्ध्वंचतुर्योंमासेभ्योविसृजेत्परिहारतः।।

The lady who has been purified in all facets ought to be suggested to eat meals added with fats i.e. ghee. The meals ought to be wholesome and simply digestible. She also needs to be suggested to endure sudation and oil-bath each day and likewise to keep away from anger.

For the primary ten days, consumption of milk boiled and ready with Vata mitigating herbs is right. For the following ten days, consumption of meat soup is right. Different appropriate meals are perfect for the remaining days.

The lady ought to be made freed from all restrictions associated to meals, actions and many others. after a interval of 4 months, after making a word that the lady has utterly been cured of all of the problems.

Balātaila 

योनिसन्तर्पणेऽभ्यङ्गेपानेबस्तिषुभोजने।।२८।।
बलातैलमिदंचास्यैदद्यादनिलवारणम्।।
बलामूलकषायस्यदशमूलीशृतस्यच।।२९।।
यवकोलकुलत्थानांक्वाथस्यपयसस्तथा।।
अष्टावष्टौशुभाभागास्तैलादेकस्तदेकतः।।३०।।
पचेदावाप्यमधुरंगणंसैन्धवसंयुतम्।।
तथाऽगुरुंसर्जरसंसरलंदेवदारुच।।३१।।
मञ्जिष्ठांचन्दनंकुष्ठमेलांकालानुसारिवाम्।।
मांसीशैलेयकंपत्रंतगरंसारिवांवचाम्।।३२।।
शतावरीमश्वगन्धांशतपुष्पांपुनर्नवाम्।।
तत्साधुसिद्धंसौवर्णेराजतेमृन्मयेऽपिवा।।३३।।
प्रक्षिप्यकलशेसम्यक्स्वनुगुप्तंनिधापयेत्।।
बलातैलमिदंख्यातंसर्ववातविकारनुत्।।३४।।
यथाबलमतोमात्रांसूतिकायैप्रदापयेत्।।
याचगर्भार्थिनीनारीक्षीणशुक्रश्चयःपुमान्।।३५।।
वातक्षीणेमर्महतेमथितेऽभिहतेतथा।।
भग्नेश्रमाभिपन्नेचसर्वथैवोपयुज्यते।।३६।।
एतदाक्षेपकादीन्वैवातव्याधीनपोहति।।
हिक्कांकासमधीमन्थंगुल्मंश्वासंचदुस्तरम्।।३७।।
षण्मासानुपयुज्यैतदन्त्रवृद्धिमपोहति।।
प्रत्यग्रधातुःपुरुषोभवेच्चस्थिरयौवनः।।३८।।
राज्ञामेतद्धिकर्तव्यंराजमात्राश्चयेनराः।।
सुखिनःसुकुमाराश्चधनिनश्चापियेनराः।।३९।।

Bala Taila, the medicated oil which is the perfect one to mitigate vata ought to be used for the beneath talked about functions –

–        anointing the vagina,

–        oil bathtub,

–        consuming,

–        enema and

–        for use together with meals

Under described is that this Bala Taila.

Decoction ought to be ready with eight elements every of the beneath talked about substances –

–        Bala

–        Dasamula

–        Yava

–        Kola

–        Kulattha and

–        Milk

Taila – sesame oil – one half ought to be taken.

Paste of the beneath talked about substances every taken in equal amount ought to be ready –

–        Herbs belonging to Madhura Gana – Kakolyadi Gana

–        Saindhava

–        Aguru

–        Sarjarasa

–        Sarala

–        Devadaru

–        Manjistha

–        Candana

–        Kustha

–        Ela

–        Kalanusariva

–        Mamsi

–        Saileyaka

–        Patra

–        Tagara

–        Sariva

–        Vaca

–        Satavari

–        Asvagandha

–        Satapuspa and

–        Punarnava

The paste of the above talked about taken collectively ought to be equal to 1 fourth the amount of the oil.

All of the above stated substances are cooked collectively within the normal method in order to arrange the medicated oil.

This oil is then put right into a vessel of gold, silver or mud and stored hid for some days.

This medicated oil thus ready is understood by the identify Bala Taila. It’s extremely reputed in curing all of the ailments produced by aggravated Vata.

The lady who has delivered ought to now be administered with this oil in appropriate doses, each day, as an inner potion.

