Suthika paricharya psr


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A Comparative Clinical Study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya, Kavya, G M, Department of post graduate studies in Prasooti Tantra & Stree roga, S. D. M. COLLEGE OF AYURVEDA, UDUPI

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Suthika paricharya psr

  1. 1.                             
  2. 2. ACKNOWLEDGEMENT At this peak of completion of my thesis work, I Undertake the honorable task ofexpressing my heart felt gratitude to all those who are part of my great task. Whowere really there for me in my blues and blooms of higher studies, and with whoseback support my present tense has been possible. I whole heartedly thank Dr.D.Veerendra Heggadeji, President of this institutionfor giving me an opportunity to study in this esteemed Institution. In this regard Iamthankful to Prof. U.N.Prasad Principal of SDMCA udupi. My deep sense of gratitude and heartful salutation to my respected teacher andguide Dr.Ramadevi G, for her comprehensive guidence & valuable suggestions. Herkind words and motherly concern through out my course kept my spirit going. I express my sincere gratitude to my HOD, Dr. Usha V.N.K, Her upgoing energy,deep and vast knowledge along with affection and care always helped me, encouragedme, to pursue right path in my academics. I am gratefully thankful to her. It is indeed a pleasing privilege for me to express my profound gratefulness andindebtedness to my professor Dr.Mamatha. My never ending gratitude to mydepartmental honorary Assistant Professors Dr.Sucheta and Dr. Vidya Ballal, forproviding me with precious training and constructive ideas, throughout my studyperiod. I am extremely energized by their presence. My sincere gratitude to the Dean Dr. Shreekanth U and associate Dean Dr.Govinda raju for their invaluable support, encouragement and guidance. I amgrateful to Dr. Veena Mayya, Dr. Krishna Bai, Dr.Subhramnya Bhat, Dr.Jonahfor giving me opportunity for gaining practical knowledge, their timely help andcarrier guidelines.. The thesis work has been carried out in SDM AyurvedicHospital, Kuthpady. Iam grateful to Dr.Y.N.Shetty, Medical Superintendent of theHospital.
  3. 3. Finally Heartfelt regards to my fellow PG’s, seniors and junior colleagues, I amfortunate enough to have such a nice colleagues, So much deeply felt love to all myfriends, specially to Dr.Sujatha, Dr.Shilpa, Dr.Sukanya, Dr.Shubha andDr.Vijayalakshmi. I am privileged to have such a wounderful friends inDr.Harshita, Dr.Prathibha, Dr.Sindhu, Dr.Sumana, Dr. Geetha andDr.Vaishali. All of your company made this journey ease. DR.G.M.KAVYA
  4. 4. Abstract  ABSTRACT Title: “A Comparative Clinical Study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya. Woman is treasured by the richness of continuing the human race. In Hindu culture,the puerperium was traditionally considered a period of relative impurity or ashoucha dueto the process of child birth. And a period of confinement of ten days. The elegant phaseof pregnancy & delivery brings adaptational changes in biophysiological & psychologicalparameters in puerperium, which may adversly affect her health if not properly takencare of. Since giving birth is stressful with an emotional touch of becoming new mother,even there is dramatic change in doshas, dhatus which result in declination of her health.The added responsibilities of nurturing the new baby along with recuperation of her ownhealth, makes suthika an aspirant for special attention. Ayurveda has ideally given prime importance to suthika and explained suthikaparicharya which helps in reverting her to the prepregnant state. In this perioddashamoola, jeeraka and panchakola are given importance. The Dashamoolajeerakakashaya and Panchakola kashaya being enriched with qualities like deepana, pachana,tridoshahara specially vatanulomana, vedana sthapana, vrana shodhana, grabhashayashodhana, garbhashaya sankochaka, sthanya janana, dhatuposhana, sandhaneya, grahi,jeevaneya, balya, medhya, hrudhya, rasayana etc. The same are the desired effects forthe study.Objectives: To study the concept of Suthika. To assess the effect of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika. To compare the efficacy of both the Kashayas in Suthika Paricharya. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya
  5. 5. Abstract Study design: This research work is a single blind comparative clinical study with pre test andpost test design. 20 Postnatal women were selected and randomly categorized into 2equal groups, Group A were given Dashamoolajeeraka Kashaya and Group B were givenPanchakola Kashaya. 90ml of kashaya is given thrice a day to each group for a period ofone month from delivery.Results: The kashaya given in both the groups showed good result with significant andsatisfying improvement in most of the parameters of assessment. The Group A with dashamoolajeeraka kashaya showed significant results in Tenparameters out-off eleven, it is ahead in the parameters like regularizing the bowel andmicturation habits, normalizing lochial discharge, doing proper healing of episiotomywound, reducing abdominal pain and backache. Group B with Panchakola kashaya also showed significant results in Ten parameters.It is ahead in the following parameters like increasing the appetite of the suthika, doingproper involution of the uterus, increasing and establishing adequate lactation,whencompared to Group A. Both the groups showed equally good result in increasing strength of the Suthika.At the same time both the groups have failed in reducing the abdominal wall thickness.In total there is a positive result for the kashaya of each of the groups and can be advisedin the suthika paricharya with confidence.Key Words - Suthika, Puerperium, Dashamoolajeeraka Kashaya, Panchakola Kashaya,Uterine Involution, lochial discharge and Lactation. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya
  6. 6. LIST OF CONTENTSSl. No. Contents Page No. 1 Introduction 1-2 2 Objectives 3 3 Review of Literature 4-30 4 Drug review 31-35 5 Methodology 38-44 6 Photo’s 36,37,45 7 Observations 46-75 8 Result 76-113 9 Discussion 114-140 10 Conclusion 141 11 Summary 142-143 12 Bibliography 144-156 13 Annexure 157-161
  7. 7. LIST OF TABLESTable No. Description Page No. 1 Previous Work Done 7 2 Samanya Suthika Paricharya 11 3 Hematological values in Puerperium 23 4 Composition of colostrums & Breast milk 27 5 Dashamoola and Jeeraka Drugs 32 6 Panchakola drugs 35 7 Incidence by age 46 8 Incidence by Religion 47 9 Incidence of Socioeconomic status 48 10 Incidence of Education 49 11 Incidence by Occupation 50 12 Incidence by Diet 51 13 Incidence by Habits 52 14 Incidence by Habitat 53 15 Incidence by Parity 54 16 Incidence of Prakruti 55 17 Incidence of Sara 56 18 Incidence of Samhanana 57 19 Incidence of Satmya 58 20 Incidence of Satwa 59 21 Incidence by Ahara Shakti 60 22 Incidence of Vayama Shakti 61
  8. 8. 23 Incidence by Pramana 6224 Incidence related to Appetite 6325 Incidence by Bowel Habits 6426 Incidence related to Micturation 6527 Incidence according to intensity of Abdominal pain 6628 Incidence of Strength 6729 Incidence of Lactation 6830 Incidence of Backache 6931 Incidence related Abdominal Wall Thickness 7032 Incidence as per Height of Uterus 7133 Incidence of amount of Lochial discharge 7234 Incidence of Colour of Lochial discharge 7335 Incidence of Odour of Lochial discharge 7436 Incidence by Episiotomy Healing 7537 Effect of Involution in Group A 7638 Effect of Involution in Group B 7739 Interval of Involution in both Groups 7840 Effect on amount of Lochial discharge in Group A 7941 Effect on amount of Lochial discharge in Group B 8042 Effect on amount of Lochia in both Groups 8143 Effect on olour of Lochia in Group A 8244 Effect on colour of Lochia in Group B 8345 Effect on colour of Lochia in both Groups 8446 Effect on odour of Lochia in Group A 8547 Effect on odour of Lochia in Group B 8648 Effect on odour of Lochia in both Groups 87
