Sushruta Samhita Nidanasthana Chapter 8 Mudhagarbha Nidanam (Fetal Obstruction)

The eighth chapter of Nidanasthana of Sushruta Samhita is called as Mudhagarbha Nidanam Adhyaya. This chapter offers with Fetal Obstruction.

अथातो मूढगर्भनिदानं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
We are going to now expound Mudhagarbha Nidanam- prognosis of fetal obstruction; as revealed by the venerable Dhanvantari.

Nidana: Causes

ग्राम्यधर्मयानवाहनाध्वगमनप्रस्खलनप्रपतनप्रपीडनधावनाभिघातविषमशयनासनोपवासवेगाभिघातातिरूक्ष-कटुतिक्तभोजनशोकातिक्षारसेवनातिसारवमनविरेचनप्रेङ्खोलनाजीर्णगर्भशातनप्रभृतिभिर्विशेषैर्बन्धनान्मुच्यते गर्भः, फलमिव वृन्तबन्धनादभिघातविशेषैः; स विमुक्तबन्धनो गर्भाशयमतिक्रम्य यकृत्प्लीहान्त्रविवरैरवस्रंसमानः कोष्ठसङ्क्षोभमापादयति, तस्या जठरसङ्क्षोभाद्वायुरपानो मूढः पार्श्वबस्तिशीर्षोदरयोनिशूलानाहमूत्रसङ्गानामन्यतममापद्य गर्भं च्यावयति तरुणं शोणितस्रावेण; तमेव कदाचिद्विवृद्धमसम्यगागतमपत्यपथमनुप्राप्तमनिरस्यमानं विगुणापानसम्मोहितं गर्भं मूढगर्भमित्याचक्षते ||३||
Etiological Elements of Mudagarbha – Beneath talked about are the causes of fetal obstruction –

Ladies

• indulging an excessive amount of in copulation,
• travelling in automobiles, using on animals,
• lengthy stroll,
• leaping,
• falling from heights,
• assaults,
• operating,
• damage,
• improper manner of sleeping and sitting,
• resorting to fasting,
• suppression of urges of the physique,
• use of meals that are very dry, pungent, and bitter;
• sorrow,
• consuming an excessive amount of of alkali (alkaline meals),
• ailments like diarrhea, vomiting or purgation;
• swinging in a hammock,
• indigestion,
• inflicting abortion artificially and such different violent- acts

Pathogenesis –

Chronological occasions within the pathogenesis of Mudha Garbha

(Analogy) Similar to a fruit will get indifferent from its attachment with the tree when it’s hit by a stone or sticks or when it’s plucked by palms and falls down,
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The fetus too will get indifferent and therefore launched from its attachments within the mom’s womb.
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The indifferent fetus comes out of the liver
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Now it descends within the house between liver, spleen and the intestines and produces actions within the girl’s stomach.
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Apana Vata activated by such actions within the stomach begins to maneuver in a fallacious manner and
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Produces ache in flanks, higher portion of the urinary bladder, stomach and vagina and in addition
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Flatulence, urinary obstruction and plenty of such signs and
Causes expulsion of the untimely fetus together with bleeding and in addition
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Generally, the developed fetus additionally descends in an irregular manner into the beginning passage however shouldn’t be delivered owing to the abnormality of Apana Vata and
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This situation is called Mudha Garbha

Forms of Mudha Garbha

ततः कीलः प्रतिखुरो बीजकः परिघ इति |
तत्र, ऊर्ध्वबाहुशिरःपादो यो योनिमुखं निरुणद्धि कील इव स कीलः; निःसृतहस्तपादशिराः कायसङ्गी प्रतिखुरः; यो निर्गच्छत्येकशिरोभुजः स बीजकः; यस्तु परिघ इव योनिमुखमावृत्य तिष्ठति स परिघः; इति चतुर्विधो भवतीत्येके भाषन्ते |
तत्तु न सम्यक्; कस्मात्? स यदा विगुणानिलप्रपीडितोऽपत्यपथमनेकधा प्रपद्यते तदा सङ्ख्या हीयते ||४||

Based on some authorities, Mudha Garbha is of 4 sorts. They’re –

1. Kila

2. Pratikhura

3. Bijaka and

4. Parigha

However this view is wrong. The reason being, the fetus which is troubled by irregular Vata would descend into the beginning passage in some ways and never simply in 4 totally different manners as defined above. In that case, the sorts of Mudha Garbha too is not going to be 4 and the quantity will get altered, i.e. it is going to be greater than 4.

