The 15th chapter of Chikitsasthana of Sushruta Samhita is named as Mūdhagarbha Cikitsitam Adhyaya. This chapter deals with Treatment of Dystocia.
अथातोमूढगर्भचिकित्सितंव्याख्यास्यामः।।१।।
यथोवाचभगवान्धन्वन्तरिः।।२।।
We will now expound Mūdhagarbha Chikitsa – treatment of difficult / obstructed delivery (dystocia); as revealed by the venerable Dhañvañtari.
Kastatama Vyadhi – Very difficult condition
गातोऽन्यत्कष्टतममस्तियथामूढगर्भशल्योद्धरणम्अत्रहियोनियकृत्प्लीहान्त्रविवरगर्भाशयानांमध्येकर्मकर्तव्यंस्पर्शन,उत्कर्षणापकर्षणस्थानापवर्तनोत्कर्तनभेदनच्छेदनपीडनर्जूकरणदारणानिचैकहस्तेनगर्भंगर्भिणीचाहिंसता,तस्मादधिपतिमापृच्छ्यपरंचयत्नमास्थायोपक्रमेत।।३।।
Mudha Garbha means obstructed foetus. Since it is obstructed and causes troublesome symptoms, it is called Salya – a foreign body.
There is no other condition which is more difficult to treat than removing the fetus which has been obstructed in its pathway just like a Salya – foreign body.
Below mentioned are the reasons for this condition to be considered as very difficult to treat –
In this condition, the treatment has to be done by hand in the space between the vagina, liver, spleen, intestines and uterus.
The below mentioned maneuvers have to be done with one hand only, without hurting the foetus and mother –
– utkarsana – pulling forward
– apakarsana – pulling down
– sthana apavartana – rotating / replacement
– utkartana – cutting,
– bhedana – dividing / splitting,
– chedana – excising, cutting,
– pidana – squeezing, rubbing,
– rujakarana – straightening,
– darana – tearing / splitting
Therefore any efforts in this direction shall be done only after consulting her husband and obtaining his permission.
Mūdhagarbha Gati – Abnormal presentation of the foetus
तत्रसमासेनाष्टविधामृढगर्भगतिरुद्दिष्टा;स्वभावगताअपित्रयःसङ्गाभवन्ति-शिरसोवैगुण्यादंसयोर्जघनस्यवा।।४।।
As enumerated earlier in Nidana Sthana section, chapter 8 of the same treatise, the abnormal presentations of the fetus are briefly eight in number.
Generally the below mentioned three kinds of obstructions of the fetus are observed –
– abnormality of the head,
– 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 |
Attempts to remove the fetus should be made when the fetus is alive itself. Hymns designed to expel the fetus should be chanted when it is difficult to extract / remove the fetus. The hymns should be chanted in a way that they are heard by the mother. Next, this ‘fetus expelling hymns’ will be told as below –
You, the pregnant lady, hear this hymn – “May Amrta – the nectar, Soma – the moon, Citrabhanu – the sun and Ucchaisrava – the horse of Lord Indra (the king of Gods) reside in your abdomen. The Amrta which is born from the ocean would make your fetus light and release it. Anala – the fire, Pavana – the air, Arka – the sun and Vasus – the Gods of the quarters who are born from the salt ocean and clouds will bestow happiness (comfort) in you. Just like the cows are released from their bindings, the rays of light would get released from the sun, you should understand that the fetus too will be released from all the fears’.
In this condition, the treatments and medicines etc. which have been described with regard to Apara Patana – for expelling the placenta (explained in chapter 10 of Sarira Sthana section of the same treatise) should also be administered.
Garbhaāharaṇa Upāya – Physical manipulations to extract the fetus
मृतेचोत्तानायाआभुग्नसक्थ्यावस्त्राधारकोन्नमितकट्याधन्वननगवृत्तिका-शाल्मलीमृत्स्त्रघृताभ्यांम्रक्षयित्वाहस्तंयोनौप्रवेश्यगर्भमुपहरेत्।तत्रसक्थिभ्यामा-गतमनुलोममेवाञ्छेत्,एकसक्थ्नाप्रतिपन्नस्येतरसक्थिप्रसार्यापहरेत्,स्फिग्देशेनागतस्यस्फिग्देशंप्रपीड्योर्ध्वमुत्क्षिप्यसक्थिनीप्रसार्यापहरेत्,तिर्यगागतस्यपरिघस्येवतिरश्चीनस्यपश्चादर्धमूर्ध्वमुत्क्षिप्यपूर्वार्धमपत्यपथंप्रत्यार्जवमानीयापहरेत्,पार्थापवृत्तशिरसमंसंप्रपीड्योर्ध्वमुत्क्षिप्यशिरोऽपत्यपथमानीयापहरेत्,बाहुद्वयप्रतिपन्नस्योर्ध्वमुत्पीड्यांसौशिरोऽनुलोममानीयापहरेत्,द्वावन्त्यावसाध्यौमूढगर्भी,एवमशक्येशस्त्रमवचारयेत्।।९।।
The below mentioned measures should be done when the fetus is found dead –
– The woman should be placed with her face upwards (supine position). Her knees should be bent and kept vertical. Her waist should be elevated and supported by pads of clothes kept beneath.