  9. 9. 49 Effect on Episiotomy healing in Group A 8850 Effect on Episiotomy healing in Group B 8951 Effect on Episiotomy healing in both Groups 9052 Effect on Abdominal pain in Group A 9153 Effect on Abdominal pain in Group B 9254 Effect on Abdominal pain in both Groups 9355 Effect on Appetite in Group A 9456 Effect on Appetite in Group B 9557 Effect on Appetite in both Groups 9658 Effect on Bowel clearance in Group A 9759 Effect on Bowel clearance in Group B 9860 Effect on Bowel clearance in both Groups 9961 Effect on Micturation in Group A 10062 Effect on Micturation in Group B 10163 Effect on Micturation in both Groups 10264 Effect on Lactation in Group A 10365 Effect on Lactation in Group B 10466 Effect on Lactation in both Groups 10567 Effect on Back ache in Group A 10668 Effect on Back ache in Group B 10769 Effect on Back ache in both Groups 10870 Effect on Abdominal wall thickness in Group A 10971 Effect on Abdominal wall thickness in Group B 11072 Effect on Strength in Group A 11173 Effect on Strength in Group B 11274 Effect on Strength in both Groups 113
  10. 10. LIST OF GRAPHSGraph No. Description Page No. 1 Incidence by Age 46 2 Incidence by Religion 47 3 Incidence of Socioeconomic Status 48 4 Incidence of Education 49 5 Incidence by Occupation 50 6 Incidence by Diet 51 7 Incidence by Habits 52 8 Incidence by Habitat 53 9 Incidence by Parity 54 10 Incidence of Prakruti 55 11 Incidence of Sara 56 12 Incidence of Samhanana 57 13 Incidence of Satmya 58 14 Incidence of Satwa 59 15 Incidence by Ahara Shakti 60 16 Incidence of Vyayama Shakti 61 17 Incidence by Pramana 62 18 Incidence related to Appetite 63 19 Incidence by Bowel Habits 64 20 Incidence related to Micturation 65 21 Incidence According to intensity of Abdominal pain 66 22 Incidence of Strength 67 23 Incidence of Lactation 68 24 Incidence of Backache 69
  11. 11. 25 Incidence related Abdominal wall thickness 7026 Incidence as per height of Uterus 7127 Incidence of amount of Lochial discharge 7228 Incidence of colour of Lochial discharge 7329 Incidence of odour of Lochial discharge 7430 Incidence by Episiotomy healing 7531 Effect of Involution in Group A 7632 Effect of Involution in Group B 7733 Effect of Involution in both Groups 7834 Effect on amount of Lochial discharge in Group A 7935 Effect on amount of Lochial discharge in Group B 8036 Effect on amount of Lochia in both Groups 8137 Effect on colour of Lochia in Group A 8238 Effect on colour of Lochia in Group B 8339 Effect on colour of Lochia in both Groups 8440 Effect on odour of Lochia in Group A 8541 Effect on odour of Lochia in Group B 8642 Effect on odour of Lochia in both Groups 8743 Effect on Episiotomy healing in Group A 8844 Effect on Episiotomy healing in Group B 8945 Effect on Episiotomy healing in both Groups 9046 Effect on Abdominal pain in Group A 9147 Effect on Abdominal pain in Group B 9248 Effect on Abdominal pain in both Groups 9349 Effect on Appetite in Group A 9450 Effect on Appetite in Group B 95
  12. 12. 51 Effect on Appetite in both Groups 9652 Effect on Bowel clearance in Group A 9753 Effect on Bowel clearance in Group B 9854 Effect on Bowel clearance in both Groups 9955 Effect on Micturation in Group A 10056 Effect on Micturation in Group B 10157 Effect on Micturation in both Groups 10258 Effect on Lactation in Group A 10359 Effect on Lactation in Group B 10460 Effect on Lactation in both Groups 10561 Effect on Back ache in Group A 10662 Effect on Back ache in Group B 10763 Effect on Back ache in both Groups 10864 Effect on Abdominal wall thickness in Group A 10965 Effect on Abdominal wall thickness in Group B 11066 Effect on Strength in Group A 11167 Effect on Strength in Group B 11268 Effect on Strength in both Groups 113
  13. 13. ABBREVIATIONS1. C.S. Charaka Samhitha2. SU.S Sushruta Samhitha3. A.S. Astanga Sangraha4. A.H. Astanga Hrudaya5. Bp.N Bhavaprakasha Nighantu6. Sh.S Sharangadara Samhita7. Y.N. Yoga Ratnakara8. Vai. S .S. Vaidyaka Shabda Sindhu.9. S.S. Shabda Samgraha10. BT Before Treatment11. AF After Treatment12. & And13. % Percentage14. IPD In Patient Department15. T.i.d Thrice in a day16. Kg Kilogram17. Cms Centimeters18. L.M.P Last Menstrual Period.19. E.D.D Expected Date of Delivery.20. RMLE Right mediolateral Episiotomy21. LMLE Left mediolateral Episiotomy22. PPH Post partum hemorrhage23. PRL Prolactin
  14. 14. Introduction  INTRODUCTION New mothers may heave a sigh of relief after the nine months of pregnancy and astressful delivery, there are many changes which have happened to pregnant lady duringher antenatal period and even more are happening in post delivery period. The body demand relaxation and rejuvenation to the normal stature. In fact it isthe womanly wisdom and right to bring back the body Beautiful. Delivering a baby istiring to say the least. The mothers body is weary and needs to recuperate. This wear andtear is further added by the swings of hormone levels which are maximum in the firstweek post delivery. The baby may be keeping her awake all the time. Her breasts feelsore, stitches are hurting…… Many things add up to make her feel down. To monitor and over come all these, a woman needs special care after delivery.The exhausted mother not only requires complete bed rest, but monitoring her generalhealth should also be done. A complete care of Puerperium especially for the first sixweeks post delivery is mandatory. Ayurveda an ancient science gives importance to Swasthya rakshana and VikaraPrashamana by explaining various procedures like Dinacharya, Rutucharya, Sadvrutta formaintaining the physical and mental health and preventing the disease. Acharyas werestill ahead in this field of science pertaining to Prasoothi Tantra. They have also givenguidelines for the management of Prasootha stree. Acharya Kashyapa narrating stage ofPrasava says, it is like that her one foot is situated in this Loka and other in Yama Loka.The lady after such a difficult process of Prasava must be advised certain mode of life ora Paricharya. This Suthika Paricharya has been explained by almost all Acharyas. Peyadikramaprocessed with different medications given to Suthika will does Agni deepana, digests A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 1  
  15. 15. Introduction the sashesha dosha in garbhasaya, yusha given to her will does Dhatuposhana, theAbhyanga, Parisheka etc Vatahara Upachara will relieve her conditions like exhaustion,strain, tiredness, back ache etc. These also have their effect on mental wellbeing & helpsin recapitulating the healthy status. The regime or the Paricharya for a stipulated periodis so necessary that it directs the Suthika towards a complete Punarnaveekarana of herbody, so that she will be a Swastha Stree and ready to bear all the day to dayresponsibilities of her family. And even her body becomes fit for future pregnancy. In this period Dashamoola, Jeeraka and Panchakola are given importance fortheir actions like Garbhashaya Shodhaka, Deepana, Pachana, Vatanulomana, ShoolaPrashamana & Sthanya Janana. Considering above factors this study is being selectedwith a hope to provide better results through the time tested Ayurvedic formulations likeDashamoolajeeraka Kashaya & Panchakola Kashaya in Suthika Paricharya. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 2  
  16. 16. Objectives  OBJECTIVES OF STUDY A detailed review of the Literature for the description of soothika, soothika kala, Suthika samanya and vishista Paricharya, pathya and apathya with modren description of puerperium. A Conceptual study on Dashamoolajeeraka kashaya and Panchakola Kashaya. To evaluate and Compare the efficacy of Dashamoolajeeraka Kashaya & Panchakola kashaya in Suthika. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 3  