Different sorts of Mudagarbha

तत्र, कश्चिद्द्वाभ्यां सक्थिभ्यां योनिमुखं प्रतिपद्यते; कश्चिदाभुग्नैकसक्थिरेकेन; कश्चिदाभुग्नसक्थिशरीरः स्फिग्देशेन तिर्यगागतः; कश्चिदुरःपार्श्वपृष्ठानामन्यतमेन योनिद्वारं पिधायावतिष्ठते; अन्तःपार्श्वापवृत्तशिराः कश्चिदेकेन बाहुना; कश्चिदाभुग्नशिरा बाहुद्वयेन; कश्चिदाभुग्नमध्यो हस्तपादशिरोभिः; कश्चिदेकेन सक्थ्ना योनिमुखं प्रतिपद्यतेऽपरेण पायुम्; इत्यष्टविधा मूढगर्भगतिरुद्दिष्टा समासेन ||५||

Fetus descends into the vaginal orifice with totally different displays. Beneath talked about are the opposite sorts of Mudha Garbha –

1. Descending with each legs or with one leg

2. Descending with one leg bent

3. Descending with each legs and physique bent with butts positioned horizontally

4. Descending with chest flanks and again obstructing the orifice

5. Descending with head bent in direction of the flanks whereas one arm is protruding

6. Descending with head bent inwards into the flanks and with one arm protruding out,

7. Descending with center portion of the physique together with arms, legs and head bent inwards,

8. Descending with one arm protruding by means of the vaginal orifice and the opposite arm by means of the anus

Thus, briefly, the actions of Mudha Garbha is of eight sorts as talked about above.

Prognosis of Mudagarbha

तत्र द्वावन्त्यावसाध्यौ मूढगर्भौ, शेषानपि विपरीतेन्द्रियार्थाक्षेपकयोनिभ्रंशसंवरणमक्कल्लश्वासकासभ्रमनिपीडितान् परिहरेत् ||६||
The final two sorts of muda Garbha are incurable among the many lot.

The opposite sorts of Muda Garbha additionally develop into incurable if the girl has developed the beneath talked about signs –

• Viparita indriyartha – Improper understanding of sense objects
• Akshepaka – Convulsions
• Yoni bramsha – Vaginal prolapse
• Yoni samvarana – Contraction of vaginal passage
• Makkalla – postpartum ache
• Shwasa – Dyspnoea
• Kasa – cough
• Bhrama – giddiness

In these circumstances remedy shouldn’t be performed.

भवन्ति चात्र-

कालस्य परिणामेन मुक्तं वृन्ताद्यथा फलम् |
प्रपद्यते स्वभावेन नान्यथा पतितुं ध्रुवम् ||७||
एवं कालप्रकर्षेण मुक्तो नाडीनिबन्धनात् |
गर्भाशयस्थो यो गर्भो जननाय प्रपद्यते ||८||
कृमिवाताभिघातैस्तु तदेवोपद्रुतं फलम् |
पतत्यकालेऽपि यथा तथा स्याद्गर्भविच्युतिः ||९||
आचतुर्थात्ततो मासात् प्रस्रवेद्गर्भविच्युतिः |
ततः स्थिरशरीरस्य पातः पञ्चमषष्ठयोः ||१०||

Some verse right here:-

Analogy 1 – The fruit naturally will get indifferent from its stalk on account of maturity / change in time and never by another motive. Equally, the fetus additionally will get indifferent from its attachments and will get freedom from its bindings within the womb (uterus) in the end of time (maturity of time) and comes out to get delivered at correct time.

Other than this, the fruits additionally fall prematurely being bothered by worms, breeze or assault. Equally, on account of totally different causes, the fetus additionally falls off prematurely.

Garbha Srava – is a situation wherein the uterine materials flows out earlier than the fourth month of being pregnant (abortion).

Garbha Pata – is a situation when the contents of the uterus within the type of a steady physique (fashioned fetus) come out / expelled within the fifth and sixth months.

Asadhya Laksana: Deadly prognosis

प्रविध्यति शिरो या तु शीताङ्गी निरपत्रपा |
नीलोद्धतसिरा हन्ति सा गर्भं स च तां तथा ||११||
Within the presence of the beneath talked about indicators / signs, both the girl kills the fetus or the fetus kills the girl –

–        Girl shaking her head vigorously
–        The physique of the girl turns into chilly
–        She loses the sense of shyness
–        Blue coloured outstanding veins on her physique

Mrta Shishu Laksana: Indicators of fetal dying

गर्भास्पन्दनमावीनां प्रणाशः श्यावपाण्डुता |
भवत्युच्छ्वासपूतित्वं शूलं चान्तर्मृते शिशौ ||१२||
मानसागन्तुभिर्मातुरुपतापैः प्रपीडितः |
गर्भो व्यापद्यते कुक्षौ व्याधिभिश्च प्रपीडितः ||१३||
Beneath talked about are the indicators indicating the dying of fetus contained in the womb –

–        Lack of actions of the fetus
–        Cessation of labor ache
–        Bluish or whitish discoloration of the girl’s physique
–        Dangerous smelling breath
–        Ache in stomach

Demise of fetus contained in the womb additionally occurs when the mom is bothered by –

–        ailments of thoughts
–        troubles attributable to exterior elements like accidents and many others. or
–        many different ailments

Atyayika Kriya: Emergency remedy

बस्तमारविपन्नायाः कुक्षिः प्रस्पन्दते यदि |

तत्क्षणाज्जन्मकाले तं पाटयित्वोद्धरेद्भिषक् ||१४||
Similar to a goat has been killed by strangulating its neck, when the girl (pregnant) too is useless however there are throbbing actions within the stomach then the doctor ought to instantly lower open the stomach of the girl and save the kid.

इति सुश्रुतसंहितायां निदानस्थाने मूढगर्भनिदानं नामाष्टमोऽध्यायः ||८||
Thus ends the Eighth chapter by title Mudhagarbha nidana in Nidana Sthana of Susrurta Samhita.