The identical oil will be consumed by –

–        the lady wanting being pregnant,

–        males whose semen has been depleted,

–        individuals having lower of vata,

–        these whose very important spots / organs are wounded,

–        those that have fractures,

–        those that are fatigued,

–        these affected by Aksepaka – convulsions and

–        these affected by ailments of vata origin

Bala Taila shall even be consumed by these affected by the beneath talked about situations / ailments –

–        hiccup,

–        cough,

–        adhimantha – eye illness, glaucoma,

–        stomach tumour and

–        extreme dyspnoea

If this oil is consumed for six months, it cures hernia and the particular person turns into endowed with sturdy tissues and steady youth.

This Bala Taila ought to be ready for using –

–        king,

–        king like individuals / noble individuals,

–        these dwelling luxurious life

–        these of tender structure and

–        rich individuals

Śatapākabalā Taila 

तैलमुत्पाद्यतत्क्वाथशतपाकंकृतंशुभम्।।४०।।
निवातेनिभृतागारेप्रयुञ्जीतयथाबलम्।
जीर्णेऽस्मिन्पयसास्निग्धमनीयात्षष्टिकौदनम्।।४१।।
अनेनविधिनाद्रोणमुपयुज्यान्नमीरितम्।।
भुञ्जीतद्विगुणंकालंबलवर्णान्वितस्ततः।।४२।।
सर्वपापैर्विनिर्मुक्तःशतायुःपुरुषोभवेत्।।
शतंशतंतथोत्कर्षोद्रोणेद्रोणेप्रकीर्तितः।।४३।।

Tila i.e. sesame seeds are taken. They’re soaked for a lot of occasions within the Bala decoction and oil extracted from sesame seeds i.e. sesame oil.

That is now boiled for 100 occasions together with Bala decoction. Each time, recent decoction of Bala ought to be used.

The particular person ought to eat this medicated oil in appropriate illness in accordance together with his energy. Whereas consuming this oil, the particular person ought to keep in a hid room devoid of heavy breeze.

He can take boiled Sastika rice added with ghee together with milk after the drugs will get digested. One drona i.e. 10.24 kg of this oil ought to be used on this method. Whereas taking this drugs, he ought to eat meals twice a day.

By taking this drugs, the particular person would get hold of good energy, color (complexion), would grow to be freed from all of the sins and acquire longevity of 100 years.

The advantages of this drugs would improve by tenfold with successive improve of consumption of the oil, one drona each time.

बलाकल्पेगातिखलागुडच्यादित्यपणिषु।।
सैरेयकेवीरतौशतावयाँनिकपडके।।४४।।
तैलानिमधुकेकुर्यातप्रसारिण्यांचबुद्धिमान।।

Within the above stated method, an clever doctor ought to put together medicated oil with every one of many beneath talked about –

–        Atibala,

–        Guduci,

–        Adityaparni,

–        Saireyaka,

–        Virataru,

–        Satavari,

–        Trikantaka,

–        Madhuka and

–        Prasarini

Nilotpaladi Taila

बलाकषायपीतेभ्यस्तिलेभ्यॊवाऽप्यनेकशः
नीलोत्पलवरीमूलंगव्येक्षीरविपाचयेत्।।४।।
शतपार्कततस्तेनतिलतलपद्धिषक।।
बलातैलस्यकल्कौस्तुसुपिष्टास्तत्रदापयेत्।।४६।।
सर्वेषामेवजानीयादुपयोगचिकित्सकः।।
बलातैलवदेतेषांगुणांचैवविशेषतः।।४७।।

Cow’s milk is boiled and processed with Nilotpala and roots of Satavari. Tila i.e. sesame seeds are soaked on this ready milk a number of occasions and oil is extracted from them.

This oil ought to be cooked by including nice paste of herbs talked about within the preparation of Bala Taila and the medicated oil is cooked for 100 occasions.

The doctor ought to know that this Nilotpaladi Taila is comparable in properties to that of Bala Taila.

इतिश्रीसुश्रुतसंहितायांचिकित्सास्थानेपूढगर्भचिकित्सितंनामपञ्चदशोऽध्यायः।।१५।।

Thus ends the fifteenth chapter by identify Müdhagarbha Cikitsitä in Cikitsă Sthāna of Susruta Samhita.