  17. 17. Review of Literature     HISTORICAL REVIEW “The function of the historian is neither to love the past nor to emancipatehimself from the past, but to master and understand it as the key to the understanding ofthe present.” -E.H. Carr The History of history goes back to eternity. Itihasa jointly with purana isregarded as the fifth veda. It is manifested simultaneously from all the four mouths of thecreator and as such is concerned with all the knowledge revealed before hand andcontained in Scriptures.Prevedic Period There is no Scriptual evidence in Pre-vedic period.Vedic Period Entire vedic literature is full of ideas and facts relating to prasoothi tantra and streeroga which guided the development of the subjects in post vedic era.Rigveda1 There is mention about a drug called “ Tejana” which means vamsha. The quathaof which is used to reduce the Lochial discharge.Atharva Veda1, 2 Various rakshasas and Krimi which can be considered as the infective organismare described, which attack the puerperial women. These were given various names according to their size and shape. Daruna,amiva etc are the krimis which causes asending or desending infection in Yoni, sroni andGavini. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  4 
  18. 18. Review of Literature    These can be destroyed by Sun rays. Drugs like Baja ie, sweta sarshapa andPinga ie, Peeta sarshapa are krumi nashaka and are said to be useful in the treatment ofPrasoothi rogas. Also the use of Dashavriksha ie, Dashamoola in the treatment ofprasoothi rogas is being mentioned and it is considered to cure the vata prakopa and thebody ache present during the suthika period. Prushna parni is considered as drug ofchoice for rakshasas trouble the women during puerperium. Here some drugs were mentioned, which will increase the quantity of sthanya.Drug Pippali also called as vatikruth bheshaji, atividha bheshaji and kshipta bheshaji isconsidered as beneficial. Along with the pashana bheda lepa of pippali is done overBreast which will increase the secretion of Breast milk. Kamala or padma kanda is alsomentioned as dugdha vardhaka and raktha vikara nashaka. Kalpasuthra11 A reference mentions the use of paste made of the roots of kaktani,machakakatani, koshataki, bruhati and kalaklitaka which is to be applied in thesuthikagara for raksoghna purpose. It may be considered as a measure of Disinfectant.To avoid vulnerability of any infection in this period.Vishnupurana11 Here there is an explanation about a type of vata which causes the delivery of thefetus and it is termed as prajaptya vata or suthimarutha. Suthika gruha is also described.Harsha Charita12 There is a reference of pravichalita hingavaha in suthika, which was commonlyfound in the vindhya region. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  5 
  19. 19. Review of Literature   Samhita Kala First and foremost complete documentation regarding suthika was seen in samhitakala. Description regarding soothika paribhasha, kaala, paricharya is available in all theGrantha’s of Bruhatrayee1,2,3,111,112,113,114,115 and laghutrayee6,8,116,117,118,121.. Elaborate explanation of suthika paricharya according to desha and jaati is foundin kashyapa samhita4,101,102. A list of suthika vyadhis are also explained with 103,104.treatment In Bhela Samhita105, Baishajya rathnavali7,119, Harita samhita106 also a briefexplalnation about suthika paricharya with chikitsa of suthika roga is available. Description regarding Dashmoola kwatha specially in suthika is available inKashyapa Samhita4, Sharangadhara Samhita6, Yogarathnakara5,120, BhaishajyaRathnavali7 and also in Bhava Prakasha8. Usage and indication of Jeeraka in Suthika ismentioned in Bhavaprakasha8 and Bruhath Nighantu Rathnakara9. Reference regardingindication of Panchakola in Suthika is available in Bruhatrayee1,2,3.History of puerperium13 In olden days the power of women was considered in the form of Goddess andlady was considered as Bearer or nurturer. In the middle ages however the child was given paramount importance. Thus inthreatening condition the life of the child was favoured, which led to high rate ofmaternal mortality. The only disease condition explained in detail was the puerperial fever which wasmuch talked about during the end of 18th century. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  6 
  20. 20. Review of Literature    During the world war 1914-18 women were seen as “Saviour of the Race”.Moulding future generation on whom the society’s hope rested, which led to improvedmaternal care during pregnancy, birth and even post natal period. Puerperial care and after pains were mentioned in all the recent obstetric textbooks.Review of some previous works : Since 1975 many of researches have been dealt in Ayurvedic field. Few ofresearch works done in different institutions on soothika are as follows.Table No – 1 Shows the list of previous workSl.No Title of the research work Name of the Scholar & Year University.1. Study on role of Amritastaka kwatha Dr. Thakar. Neela. N 1991 & Dashamoolakwatha in soothika GAU, Jamnagar paricharya.2. Soothikawasthet Dashamoola Dr.Kutaskar.C.S. Tilak 1993 Kwatha Upayoga Ayurveda Mahavidyalaya. Poona3. Management of Soothika – An Dr.Mamta.B.S. BHU. 1998 Ayurvedic approach.4. Management of soothika with Dr. Sunita. Sumana 2004 Panchakola churna BHU.5. Efficacy of Panchokola Ghrita in Dr. Sachin. Choudhary SNK 2005 Soothika Paricharya Jabshetty Ayurvedic Medical College. Bidar    A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  7 
  21. 21. Review of Literature    SUTHIKA PARICHARYA Birth which is a natural process represents the utmost important event thatmakes a lady responsible for producing offsprings. The physiological transition frompregnancy to motherhood heralds an enormous change in each women physically andmentally. This fabulous phase of pregnancy and delivery is strenuous and tedious to thelady. Inspite of that post delivery period itself needs adjustment of lady not only to theinfant needs but also to her own physiological and psychological variations. The suthika avastha is described in ayurveda with a particular mode of life for astipulated period. mÉëÉmiÉå mÉëxÉuÉ MüÉsÉå cÉ pÉrÉqÉÑimÉÉkrÉiÉå rÉiÉÈ | AÎxqɳÉåMüÈ ÎxjÉiÉÈ mÉÉSÉå pÉuÉSlrÉÉå rÉqɤÉrÉå: || MüÉ. xÉÇ.ÎZÉ. 11/2 LuÉÇ ÌWû aÉpÉïuÉ×̬ ¤ÉÌmÉiÉ ÍvÉÍjÉsÉ xÉuÉï vÉUÏU kÉÉiÉÑmÉëuÉÉWûhÉ uÉåSlÉÉ YsÉåS U£ü ÌlÉxÉ×iÉ ÌuÉvÉåwÉ vÉÔlrÉ vÉUÏUÉccÉ mÉÑlÉlÉïuÉÏpÉuÉÌiÉ|| (A. xÉÇ. vÉÉ. 3/39)  The life of Pregnant women will be at risk during delivery or it is one of the mostcrucial time in her life15. The sarva shareera dhatu of mother will be in shetila avasthabecause of growth and development of fetus in her. This is further added by pravahanavedana and kleda raktha srava during delivery16. Hence the women is with shunya shareera because of prasava vedana and she isprone for certain diseases. The suthika paricharya itself helps in punar navikarana of herbody.    A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  8 
  22. 22. Review of Literature    Nirukthi17,18 xÉÔÌiÉMüÉ-  x§ÉÏ xÉÔ + £ü: + OûÉmÉç | - lÉuÉmÉëxÉÔiÉÉ (vÉoS MüsmÉSÙqÉç) mÉËUcÉrÉÉï – x§ÉÏ mÉËU + cÉUç + mÉËUcÉrrÉÉïmÉËUxÉrrÉåïÌiÉ | - xÉåuÉÉ (vÉoS MüsmÉSÙqÉç) x§ÉÏ xÉkrÉ: mÉëxÉÔiÉÉrÉÉqÉç x§ÉÏrÉÉqÉ||  ( uÉæ. vÉ. ÍxÉ.)   A women who has been just / recently delivered.  Paribhasha xÉÔiÉÉrÉɶÉÉÌmÉ iÉ§É xrÉÉSmÉUÉ cÉå³É ÌlÉaÉïiÉÉ | mÉëxÉÔiÉÉÌmÉ lÉ xÉÔiÉÉ x§ÉÏ pÉuÉirÉåuÉÇ aÉiÉå xÉÌiÉ || (MüÉ.xÉÇ. ÎZÉsÉ. 11/6)                         The word soothika is coined to a women, who has just given birth to a baby andafter apara patana. The process of labour is said to be completed only after theexpulsion of placenta19. qÉÑ£ü aÉpÉÉï AmÉUÉÇ rÉÉåÌlÉ…… (AÉ.¾è.vÉÉ.1) Vagbhata also has explained suthika paricharya only to be started after theexpulsion of garbha and apara20. Hence after the delivery of child till the placenta is not expelled the lady cannot becalled as soothika. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  9 