– After positioning the woman, the physician should smear and lubricate his hand with slimy materials such as dhanvana, nagavrttika (sallaki), salmali or ghrta (ghee).
– The physician should now introduce his lubricated hand into the vagina and try to pull out the fetus.
Methods of pulling out the fetus in different forms of its presentation –
The fetus which is coming by its legs should be pulled downwards only.
If one leg of the fetus is prolapsing and the other leg is bent, the bent leg should be straightened and the fetus should be pulled out.
In case of breech presentation of the fetus i.e. if the fetus is coming out by its buttocks, the physician should push the buttocks up, extend the legs of the fetus and pull it out.
In case of transverse presentation of the fetus i.e. if the fetus is coming out obliquely, like a door bolt, the lower half of the body of the fetus should be pushed up. The upper half of the fetus should be down into the delivery canal and then pulled out.
The head and shoulder of the fetus should be pulled down and the head is brought into the delivery canal and then pulled out if the fetus is coming out by its flanks.
If the fetus is coming out by both arms, the shoulders of the fetus should be pushed up. The head is brought down and pulled out.
It is impossible to manage the last two kinds of fetal obstructions. If it becomes very difficult, use of sharp instruments i.e. surgical operation must be considered and resorted to.
सचेतनंचशस्त्रेणनकथञ्चनदारयेत्।।
दार्यमाणोहिजननीमात्मानंचैवघातयेत्।।१०।।
अविषह्येविकारेतुश्रेयोगर्भस्यपातनम्।।
नगर्भिण्याविपर्यासस्तस्मात्प्राप्तंनहापयेत्।।११।।
The living fetus should never be cut. If done, it will cause damage to both the mother and the fetus. If the abnormality in the form of fetal obstructions is impossible to manage, removal of the fetus should be preferred rather than causing death of the mother. Hence, time should not be wasted.
Sastra kriya – Surgical operation
त्ततःस्न्नियमाश्र्वास्यमण्डलाग्रेणाङ्गुलीशस्न्नेणवाशिरॊविदार्य,शिरःकपालान्याहृत्य,शङ्कुनागृहीत्वोरसिकक्षायांवाऽपहरेत्;अभिन्नशिरसमक्षिकूटेगण्डेवा,अंससंसक्तस्यांसदेशेबाहूछित्त्वा,दृतिमिवाततंवातपूर्णोदरंवाविदार्यनिरस्यान्त्राणिशिथिलीभूतमाहरेत्,जघनसक्तस्यवाजघनकपालानीति।।१२।।
After this, the woman should be given words of courage. Using mandalagra sastra or anguli sastra, the head of the fetus is punctured and the skull is squeezed. Later, it is pulled out being held by a hook either by the chest or axilla.
The eye socket or cheek of the fetus is punctured if it is not possible to puncture the head and then it is pulled out.
The arm of the fetus should be cut at the shoulders and the fetus pulled out if the shoulders are found obstructing.
The intestines of the fetus should be cut open, made loose and the fetus is pulled out if the abdomen of the fetus is bloated due to accumulation of gas inside it.
The flat bones of the hip are cut and the fetus removed if the fetus is found obstructed by the hips.
किंबहुना –
यद्यदङ्गंहिगर्भस्यतस्यसज्जतितद्भिषक्।।
सम्यग्विनिहरेच्छित्त्वारक्षेन्नारीचयत्नतः।।१३।।
गर्भस्यगतयश्चित्राजायन्तेऽनिलकोपतः।।
तत्रानल्पमतिर्वैद्योवर्तेतविधिपूर्वकम्।।१४।।
नोपेक्षेतमृतंगर्भमुहूर्तमपिपण्डितः।।
सह्याशुजननींहन्तिनिरुच्छ्वासंपशुंयथा।।१५।।
मण्डलाओणकर्तव्यंछेद्यमन्तर्विजानता।।
वृद्धिपत्रंहितीक्ष्णाग्रंनारीहिंस्यात्कदाचन।।१६।।
Instead of speaking elaborately, the physician should completely cut whichever part of the fetus is found to cause obstruction. Following this, the physician / surgeon should pull out the fetus and protect the mother with all the efforts.
