Prasuti Tantra evam Stri Roga प्रसूति तन्त्र एवं स्त्री रोग

Obstetrics and gynaecology · Third (Final) Professional (Tritiya Varsha) · AyUG-PS

Papers

• Paper I — Prasuti Tantra (obstetrics)
• Paper II — Stri Roga (gynaecology)

Units in this subject

Study notes

Two subjects examined as one: Prasuti Tantra is obstetrics, Stri Roga is gynaecology. The classical account of conception and fetal development is examined alongside modern obstetrics, and the honest position is that they describe the same events in different languages and occasionally disagree about the facts.

Stri sharira and Artava

• Artava is an upadhatu of rasa dhatu, as is stanya. Anything depleting rasa affects both first.
• Ritukala: the fertile period, classically twelve days from the onset of menstruation, with conception said to be most likely in the earlier part.
• Artava lakshana of healthy menstruation: colour of a rabbit's blood or lac, does not stain, without pain, neither too scanty nor too profuse.

Garbha — conception and development

• Garbha Sambhava Samagri: Ritu, Kshetra, Ambu, Beeja. All four must be sound.
• Month-wise development (Masanumasika Garbha Vriddhi). Third month: all parts manifest simultaneously and the fetal heart forms. Fourth month: the garbha becomes sthira and the mother experiences dauhrida — the two-hearted state — whose cravings the texts say must be honoured.
• Sixth to eighth month: bala, varna and further development. The texts hold that a child born in the eighth month does not survive because ojas oscillates between mother and child; modern obstetrics explains eighth-month risk differently and a good answer gives both.
• Panchabhautika composition of the garbha and the contributions of matrija, pitrija, atmaja, satmyaja, rasaja and sattvaja bhava.

Garbhini paricharya

• Month-wise diet and regimen, with the general rule of madhura, sheeta and drava ahara.
• Standing prohibitions throughout: ativyavaya, atishrama, vegadharana, heavy and ushna-tikshna food, excessive travel, squatting, and mental disturbance.
• Garbhopaghatakara bhava — the factors held to injure the fetus.
• Modern antenatal care: visits, investigations, tetanus prophylaxis, iron and folic acid, danger signs.

Prasava and its complications

• Prasava kala lakshana; the classical description of labour and the conduct of delivery.
• Modern stages: first (dilatation), second (expulsion), third (placental), fourth (the hour of observation).
• Prasava vyapad: mudhagarbha (malpresentation), obstructed labour, retained placenta, postpartum haemorrhage.
• Naegele's rule: first day of the LMP plus nine months and seven days.

Sutika and stanya

• Sutika kala: most texts give one and a half months, or until artava returns; some say six months.
• Sutika paricharya and sutika roga, of which sutika jwara is the one most examined.
• Stanya: its formation from rasa, stanya sampat (the qualities of good milk), stanya kshaya and stanya dushti.
• Stanyajanana dravya: Shatavari heads them. Exclusive breastfeeding for six months is the modern standing recommendation.

Stri roga

• Yoni vyapad: twenty types, attributed to mithya ahara-vihara, pradushta artava, beeja dosha and daiva.
• Artava dushti and its disorders. Asrigdara corresponds to abnormal uterine bleeding — a presentation with many causes, some urgent, which is why the cause is found before a dravya is chosen.
• Modern gynaecology: menstrual disorders, PCOS, fibroids, infections, prolapse, infertility.
• Contraception: spacing methods (barrier, hormonal, IUCD) and terminal methods (tubectomy, vasectomy).

Garbha vyapad

• Garbha srava is expulsion up to the fourth month, while the garbha is still liquid; Garbha pata is the fifth and sixth month, once it has formed; from the seventh month it is premature delivery. This is a standard viva question and the order is easy to reverse.
• Garbha shosha, Upavishtaka, Nagodara — the classical accounts of fetal growth failure.
• Modern: threatened, inevitable, incomplete, missed and recurrent abortion; ectopic pregnancy; hydatidiform mole.
• Dravya absolutely contraindicated in pregnancy, and why: Vatsanabha, Langali (paryaya Garbhapatani), Chitraka, Karpasa mula, Apamarga, Vasa (vasicine is uterotonic), Shatapushpa in medicinal quantity.

Modern gynaecology

• Menstrual disorders: amenorrhoea, dysmenorrhoea, menorrhagia, PCOS.
• Infections: vaginitis, cervicitis, pelvic inflammatory disease.
• Structural: fibroids, endometriosis, prolapse.
• Screening: cervical cytology and its schedule; breast examination.
• Infertility: the basic workup for both partners, which is a frequently asked question.

Masanumasika pathya and the garbhini paricharya

• Month by month, as Charaka Sharira 8 gives it: 1st milk; 2nd milk medicated with madhura dravya; 3rd milk with madhu and ghrita; 4th milk with navaneeta; 5th ghrita made from that navaneeta; 6th ghrita medicated with madhura gana; 7th the same with a vidaryadi preparation; 8th asthapana basti with milk gruel and then anuvasana with madhura taila; 9th anuvasana and a pichu.
• The 8th-month basti is the classical preparation for labour and is the one detail most often missed.
• GARBHOPAGHATAKARA BHAVA — what harms the fetus: vegadharana, atiвyavaya, atishrama, katu-ushna-tikshna ahara, day sleep, night waking, fear, grief and travel by rough vehicle.
• DAUHRIDA in the fourth month: the fetal heart becomes manifest and the fetus expresses desires through the mother. Denying a dauhridini her wish is said to harm the child, and the texts are specific that her wishes should be met unless harmful.
• RITUKALA is twelve days from the onset of artava, and the first three nights are PROHIBITED for conception. The texts favour the later even nights for a male child and odd for female — record what the texts say without asserting it as biology.

Yonivyapad, Mudhagarbha and the sutika counts

• YONIVYAPAD twenty in Charaka Chikitsa 30. Vata is involved in all twenty, which is why vatahara and basti run through their treatment.
• MUDHAGARBHA eight by presentation in Sushruta Nidana 8 — the classical malpresentations, with the instruction to attempt version, and craniotomy only when the fetus is known dead.
• SUTIKA KALA is one and a half months, or until artava returns. Sutika paricharya is snehana, swedana, and a graduated diet, and sutika roga arising in this period are the hardest to treat.
• APARA SANGA is retained placenta and the classical measures for it are named; RAKTAGULMA is the pseudo-pregnancy that must be distinguished from garbha before any garbhapatana measure is even considered.
• VANDHYATVA types and the four essentials for conception — ritu, kshetra, ambu and beeja. All four must be sound; naming them is the standard answer to any question about fertility.

Where the texts disagree

• The eighth month is called unsafe because ojas moves between mother and child; the mechanism is stated differently by different commentators.
• The count of yonivyapad is twenty in Charaka and differs in Sushruta and Vagbhata.
• Whether artava is an updhatu of rasa or of rakta is answered differently across the texts.

Commonly confused

• Garbhasrava (before the fourth month) and Garbhapata (after it).
• Stanyajanana (increasing milk) and Stanyashodhana (cleansing it).
• Sutika (the mother after delivery) and Sutikagara (the room).
• Ritukala (the fertile period) and Rajahsrava (the bleeding).

Practise it, and prove it