  23. 23. Review of Literature   Soothika Kala All acharyas, except charaka have given a definite duration for period of suthika.                 AlÉålÉ ÌuÉÍkÉlÉÉ AkrÉkÉï qÉÉxÉqÉÑmÉxÉÇxM×üiÉÉÌuÉqÉÑ£üÉWûÉUÉcÉÉUÉ  ÌuÉaÉiÉ xÉÔÌiÉMüÉÍpÉkÉÉlÉÉ xrÉÉiÉç mÉÑlÉUÉiÉïuÉSvÉïlÉÉÌSirÉåMåü|| (xÉÑ.xÉÇ. vÉÉ. 10/16) LuÉÇ cÉ qÉÉxÉÉSè AkrÉkÉÉïlqÉÑ£üÉWûÉUÉÌSrÉl§ÉhÉÉ| aÉiÉxÉÔiÉÉ AÍpÉkÉÉlÉÉ xrÉÉimÉÑlÉUÉiÉïuÉ SvÉïlÉÉiÉç|| (A.¾è. vÉÉ.1/100, 101) Accoding to sushruta21 and vagbhata22 time period of soothika is said to be oneand half month or until the reappearance of her menstrual cycle. Four months period of soothika kala is explained for soothika after the extractionof mudha garbha(obstructed labour)23.                wÉQèÍpÉqÉÉïxÉæ: mÉëxÉÔiÉÉrÉÉ kÉÉiÉuÉÉå ÃÍkÉUÉSrÉ: |(MüÉ.xÉÇ. ÎZÉ.11)  Acharya kashyapa24, Bhavaprakasha25 and yogarathnakara26 have explainedone month period of specific dietic management and Still kashyapa specially confirmsthat soothika kala is for 6 months. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  10 
  24. 24. Review of Literature   SAMANYA SUTHIKA PARICHARYA –Table no – 2 - Suthika Samanya Paricharya according to different Acharyas Charaka27 Sushruta28 Vagbhata29,30 Kashyapa31Vihara 1.Parisheka 1.Abhyanga 1.Abhyanga 1.Rakshoghna dravya, (ubhayata (sarvadaihika, (Yoni and 2. kukshi, parshva kala) Bala Taila) Sarvadaihika prusta Abhyanga, 2.Abhyanga 2.Parisheka Taila mardana - Samvahana 3.Udara (Vatahara Bala Taila) in nubja shayana, vestana Aushadha - 2. Parisheka with 3.Udara vestana, Badradarvadi ushnaJala 4. Bala taila purita kashaya etc) (Ubhayata kala) ushna 3. Sthanika charmavana asana, Udara abhyanga 5.Yoni Swedana 4. Udaravestana, (priyanguka, 5. Acchadana krushara), 6. Udvartana, 6.Suthika Snana, 7. Avagaha (Ushna Jala) (Jeevaniya,madh 7.Vishranta, ura,Bruhmaneya 8.Dhupana varga aushadi (kusta, guggulu, agaru, siddha) ghrutha)Ahara 1.Sneha 1.Ushna 1.Sneha pana 1.Manda pana3-7 days pana gudodaka (Pippalyadi 2.Hita Bhojana (Pippalyadi (pippalyadi Dravya with 3-5 days. Dravyas ) gana dravyas) saindhava) 3. Sneha pana 2.Yavagu 3-4 days. or 4. Sneha yavagu pana Pana 2.Sneha or 2.Ushna (Pippali, nagara etc (Pippalyadi Ksheera gudodaka/ dravya lavana rahita) Gana Yavagu Vatahara Kwatha 5-7 days. Dravyas) (Vidari with Harsva ganasadhita Panchamoola. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  11 
  25. 25. Review of Literature    dravya) 3.Yavagu or 3-7days. Ksheera yavagu Pana. (pippalyadi or Vidari gana dravya) 4. Peya (purvoktha dravya)7-11days Swastha 1.Jangala 1.Yusha pana Yavagu Pana (Lavana, vritha Mamsa rasa ( yava, kola sneha aushadha palana 2.Yava,kola, Kulathadi yuktha) Kulathayusha, dravya) 3.Shali 2.Laghu Bhojana. annapana12 days 1.Jangala 1. Kulatha Yusha, Mamsarasa 2. Jangala Mamsa 2.Jeevaneeya, rasa Madura 3. Gritha bharjita Bruhmaneeya, shaka (Kushmanda, balya,Vatahara Mulaka, Earvaruka) dravya sadhita 4. Snehana,Swedana, annapana. Ushna jala sevana 1month.           Almost the same explanation is given by Harita, Yoga rathnakara andBhavaprakasha. The regimen explained to suthika by different acharyas can besummarised as follows.VIHARA – Soon after muktha garbha apara, the suthika stree should be given with yoni tailaabhangya and yoni mardana should be done, which is followed by yoni swedana usingpriyangu, krushara etc. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  12 
  26. 26. Review of Literature    The lady is made to lie down in nubja position, abhyanga, samvahana is done overudara, prusta and kati pradesha, using sarpi or taila or yamaka sneha. This udara peedanahelps in removing the pravartita garbha dosha. Sthanika abhyanga is followed by udara vestana using a big clean cloth. Tieing itaround kukshi parshva helps udara or garbhashaya to be in its swasthana. It also preventsthe accumulation of vayu in Udara, Hence avoiding vayu vikruthi. Sarvadaihika abhyanga to suthika stree is advised using bala taila, followed byparesheka using vatahara aushadha kwatha or ushna jala, twice a day. The suthika is alsoadvised with avagaha, acchadana etc procedures. All these procedures done are mainly to suppress or controle the vitiated vata ie,for vatanulomana. Ushna bala taila purita charmavana asana / leather bag is prepared and suthika ismade to sit over that asana. This will help in yoni prasadana. Ushnambu snana isadvised to suthika followed by dhupana using Kusta, Guggulu, Agaru, Gritha etc. All these therapies are followed by adequate vishrama which helps in klamanirharana. AAHARA – The Suthika should be given with one of the chaturvidha sneha (Sarpi, taila, vasa,majja) in Uttama matra considering her agnibala and Sneha satmya. The sneha should bemixed with Pippali, Pippali mula, Chavya, Chitraka, Nagara, Hasti Pippali, Yavani,Upakunjika etc Churna. Ksheera yavagu or Sneha yavagu processed with vidaryadi ganadravyas is given after the digestion of Sneha. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  13 
  27. 27. Review of Literature    If Sneha is contra-indicated for suthika in anupa desha then she should be givenwith vatahara Aushadha Kwatha or Laghu Panchamula Kwatha. To remove sasheshadosha in suthika, Ushna gudodaka with panchakola churna is beneficial. The lady needs vatanulomana and agnideepana soon after her child birth. Assoon as suthika feels hunger, here the immediate regime starts with snehapana withdeepana pachana drugs followed by yavagu pana after the digestion of sneha. The manda or yavagu pana processed with sneha, ksheera and Vidaryadi ganadravyas acts as agni deepana, vatanulomana, sweda janana, brings mrudutwa to srotas. After one week suthika should be given with yusha prepared of yava, kola,kulatha etc dravyas. Laghu annapana ie, shali odana with sufficient quantity of sneha,amla, lavana is given. This paricharya will inturn does agni deepana, acts as rochana,sweda janana, gives a feeling of contentment. It is shrama hara, glani hara and doesdhatu poshana ie it nourishes her body. After 12 days suthika is advised with brumhana dravya. She can be given withmamsa rasa with yava, kola, kulatha etc dravyas. Gritha bharjita shakas like kushmanda,earvaruka, mulaka are given. Gritha or taila or kwatha which is prepared with jeevaneya,brumhaneya, madhura, vatahara, hrudhya dravya or annapana advised is very muchneeded in this period. This hrudya laghu annapana given to suthika mainly after agnideepana andamapachana does tarpana and bruhmana karma, acts as dhatu vardhaka. The sasheshadosha nirharana from garbhasaya will help in garbha koshta shuddhi which is broughtabout by ushna gudodaka processed with different drugs. The dhatu poshana or paricharya to make dhatu paripurnata will in turn nourishesthe upadhatu which is needed for sthanya uthpathi, sthanya vruddhi and even for rudhirasanchaya in yoni for punar artava darshana. In total all these regimen will mitigate vata, increase agni, does bala vardhana anda total punarnaveekarana of Suthika. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  14 
  28. 28. Review of Literature    32VISHISTA SUTHIKA PARICHARYA This particular regimen is explained by Kashyapa, based on the particular type ofdesha, in which suthika is residing.Anupa Desha - In this desha the suthika should use manda which is processed by agnibalavardhaka drugs. Nivata shayana, svedana and use of only ushna dravya is beneficial. All sneha dravyas and abhishyandi ahara should be avoided.Jangala Desha - Here Sneha upachara is advised to suthika stree specially. The suthika in thisdesha should be given with grutha, taila etc. Sneha pana or yavagupana for at least 3 or 5days is beneficial , Then followed by using snigdha anna samsarjana karma. Ushnodakaparisheka is also advised.Sadharana Desha - For the suthika from this kind of land, usage of neither too sneha nor too rukshadravyas is said to be beneficial. One should advise for sadharana vidhi.Videsha Jati – The suthika stree of mlecha jaati should use raktha, mamsarasa niryuha,kandamula and phala in their paricharya. Kashyapa also has given use of taila and gritha in case of delivery of male andfemale child respectively33. Followed by yavagu pana processed with deepaneya dravyaafter the digestion of sneha. This is for 5 to 7 days then mandadi upakrama should befollowed.GENERAL INDICATIONS AND CONTRA INDICATIONS - A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  15 