Due to the aggravation of Vata, the movements of the fetus become varied. Therefore it is very much important that the intelligent physician should follow correct procedures. Even for a moment, the wise physician should not neglect the dead fetus. If neglected, the dead fetus will also kill the mother quickly just like absence of respiration by strangulation kills the animals.
The sharp and pointed Vriddhipatra Sastra should not be used to cut the fetus inside since it would sometimes hurt the mother. Instead Mandalagra Sastra should be used for cutting the fetus inside.
Aparā Pātana – Removal of the placenta
अथापतन्तीमपरांपातयेत्पूर्ववद्भिषक्।।
हस्तेनापहरेद्वाऽपिपार्श्वभ्यांपरिपीड्यव।।१७।।
धुनुयाच्चमुहुर्नारीपीडयेद्वांऽसपिण्डिकाम्।।
तैलाक्तयोनेरेवंतांपातयेन्मतिमान्भिषक्।।१८।।
एवंनिहतशल्यांतुसिञ्चेदुष्णेनवारिणा।।
ततोऽभ्यक्तशरीरायायोनौस्नेहंनिधापयेत्।।१९।।
एवंमृद्वीभवेद्योनिस्तच्छूलंचोपशाम्यति।।
Attempts to remove the Apara – placenta should be made as described in chapter 10 of Sarira Sthana section of the same treatise if it is not coming out on its own.
Apara should be pulled out either by –
– by the hand,
– by squeezing the flanks of the mother,
– by shaking her violently,
– by squeezing or hitting hard on her shoulder or
– by anointing the vagina of the mother with oil
The woman should be sprinkled with warm water after removing the foreign body i.e. retained placenta as explained above. Following this, her whole body should be anointed and also instil medicated oil into her vagina. The vagina would become soft and the pain also would subside by these measures.
कृष्णातन्मूलशुण्ठ्येलाहिङ्गुभार्गीःसदीप्यकाः।।२०।।
वचामतिविषांरास्त्रांचव्यंसंचूर्ण्यपाययेत्।।
स्नेहेनदोषस्यन्दार्थवेदनोपशमायच।।२१।।
क्वाथंचैषांतथाकल्कंचूर्णंवास्नेहवर्जितम्।।
शाकत्वग्घिङ्ग्वतिविषापाठाकटुकरोहिणीः।।२२।।
तथातेजोवतींचापिपाययेत्पूर्ववद्भिषक्।।
त्रिरात्रंपञ्चसप्ताहंततःस्नेहंपुनःपिबेत्।।२३।।
पाययेतासवंनक्तमरिष्टंवासुसंस्कृतम्।।
शिरीषककुभाभ्यांचतोयमाचमनेहितम्।।२४।।
उपद्रवाश्चयेऽन्येस्युस्तान्यथास्वमुपाचरेत्।।
The below mentioned herbs are nicely powdered –
– Krsna (pippali),
– Pippalimula
– Sunthi
– Ela
– Hingu
– Bharngi
– Dipyaka
– Vaca
– Ativisa
– Rasna and
– Cavya
This powder is mixed with any fat i.e. oil or ghee. This recipe is administered to the mother. This recipe would not only liquify the doshas but also would relieve the pain.
Decoction or paste or powder prepared with the above mentioned herbs may also be administered without adding ghee or oil (sneha – fats).
Alternatively, the powder of the below mentioned herbs may also be administered in the above said manner –
– Saka Tvak
– Hingu
– Ativisa
– Patha
– Katukarohini and
– Tejovati
She should once again drink this oil after a lapse of three, five or seven days. She should be administered with well processed asava (fermented infusion) or arista (fermented decoction) at night. For drinking and bathing purposes, she should use the water treated and prepared from Sirisa and Kakubha. These medicated waters are ideal for these purposes. If any complication arises in the middle, they should be appropriately treated.
सर्वतःपरिशुद्धाचस्निग्धपथ्याल्पभोजना।।२५।।
स्वेदाभ्यङ्गपरानित्यंभवेत्क्रोधविवर्जिता।।
पयोवातहरैःसिद्धंदशाहंभोजनेहितम्।।२६।।
रसंदशाहंशेषेतुयथायोगमुपाचरेत्।।
व्युपद्रवांविशुद्धांचज्ञात्वाचवरवर्णिनीम्।।२७।।
ऊर्ध्वंचतुर्योंमासेभ्योविसृजेत्परिहारतः।।
The woman who has been purified in all aspects should be advised to consume foods added with fat i.e. ghee. The foods should be healthy and easily digestible. She should also be advised to undergo sudation and oil-bath every day and also to avoid anger.
