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Introduction

Infertility is with higher rates in urban areas where one out of six couples is impacted. [1] The incidence of Abortions is 1 in 300 pregnancies. [2] “Abortion is defined as the expulsion or extraction from its mother of an embryo or fetus weighing 500gm or less when it is not capable of independent survival.” [3] One of the main causes of Abortion, is the deficit in the hormones of Pregnancy needed for the nourishment of the fetus.The expulsion of Garbha upto 4th month of pregnanacy is termed as garbhasrava, and later thereafter in 5th and 6thmonth it is termed as Garbha pata. Garbhasraavi is one among the six types of Vandhya described by Acharya Haarita. [4] There are multiple drugs and approaches to the treatment of Garbha Srava, the drugs combat the pathologies at every level to prevent and treat the varied causes of Abortion. This article discusses the rationality of the use of drugs at every stage and type of Abortion.

Approach to Garbhasrava Chikitsa:

1. Ama Pachana in Garbha srava:

• Ruksha , sheetadravyaprayoga

• After upavasakashaya of duralabha, amruta, usira, parpata, candana, ativisha, bala, katwanga, dhanyaka

• Trunadhanya and shaali in the form of peya or bhojana.

• Mudghayusha

Rationality: Enhancement of Bio availability and absorption of Drugs which are further used for treatment of Garbhasrava. [7]

2. Role of GarbhasthapanaDravyas in maintenance of Pregnancy

Bahya Prayoga: [5,6]

Pichu soaked with yasthimadhu and gritha placed in atisheethalajala should be kept in vagina. Shatadhouta or sahasradauthagritha – pradehalepa below naabhi, Sheetaladugda /yeshtimadhukwatha/nyagrodadhiganakashaya – parisechana below naabhi.

Abhyanga with Lakshaditaila.

Rationality:

Yeshtimadhu: Over 200 studies prove that it is a steroid like glycoside having corticoid properties. Supports the Adrenal glands with steroid hormones ‘Glycyrrhizin ‘- a saponin glycoside is structurally like cholesterol, thus it is a potent source for steroidogenesis and to produce Progesterone and estrogen hormone. [8]

Ghrita: A source of LDL and cholesterol is a prime precursor for production of Progesterone hormone.

Lakshaditaila: Source of phyto estrogens

Nyagrodha: High amount of tannins cause effective styptic action and control bleeding per vagina to prevent the further progress of abortion.

Abhyantaraprayoga for maintenance of Pregnancy:Milk medicated with jivaniya group of drugs

Rationality: Phyto oestrogens as active principles – Hypertrophy and hyperplacia of uterine myometrium[9]

Use of Garbhasthapana Aushadhis:

Rationality: Major active principle - saponin , glycoside is structurally like cholesterol. Thus, it is a potent source for steroidogenesis and to produce Progesterone and estrogen hormoneMrudu ,sheetalarakthashali should be given with mamsarasa of jangalapashupakshi of sheetaveerya. Mamsa rasa of Laava, kapinjala, Mruga, Shasha, harina processed with ghrita and cooked with raktashali served to pregnant woman in a cool area.

Rationality: Supplementation with starch (glucose) and proteins(amini acids) for the nourishment of fetus – Function of hPL

Kalka of either utpaladi group of drugs or kaseru, srngataka, and saluki (rhizome of lotus) or only utpala should be given with boiled milk Kalka of Padma, utpala, Kumudakesara mixed with Madhu and Sharkara Rationality: Kesara of Utpaladi drugs possess maximum % of Carbohydrates and proteins – Fn of hPL High content of minerals - Ca, P , Fe, K, bringing about osmoregulation – Fn of Atrial natriuretic peptide [10]
 

Use of Kevala Ksheerasarpi

Rationality: A main source of LDL and cholesterol which is a prime precursor for production of Progesterone hormone

The blood of Shasha, ena (a species of deer or antelope) with madhu should be prescribed Rationality: Rich source of folic acid, required for development of fetus – Fn of HPL Powder of Shweta Aparajita with madhu taken with ajaksheera prevents abortion.

Rationality: Immuno modulation – prevents tissue rejection and protects the conceptus.[11]

Discussion

The Rationality of the Dravyas used for the treatment of the Garbhasrava are discussed in this study. The two main phases in the approach towards the  rabhasrava Chikitsa are Amapacana . Garbhasthapana Garbhasthapana further includes i. Raktasthambhana and ii. Garbha Poshana Function of Corpus luteum is essential to maintain the early pregnancy. hCG and hPL Secreted by syncytiotrophoblast cells maintain the growth and function of Corpus luteum.At 6-8 weeks, there is transfer of functions of corpus luteum to placenta – which acts temporarily as a new endocrine organ.The nourishment to the zygote in its early days is by two sourses of hormones , Steroidal and protein hormones.

Dravyas like Yashtimadhu , Ksheera, Ghrita are sources of phytosteroids which enhance the production of steroidal hormones. Shonita of Shasha and Ena, Kesara, Madhu, Sharkara enhance the production of protein hormones which is responsible for the fetal nourishment.

Rationality for the external (local) use of Yeshtimadhu

Maternal ACTH does not cross the placental barrier , so the aim of the treatment is making available the steroidal sources more externally than internally.[12]

Probable mode of action of Pumsavana Dravyas is by Hormonal stimulation at higher centers i. Hypothalamic hormone – GnRH  ii. Pituitary Hormone – ACTH

Which brings action on the target organs to the produce Progesterone and estrogen hormones.

Conclusion

The action of the drugs are multifaceted , they act by enhancing the bio availability of dravyas, control the bleeding per vagina and prevent the progress of threatened abortion, substitute phytoestrogens and phyto proteins for the further nourishment of the fetus. The Garbhasthapana action is not only by supplementation and homeostasis of hormones but also acts at the level of immunology which is responsible for the early rejection of the embryo.