  29. 29. Review of Literature                            mÉëxÉÔiÉÉ ÌWûiÉqÉÉWûÉUÇ ÌuÉWûÉUÇ cÉ xÉqÉÉcÉUåiÉç | urÉÉrÉÉqÉÇ qÉæjÉÑlÉÇ ¢üÉåkÉÇ vÉÏiÉxÉåuÉÉÇ ÌuÉuÉeÉïrÉåiÉç|| xÉuÉïiÉÈ mÉËUvÉÑ¬É xrÉÉSè ÎxlÉakÉ mÉjrÉÉ AsmÉpÉÉåeÉlÉÉ| xuÉåSÉprÉXûmÉUÉ ÌlÉirÉÇ pÉuÉålqÉÉxÉqÉiÉÎlSìiÉÉ ||(pÉÉ.mÉë.mÉÔuÉïç. 4)                          The prasutha stree should use hitakara ahara and vihara, avoid vyayama, vyavaya,sheeta maruta sevana and krodha. When she becomes parishudha, continue with snigdha,pathya alpa bhojana, abhyanga and sweda every day34. The Panchakarma procedures like Asthapana Basti, Nasya, Virechana, Siravyadhana, teekshna Sweda are also contraindicated in suthika.IMPORTANCE OF DOING SUTHIKA PARICHARYA35                        ÍqÉjrÉÉcÉÉUÉiÉç xÉÔÌiÉMüÉrÉÉ rÉÉå urÉÉÍkÉÂmÉeÉÉrÉiÉå |  xÉ M×ücNíûxÉÉkrÉÉå AxÉÉkrÉÉå uÉÉ pÉuÉåSèAirÉmÉiÉmÉïhÉÉiÉç || (xÉÑ. xÉÇ. vÉÉ 10/19) For proper naveekarana of suthika, the paricharya explained by our acharyas ismust to follow. Other wise improper regime in the form of excessive nourishing or moreof apatarpana procedures will make suthika easily suceptable for diseases. Kashyapa hasdescribed nearly Thirtyfive types36 and Sixtyfour types37 of suthika rogas. Twentyfivediseases are common38 at both the places, most of these are difficult to treat or incurable.Suthika if she does ratri nirgamana, divaswapna, having earsha, bhaya, shoka etc, A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  16 
  30. 30. Review of Literature    36manasika abhitapa, ajeerna, adhyashana etc is prone to get all sort of vikara . So Suthikaparicharya is a part and parcel of every prasava.                   PUERPERIUM"Motherhood is neither a duty nor a privilege, but simply the way that humanitycan satisfy the desire for physical immortality and triumph over the fear of death." - - Rebecca West39 The Puerperium is the period of maternity care. Is also a time of psychologicaladjustment, This tuning back period in fact has received relatively less attention thanpregnancy and delivery. It is a time of great importance for both the mother and herbaby. The mother’s joy at the arrival of the new baby may be tempered by anxiety abouther child’s welfare and her ability to cope. From latin language “Puerperium“ word got originated or derived, which meansto bring forth (pario) a child (puer)40. It is the period of adjustment after child birth whenanatomical and physiological changes of conception are reversed to an almostprepregnancy level41. The pelvic organs returns to the non-gravid state, the metabolicchanges of pregnancy are reversed and lactation is established. This postpartum periodlasts from delivery of the placenta until 6 weeks after delivery. Ofcourse all maternal A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  17 
  31. 31. Review of Literature   adaptations during pregnancy do not necessarily subside completely by 6 weekspostpartum42. For the purpose of proper management this period can be divided into an43,44 – 1. Immediate Puerperium 2. Early Puerperium 3. Remote PuerperiumImmediate Puerperium - It includes the first 24 hours after delivery, the stage of acutepost partum period.Early Puerperium - It is the period of first week after delivery.Remote Puerperium - It starts from second week to six weeks post-delivery. Following delivery, when the endocrine influences of the placenta are removed,the physiological changes of pregnancy are reversed and the body tissues, especiallypelvic organs, return to their previous state.POSTPARTUM CHANGES45,46,47 ,48 Changes in Uterus Involution of The Uterus The principal changes of puerperium is uterine involution. Immediately afterdelivery uterus weighs 1000gms and comes up to the level of umbilicus (about 24 weekspregnancy size). Within 10 days of delivery the uterine fundus will disappear below thesymphysis pubis. It is aided by oxytocin release and shrinks to around 50 – 60 gms inweight51. The puerperial uterus on section appears ischemic when compared with thereddish purple hyperemic pregnant organ. The process of involution is affected by A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  18 
  32. 32. Review of Literature    52autolysis , where the protein of the uterine musculature is broken down into simplercomponents, which are then absorbed and excreted in the urine53. During the first week of post partum involution is up to the level of pubicsymphysis. There is approximately 34% decrease in uterine size (1.25cm per day). Bysecond week uterus usually returns to the pelvis. In the second and third week there is48% decrease in uterine size and the rest of the 18% reduction in size occurs after thethird week. The involution changes are due to a reduction in the length and overall sizeof muscles49,50. After delivery, the endometrial surface of the uterus is thick and rough especiallyover the placental site. The decidua is cast off as a result of ischaemia and is lost as thelochial flow which usually clears completely within 4 weeks of delivery. There are nodecidual cells seen at 6 weeks postpartum. New endometrium will grow from the basalareas of the deciduas53. The markedly thinned out, flabby, collapsed lower uterinesegment contracts and retracts but not as forcefully as the body of the uterus. Over thecourse of a few weeks, it is converted into uterine isthmus.Lochia54,55,56 It is the discharge, which escapes from the genital tract during the first 3 to 4 weeksof puerperium. It consists of sloughed decidua.Lochia Rubra: This occurs for 1 to 4 days. It is red in colour and consists of blood,fetal membranes, deciduas, vernix caseosa, epithelial cells, bacteria and meconium.Lochia Serosa: It is yellowish initially, then brownish in colour and lasts for next 5 to 9days. It consists of fewer RBCs more leucocytes, wound exudates, mucous from thecervix and micro organisms (anerobic streptococci and staphylococci), the presence ofbacteria is not pathogenic unless associated with clinical signs. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  19 
  33. 33. Review of Literature   Lochia Alba: This is white in colour and lasts for 10 to 15 days after lochia serosa hasdisappeared. It consists of plenty of dicidual cells, leucocytes, mucus, crystals, granularepithelial cells and micro organisms. The lochia has fishy odour and is alkaline, tending to become acidic towards theend. During the first 5 to 6 days the amount secreted is 250 ml, It is excessive indeliveries following multiple gestation, hydramnios and big babies. It is scanty inpreterm deliveries. Changes in The Cervix 57,58 – After delivery, the cervical epithelium becomes very flaccid and thinner in thefirst 4 days, the outer cervical margin, which corresponds to the external os, is usuallylacerated, especially laterally. The cervical opening contracts slowly, and for a few daysimmediately after labour it readily admits two fingers. By the end of the first week it hasnarrowed, hence the cervix thickens and the canal reforms. At the completion of involution, however, the external os does not resume itsprepregnant appearance completely. It remains wider, with bilateral depressions at thesite of lacerations and remains as permanent changes that characterize the parous cervix.The cervical epithelium undergoes considerable remodeling; this complete re-epithelisation takes 6- 12 weeks. Vagina59- The over distended vagina, slowly returns to its prepartum shape around 3rd week.The reverting process is completed within 4-8 weeks. The tone of the vagina neverreturns back to virginal state. The increased venous congestion makes the mucosadelicate in this period. Even the vaginal rugasities reappear partially, introitus remainspermanently larger than virginal state. The lacerated, fibrosed healing hymen representsin the form of carunculae myrtiformes.Fallopian Tubes and Ovarian Functions60- A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  20 