For the first ten days, consumption of milk boiled and prepared with Vata mitigating herbs is ideal. For the next ten days, consumption of meat soup is ideal. Other suitable foods are ideal for the remaining days.
The woman should be made free of all restrictions related to foods, activities etc. after a period of four months, after making a note that the woman has completely been cured of all the complications.
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 best one to mitigate vata should be used for the below mentioned purposes –
– anointing the vagina,
– oil bath,
– drinking,
– enema and
– to be used along with food
Below described is this Bala Taila.
Decoction should be prepared with eight parts each of the below mentioned ingredients –
– Bala
– Dasamula
– Yava
– Kola
– Kulattha and
– Milk
Taila – sesame oil – one part should be taken.
Paste of the below mentioned ingredients each taken in equal quantity should be prepared –
– 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 mentioned taken together should be equal to one fourth the quantity of the oil.
All the above said ingredients are cooked together in the usual manner so as to prepare the medicated oil.
This oil is then put into a vessel of gold, silver or mud and kept concealed for some days.
This medicated oil thus prepared is known by the name Bala Taila. It is highly reputed in curing all the diseases produced by aggravated Vata.
The woman who has delivered should now be administered with this oil in suitable doses, every day, as an internal potion.
The same oil can be consumed by –
– the woman desiring pregnancy,
– men whose semen has been depleted,
– persons having decrease of vata,
– those whose vital spots / organs are wounded,
– those who have fractures,
– those who are fatigued,
– those suffering from Aksepaka – convulsions and
– those suffering from diseases of vata origin
Bala Taila shall also be consumed by those suffering from the below mentioned conditions / diseases –
– hiccup,
– cough,
– adhimantha – eye disease, glaucoma,
– abdominal tumour and
– severe dyspnoea
If this oil is consumed for six months, it cures hernia and the person becomes endowed with strong tissues and stable youth.
This Bala Taila should be prepared for the use of –
– king,
– king like persons / noble persons,
– those living luxurious life
– those of tender constitution and
– wealthy persons
Śatapākabalā Taila
तैलमुत्पाद्यतत्क्वाथशतपाकंकृतंशुभम्।।४०।।
निवातेनिभृतागारेप्रयुञ्जीतयथाबलम्।
जीर्णेऽस्मिन्पयसास्निग्धमनीयात्षष्टिकौदनम्।।४१।।
अनेनविधिनाद्रोणमुपयुज्यान्नमीरितम्।।
भुञ्जीतद्विगुणंकालंबलवर्णान्वितस्ततः।।४२।।
सर्वपापैर्विनिर्मुक्तःशतायुःपुरुषोभवेत्।।
शतंशतंतथोत्कर्षोद्रोणेद्रोणेप्रकीर्तितः।।४३।।
Tila i.e. sesame seeds are taken. They are soaked for many times in the Bala decoction and oil extracted from sesame seeds i.e. sesame oil.
This is now boiled for one hundred times along with Bala decoction. Every time, fresh decoction of Bala should be used.
The person should consume this medicated oil in suitable disease in accordance with his strength. While consuming this oil, the person should stay in a concealed room devoid of heavy breeze.
He can take boiled Sastika rice added with ghee along with milk after the medicine gets digested. One drona i.e. 10.24 kg of this oil should be used in this manner. While taking this medicine, he should consume food twice a day.
By taking this medicine, the person would obtain good strength, colour (complexion), would become free of all the sins and gain longevity of one hundred years.
The benefits of this medicine would increase by tenfold with successive increase of intake of the oil, one drona every time.
बलाकल्पेगातिखलागुडच्यादित्यपणिषु।।
सैरेयकेवीरतौशतावयाँनिकपडके।।४४।।
तैलानिमधुकेकुर्यातप्रसारिण्यांचबुद्धिमान।।
In the above said manner, an intelligent physician should prepare medicated oil with each one of the below mentioned –
– 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 in this prepared milk several times and oil is extracted from them.
This oil should be cooked by adding fine paste of herbs mentioned in the preparation of Bala Taila and the medicated oil is cooked for one hundred times.
The physician should know that this Nilotpaladi Taila is similar in properties to that of Bala Taila.
इतिश्रीसुश्रुतसंहितायांचिकित्सास्थानेपूढगर्भचिकित्सितंनामपञ्चदशोऽध्यायः।।१५।।
Thus ends the fifteenth chapter by name Müdhagarbha Cikitsitä in Cikitsă Sthāna of Susruta Samhita.