  34. 34. Review of Literature    After delivery the low level of estrogen and progesterone will effect the increasednumber of tall nonciliated cells in the fallopian tubes. Their nuclei will extrude out,thickness of the cellular layer decreases, inflammatory changes are also seen. Elevated prolactin levels are the basis of anovulation in lactating mothers. As theovarian activity is suppressed, the resumption of menstruation may be delayed for manymonths. Other wise in non-lactating mother, ovulation can occur as early as 70-75 dayspostpartum with the resumption of menstrual period after 7 – 9 weeks. Pelvic Changes61,62,63 For easy passage of the fetus, Even pelvic cavity increases in its width, thewideneing of the symphysis pubis and sacro-iliac joints are well observed. Afterdelivery the voluntary muscles of the pelvis and other pelvic supports slowly regain theirtone. Involution of muscles takes up-to 6-7 weeks, hence exercises should be postponedtill these stretched muscles come to their original state. Systemic Changes -Cardio Vascular System64,65,66 - Just after parturition, plasma volume decreases due to bleeding. Hematocrit valuesincreases by 5% and cardiac out put increases by 50%. Pulse rate is increased on the 1stday. On the 3rd day post delivery there is a shift from extracellular fluid into the vascularcompartment causing 900 to 1,200ml increase in intravascular volume. There is alsoslight increase in blood pressure in the first 5 days of puerperium. Ventricularhypertrophy of pregnancy resolves in about one year. Within 8 weeks after delivery the red cells volume returns to normal. The rapidloss of blood during delivery stimulates reticulocytosis (which is maximum at the 4thpostpartum day) and a moderate increase in the erythropoitin level during the first weekafter delivery. There is hyper activity of bone marrow during puerperium, prolactin also A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  21 
  35. 35. Review of Literature   stimulates bone marrow. Due to stress of labour there is marked leucocytosis, consistingespecially of granulocytes. Respiratory SystemS67 – The oxygen consumption is increased during pregnancy and even in 7– 14 daysafter delivery. The delivery of child has decreased the uterine size hence the diaphragmcomes down. The volume of lungs will increase which reduces the respiratory alkylosisand metabolic acidosis. The hypoapnea will also reduce. Decreasing level ofProgesterone is also responsible for the increased PCO2 in first week postpartum. Theoxygen saturation is increased to 95% during day one after delivery.Urinary System64,68,69,70 During labour, the sustained trauma to the nerve plexus will make the bladderinsensitive to raised intravesicular pressure. The changes which occur in urinary tractduring pregnancy disappear in a similar manner as the involutional changes. Thebladder mucosa become oedematus, enlarged with increased capacity of urine. The overdistended bladder with incomplete emptying leads to significant amount of residual urine.Within 2 – 3 weeks the hydroureter and caliceal dilation of pregnancy is much lessevident. Diuresis occurs to get rid of excess of extracellular fluid accumulated duringpregnancy. Even there is mild proteinuria in immediate postpartum period which isnormal. And Pregnancy induced glycosuria disappears. Increased Glomerular FiltrationRate comes to normal by 8 weeks of puerperium and there is 25% increase in renalplasma flow. Metabolic Changes71 Fatty acids (Total and non esterified) return to the prepregnancy level on thesecond post partum day. Plasma Triglyceride levels slowly fall to normal by 6-7 weeks. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  22 
  36. 36. Review of Literature   Lactation does not affect the fatty acid levels. Blood sugar level falls below thepregnancy level on the 2nd and 3rd day after delivery due to an elevated renal threshold.Free plasma amino acids increase post-partum on 2nd or 3rd day. Hemodynamic Re-adjustment72,73 Delivery leads to obliteration or low resistence of uteroplacental circulation andresult in 10-15% reduction in the size of the maternal vascular bed. Loss of placentalendocrine function also removes a stimulus to vaso dilatation. This reduction of bloodvolume and venous tone which becomes normal with a significant decrease in deep veinsize and increase in uterine vascular resistance. There is increase in venous blood flowvelocity in lower limbs. A declining in blood volume with a rise in hematocrit is usually seen with in 3-5days after delivery. Hemoconcentration occurs if the loss of red cells is less than thereduction in vascular capacity. Hemodilution takes place in woman who loses 20% ormore of their circulatory blood volume at delivery.Table no – 3 Shows Hematological Values in Puerperium Total Blood Decreases immediately Post Partum due to volume blood loss at delivery Plasma volume Decreases immediately Post Partum due to blood loss at delivery Increases 3 days Post Partum due to shift of extra cellular fluid into vessels RBCs RBC production returns to normal levels RBC count returns to normal by 8 weeks PP Hb & Hct Immediate decrease in Hb immediately PP due to blood loss at delivery Hb levels stabilize by 2-3 days HCT remains relatively stable immediately after delivery Hct returns to non-pregnant levels 4-6 weeks A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  23 
  37. 37. Review of Literature    WBCs Decrease to 6- 10,000 after high of 25-30,000 during intrapartum and immediate postpartum Returns to normal 4-7 days Platelets Increases at 3-4 days Gradually returns to non-pregnant levels ESR Gradually returns to non-pregnant levels after antepartum increase Serum Fe Increases as Hgb is catabolized Gradually returns to non-pregnant levels Coagulation Increase in fibrolytic activity in first few hours factors Slow decrease to non-pregnant levels by 1-4 weeks Slow decrease in coagulation factors by 1-4 weeksCoagulation Mechanism74,75 A sudden reduction in the platelet count is seen immediately after the placenta hasseparated, but a secondary raise can occur later with an increase in their adhesiveness. During the 1st day after delivery the plasma fibrinogen concentration startsdecreasing and the lowest level is reached. After that a secondary increase in its leveloccurs which is maintained till the second week after parturition, after which a downword trend again starts for the next 7 to 10 days. These changes make the delivered women susceptible to thrombosis during thepuerperium. How ever a sharp return of normal fibrinolytic activity after delivery doesprevent this complication. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  24 
  38. 38. Review of Literature    The clotting factors increased during pregnancy are used to provide a reserve tocompensate for their rapid utilization during delivery and also to achieve haemostasisafter delivery. A large deposition of fibrin occurs in the placental bed after the deliveryof the placenta. Thus there is a continous release of fibrin breakdown products from theplacental site.Weight Loss76,77,78 Approximately 10–13 kg weight is gained during pregnancy. There is animmediate loss of about 5–6 kg due to delivery of the infant, placenta, amniotic fluid andblood loss. At the end of 6 weeks most the mothers have lost the excess of 4-5 kgsweight due to excretion of fluids and electrolytes. At least 2 liters of fluid is lost withinthe first week and 1.5 liters in next 5 weeks after delivery. Factors that influence increased puerperial weight loss includes weight gain duringpregnancy, prime parity, early return to work. Of course breast feeding or maternal agewon’t affect weight loss.Hormonal Changes79 Placental hormone levels decline very fast following delivery.Human Placental Lactogen (HPL) - This has a half life of 20 min. No HPL can be seenin the maternal blood on the 1st day after delivery.Human Chorionic Gonadotrophin (hCG) - This has a half life of 9 hrs. 48 to 96 hrsafter delivery the levels are below 1000 mu/ml and 7th day post partum they are less than100 mu/ml. It virtually disappears by the 11 – 16th day after delivery.Plasma 17 B Estradiol - The level falls to 10% of pregnancy value within 3 hours of the3rd stage of labour. By one week after delivery its lower level is achieved. Follicularphase level (>50 pg/ml) is reached earliest by 19 to 21 days after parturition in non-lactating women and by 60 – 80 days in lactating women. In latter, during the period of A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  25 
  39. 39. Review of Literature   lactational amenorrhoea the estrogen levels are less than 10pg/ml. Breast engorgementthat occurs 3-4 day after delivery is due to low estrogen levels (because high estrogenlevels suppress lactation)Progesterone - This has very short half life (in minutes) hence by 3rd post partum day,the levels are far less than 1ng/ml (luteal phase level).Prolactin (PRL)- During pregnancy prolactin level rises up to 200ng/ml or more. Thelevels rises in breast feeding mothers. With each suckling episode the level of prolactinraises up to 100ng/ml. Therefore the frequency of breast feeding has an important role inmaintaining the prolactin level.Serum FSH and LH -These levels during first 10 – 12 days after delivery are very low,irrespective of the status of lactation. After 12 days their levels increase, by the 3rd weektheir concentration is same as in follicular phase. Low level of FSH and LH in earlypuerperium is due to a reduced GnRH during pregnancy and the early post partumperiod. There is also reduction in the secretion of GnRH, Growth Hormone, Insulin,Thyroid Hormones and even the secretion of ACTH. There is relative normal or highlevel of these hormones during pregnancy, which reduces soon after parturition. Againall these levels are stabilized by 6-8 weeks of postpartum period. Lactation80,81 The major physiological event of the puerperium is the establishment ofLactation. The humoral and neural mechanisms involved in lactation are complex.Progesterone, estrogen, cortisol, placental lactogen as well as prolactin appear to act inconcert to stimulate the milk secreting apparatus82,83. Mainly prolactin helps in milk production and oxytocin helps in ejection of milk.Release of prolactin acts upon the glandular cells of the breast to stimulate milk secretionand the second induces the release of oxytocin which acts upon the myoepithelial cells ofthe breast to induce the milk ejection reflex. This milk ejection reflex is mediated by the A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  26 
  40. 40. Review of Literature    85release of oxytocin from the posterior pituitary gland . It is readily inhibited by theemotional stress, maternal anxiety etc which frequently leads to a failure of lactation84. Both estrogen and progesterone are necessary for mammary development inpregnancy but prolactin, growth hormone and adrenal steroids may also be involved.During pregnancy only minimal amounts of milk is formed in the breast despite highlevels of the Placental lactogenic hormones and even prolactin. This is because theactions of these lactogenic hormones are inhibited by the secretion of high levels ofoestrogen and progesterone from the placenta and it is not until after delivery that copiousmilk production is inhibited85. The composition of breast milk varies according to the age of the baby and fromthe beginning to end of the feed. Colostrum is the breast secretion of the mother in thefirst few days after delivery. It is a deep yellow coloured thick serous secretion havinghigh specific gravity and alkaline reaction. contains high protein, vitamin A, sodium andchloride. More of antibodies (IgA, IgG, IgM), white blood cells and other anti infectiveproteins in cholestrum provides immunological defence to the new born. This colostrumalso has a mild purgative effect, which helps to clear the baby’s gut of meconium. Thisclears bilirubin from the gut and thus helps to prevent jaundice86. The milk secreted later is having more fat and lactose but less protein. The longchain poly unsaturated fatty acids present are important for neurodevelopmentalconsequences for the baby. ie, it helps in myelination of central nervous system.Facilitates absorption of calcium. The amino acids like taurine and cystein which areimportant neurotransmitters. Breast feeding protects the infant against infection ie,prevents gastrointestinal illness (diarrhea), respiratory tract infections etc. The protective factors like IgA, Macrophages, lymphocytes, Complements andinterferon etc. present are very much important in this aspect87.Table no – 4 shows Composition of colostrum and Breast milk88 Protein Fat Carbohydrates Water Colostrum 8.6% 2.3% 3.2% 86% A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  27 
  41. 41. Review of Literature    Breast milk 1.2% 3.2% 7.5% 87%                                                                                    The proteins present are lactalbumin, lacto globulins, lactoferrin and casein. Among carbohydrates mainly lactose along with glucose and galactose. Mainly triglycerides (olein, palmitin, stearin) in fats. Vitamins like B,C,D with abundance of Vitamin A and exception of Vitamin K. There is no doubt that breast milk is the ideal nutrition for the New born baby.Highly nourishing, easily digestible and immunizing contents in mothers milknecessitates the exclusive breast feeding during first 6 months of neonatal life. A healthymother will produce about 500 – 800ml of breast milk a day to feed her infant with about500kcal/day. In well established lactation, it is possible to sustain a baby on breast milkalone for 4-6 months. This requires about 600 k cal / day for the mother which must bemade up from the mothers diet or from her body store. For this purpose a store of about 5kg of fat during pregnancy is essential to make up any nutritional deficit during lactation. Breast feeding accelerates the process of uterine involution in mother89, reducingthe chances of post partum hemorrhage, Improves post partum weight loss90, Inexclusively breast fed mothers it provides 98% protection against pregnancy for first 6months. It also lowers the risk of breast cancer and ovarian cancer91. Lactation or breastfeeding or nursing the child - What ever the terminology it strengthens the psychologicalbonding between mother and the baby.Care of Puerperium 92,93,94,95 A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  28 
  42. 42. Review of Literature    The care of a pregnant woman does not end with the delivery of the child and theconclusion of the 3rd stage of labour. Even pregnancy should be considered as a natural,physiological event, Management and care of the delivered lady is a must. So the main objectives of puerperial management are - To monitor the physiological changes of puerperium. To diagnose and treat any postnatal complications. To establish infant feeding. To give the mother emotional support. To advise about contraception and other measures, will contribute in continuing her health. Immediately following delivery, lady may be given a drink or something to eat ifshe is hungry. Close monitoring of general health (BP, Pulse, Temperature, vaginalbleeding, P/A size of the uterus etc) of the lady and adequate bed rest is must. Roomingin, ie, keeping the infant with the mother, is very important, it builds up the parent-infantbonding. New mother is made ease by proper care of vulva, episiotomy wound, breast andnipple care. Proper feeding methods, care of bowel and bladder are advised. The lady ismoved out of bed with in 48hrs of post partum. By early ambulation, she feels strongerand better, Bladder complications leading to catheterization and even complaints ofconstipation are less frequent. Adequate fluid intake, liberalization of nourishing andfiber rich diet is necessary to prevent constipation. Bladder is to be emptied by thepatient as frequently as possible. Proper aseptic care, perineal wound dressing, observing the involution of uterusand lochial discharge is a part and parcel of the puerperial management. For all thesenecessary care and advice a minimum of 3-5 days of Hospital stay is needed. Correctionof anaemia in puerperial women is done by supplementation of iron therapy ie, ferrous A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  29 
  43. 43. Review of Literature   sulphate 200mg daily and also with a supplementation of calcium 1500mgdaily, for 4-6weeks96. ‘After pains’ in puerperium may need the help of analgesics97.Post Natal Exercises98,99,100 – Post natal postures and exercises must be taught for better puerperialrehabilitation. Softness of elastic ligaments and collagenous connective tissue persists for4-5 months after delivery. The abdominal muscles are stretched and elongated duringpregnancy. Hence entire abdominal wall is weakened. If the back is not properly held (incorrect postures during lifting weight) it isvulnerable to injuries. The pelvic floor is also weakened during pregnancy duecontinuous support of the gravid uterus, stretching and trauma during delivery. Theperineum is stretched and sometimes may have tears or episiotomy. Hemorrhoids maycause severe pain; legs may be painful or swollen. The management starts with breathing exercises and free hand movements of thebody parts. Deep breathing is helpful for relaxation and improving circulation.Movement of the foot, ankle and leg also improve circulation. Proper Postures, lactatingmethods are important in prevention of future back ache etc. Correct postures itself willtone up the back muscles. Pelvic floor exercises are must and to be started as early as possible. Repeatedcontraction and relaxation of the pelvic floor muscles will help in regaining the tone andelasticity. Abdominal muscle exercises are essential to regain the size of over stretchedmuscles. And to prevent divarication of recti. For this lady should lie in dorsal position,with knee flexed, abdominal muscles are contracted and relaxed alternatively. Again sheshould lie on her face, then head and shoulders are slowly moved up and down. Theprocedure is to be repeated 3-4 times a day. These Exercises should be continued for atleast 3 months. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  30 
  44. 44. Review of Literature   The main advantages of these exercises are – It minimise the risk of puerperial venous thrombosis by promoting arterial circulation and preventing venous stasis. It prevents back ache. It prevents genital prolapse and stress incontinence of urine. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  31 
  45. 45. Drug Review   DRUG REVIEW Dravya, one of the chikitsa chatushpada109, Usage of it in particular disease dependson yukti of vaidya, as there is no drug which cannot be used as medicine. xÉuÉï UÉåaÉ ÌuÉvÉåwÉ¥ÉÈ xÉuÉï MüÉrÉï ÌuÉvÉåwÉÌuÉiÉç| xÉuÉï pÉåwÉeÉ iÉiuÉ¥ÉÉå UÉ¥ÉÉÈ mÉëÉhÉmÉÌiÉpÉïuÉåiÉç || cÉ.ÌuÉ. 6/19 With the art and skill of formulations, a poisonous drug could be transmuted into a safeand effective drug. A simple drug could be converted into a most potent one14. Dashamoola, jeeraka and panchakola even though are considered as simple drugs, Butare very beneficial during suthika Avastha.DASHAMOOLAJEERAKA KASHAYA In classics a reference regarding Dashamoola kwatha specially in Suthika isavailable4,5,6,7,8. A clear reference regarding indication of Jeeraka in Suthika is alsoavailable8,9,108.Ingradients- Bilva, Agnimantha, Shyonaka, Patala, Gambhari, Bruhati, Kantakari, Shalaparni, Prushnaparni, Gokshura, Jeeraka and Jala. Above mentioned drugs has to be made in coarse powder form separately. Taken inequal quantity. Added with 4 parts of water. Boiled, reduced to ¼ th part and filtered107. Dosage – 2 pala (96 ml) Rasa- Swadu, Katu, Tikta, Kashaya. Guna- Laghu. Veerya- Ushna. Vipaka- Katu. Doshaghnata- Tridosha Shamaka. Rogaghnata – Vata Shleshma Jwara, Sannipata Jwara, Soothika Dosha Shamaka. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  31 
  46. 46. Drug Review    Table Number: 5 shows drugs of Dashamoola & Jeeraka Drugs Latin name Rasa Guna Veerya Vipaka Karma Chemical and family composition BILVA Aegle Kashay Laghu Ushna Katu Kapha Marmelosin, marmelos a Ruksha Vata marmelide, tannic (Rutaceae Tikta Shamaka Grahi acid, family) Agnikruth skimmicianine, Pachaka marmelin, Shotha hara, skimmin, vedana sthapana mermesin,.AGNIMANTA Premna Tikta Ruksha Ushna Katu Kapha ceryl alcohol, mucronata Katu Laghu Vata clerodin, (Verbenacea Kashay Shamaka clerosterol and e family) a Shothahar, clerodendrin- A. Madhu Pandu ra Nashak, Agnikruth, Vibhandha nashakaSHYONAKA Oroxylum Madhu Laghu Ushna Katu Kapha Baicalein, chrysin, indicum ra Ruksha Vata 6- methylether of (Bignoniace Tikta Shamaka Vedana baicalein ae family) Kashay shtapana, a Shotha Hara, Aruchi nashaka, Grahi, Basti roga HaraPATALA Stereosperm Tikta Laghu Ushna Katu Kapha Albuminous, um Kashay Ruksha Vata Sacchrine and suaveolelns a Shamaka Vedana Mucilaginous (Bignoniace sthapaka, matter & Wax ae Family) Shothahar, Vrana ropana.GAMBHARI Gmelina Tikta Guru Ushna Katu Tridosha Root contains arborea Kashay Shamaka Deepana, Gmelofuran- a (Verbenacea a Pachana, furanosesquiterpe e Family) Madhu Medhya, noid, gmelinol, ra Shothhara, sesquiterpene, and Ama, shulahara, cerylalcohol Jwarahara, Vishahara A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya   32 
  47. 47. Drug Review   BRUHATI Solanum Tikta Laghu Ushna Katu Kapha Vata Solanine, indicum Katu Ruksha Shamaka Kushta, Solanidine, (Solanaceae Tikshna shwasa, Jwara, Solasonine & Family) Shula-Kasa- Wax Agnimandya nashakaKANTAKARI Solanum Tikta Laghu Ushna Katu Kapha Vata Root contains surattense Katu Ruksha Shamaka , Vedana scopolin, (Solanaceae Tikshna sthapaka, Shotha scopoletin, esculin Family) hara, Krimighna, and esculetin. Kasahara, HikkanashakSHALAPARNI Desmodium Madhu Guru Ushna Madhu Tridosha Plant constitutes gangeticum ra Snigdha ra Shamaka Vedana N- (Leguminos Tikta Sthapaka, dimethyltryptamin ae Family) Vranaropaka, e, 5- methoxy-N, Shothahara, hypaphorine, Chardi-shwasa- horderine, caudine AtisaranashakaPRUSHNA Uraria picta Madhu Laghu Ushna Madhu Tridosha Amino acids &PARNI (Leguminos ra Snigdha ra Shamaka Vatahara, fatty acids ae Family) Tikta Deepana, Anulomana,,Balya, Shothahara, Sandha niya,Angamarda prashamana.GOKSHURA Tribulus Madhu Guru Sheeta Madhu Vata Pitta Roots contain terrestris ra Snigdha ra Shamaka Balya, neotigogenin, (zygophylla Mutrala, Vrishya, aminoacids ceae Ashmarihara, Family) BastirogaharaJEERAKA Cuminum Katu Laghu Ushna Katu Kapha vata Cumaldehyde, cyminum Ruksha shamaka Proteins, (Umbellifer pittavardhaka, carbohydrates, ae Family) Agnimandya phosphorus, Ajirna Sootikaroga hara Garbhasya vikara Stanya vikara shamaka A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya   33 
  48. 48. Drug Review  PANCHA KOLA KASHAYA In classics reference regarding indication of Panchakola in Suthika is available1,2,3.Ingradients – Pippali, Pippali Mula, Chavya, Chitraka, Nagara and Jala. Preparation Method – Above mentioned drugs has to be made in coarse powder form separately and taken inequal quantity. 4 parts of water should be added, boiled and reduced to ¼ th part. It is filteredand used110. Dosage – 2 pala (96 ml) Rasa – Katu. Guna- Teekshna. Veerya – Ushna. Vipata – Katu. Karma – Ruchya, Deepaniya, Pachana. Rogaghnata – Anaha, Pleha, Gulma, Shula, Sleshmodara. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  34