1. The document discusses the applied aspects of procuring healthy offspring in Ayurveda, including various pre-conception, prenatal, and postnatal practices. 2. It covers topics like conception rituals, embryonic development processes, the role of maternal factors, and causes of congenital defects. 3. The goal of all the practices discussed is to support physical, psychological, moral, and genetic health of both the mother and child through a planned process beginning from puberty.

2. Applied aspect of procuring Healthy
progeny in Ayurveda
Dr. Shrinidhi Kumar Acharya
Associate professor
Department of Kaumarbhritya ,
National Institute of Ayurveda ( Denovo)
Jaipur

3. Topics included are-
• Putresti Samaskra
• Pumsavana Karma
• Simanthonnayana samskara
• shad bhavas
• Dauhrida
• Manasaumasika Vridhi
• Jatahharini
• Organogenesis
• Teratogenesis
• Fetal circulation
• Upashushka

4. Process starts from puberty period….
 Perpetration of healthy progeny is a long process- planed process
 Marriage is not only for sexual enjoyment – in Ayurveda
• Only intention is – Getting healthy Progeny
• So all efforts are aimed at same
• Healthy means – Physical health , psychological health , Moral health , Genetic
health etc.
• Process starts from – Puberty itself

5. Process starts from puberty period….
Godana Samskar
Upanayana samskara
• Rajaswala paricharya – For female
• Ritumati paricharya – For Female
• Nasitiki and Viavahika brahmacharya for the male
• Prevention from Revati Jataharini

6. Process of getting healthy progeny
• Menstrual care – Pubertal
• Ovulation care
• Pre -marital care
• Pre -conceptional care
• Post conceptional care
• Care during embryogenesis
• Care during Organogenesis- Douhrida care
• Intrauterine care – Masanumasika Paricharya ( Garbini paricharya )
• Prevention of Intrauterine infections – Jataharini
• Care during the Third trimester – Varana bandha , Matangi Homa ( prevention of
preterm delivery)

7. Premarital counselling / Care
• Marriage rites – Varna, Kula, Roopa, Sheela etc. of the both partners
• Sagotra vivaha – is prohibited
• Prevent Revathi Jataharini- Social and hygienic rules for adolescent
girl
• Astrological calculations-
• Marriage function – Another step of counselling ( Rules of marriage
life , trust, responsibilities , aim , objectives etc. )
• Difference between
• Vivaha samskara v/ s Garbha dhana samskara

8. Pre copulation care – Garbhadhana Samskara
 Development of trust and belief
 A celibacy of 2 months will be followed before copulation and male
and female patterner will be advised to take Vrishya drugs.
 Healthy life style and diet – Role of folic acid
 Positive life style
 Relaxed mind – with mutual understanding
 Stress free
 Hygiene
 Position of copulation
 Days of Copulation

9. Pre- conceptional care - Putra kamesti Yajyna
 Kashypa Samhita ( Jatisutriya ) , Charaka Samhita ( Shareera 8/7)
 Is it only limited to Putra ? Or also for Putri?
 Priest/ physician has to perform
 This has to be done before copulation – so it Pre- conceptional care
 Before copulation – Homa and Havana should be done infront of
Agni and many offerings and oblation are given
 Materials include - vegetable- non vegetables, drugs , Vatahara
medication

10. Pre- conceptional care - Putra kamesti Yajyna
 Left over medication should be taken by the couples
 Then couples will have a planned copulation – and Nasya of Laxman will done
on female partner – by uttering some of the mantras .
 Husband will sleep on the right side of wife – copulation
 If mother desires a baby with fair complexion – Ojaswi , Pavitra , Deergayu –-
take unequal quantities of honey and ghee , yava , krita manntha by mixing
with milk of white colored cow.

11. Pre- conceptional care - Putra kamesti Yajyna
 Use silver vessel and take Shali , ghee, navaveeta etc. daily
 Wear white colored dress, visualize white colored cow etc.
 Relaxed life style , spending time with close friends
 If they desire the Shyama verna of baby - she should see the same things
 Desire a female baby – take Yavagu , Ksheeera- taila etc
 Reference in Purana – Dasharatha maharaja

12. Relevancy of Putra kamesti procedure in
periconceptional care
 Developing a positive attitude in couple before the conception
 Clinical practice – couples are unbale to achieve the conception in spite of
repeated efforts -normal investigation reports
 Correct the irregular life style, Mechanical life style , stress- anxiety free life
style are the major causes.
 Attain the free state of mind with positive thinking
 Nutritional care -
 Role of Nasya – in modulating the hormonal secretions of pituitary gland –
like FSH – Is matter of discussion.
 Mother health and nutrition and body mass index (less than 19) affects the
future baby.
 Effect on primary and secondary meiosis division which takes place in
the gametes

13. Pre- conceptional care - Putra kamesti Yajyna
1. Different diet plans will be explained during this procedure
2. Rules and regulation will be explained
3. Couples are advised have the strong desire to get desired sex of offspring and
advice to look at the same in daily routine ( Strong will power )
4. For male a baby and female baby separate routines
5. Genetic disorders in family, diet plan, BMI of the mother, nutritional support,
psychological status plays a vital role

14. Pre- conceptional care - Putra kamesti Yajyna
 If BMI is more – obesity- then chances of obesity , DM , Blood
pressure etc.
 Vitamin D or folic acid to avoid the congenital anomalies –
 3 months prior it should be starts (0.5 mg) – prevent the neural tube
defects
 Calcium and Vitamin D3 – prevent the Musculo skeletal defects
 Iodine deficiency
 Iron – For hemoglobin – anemia of pregnancy – India very common

15. Post conceptional care – Pumsavana Karma
• After the formation of Zygote
• Usually occurs in the middle of the cycle. ( mother is unaware)
• Pumsaavna karma – has been told
• Unfortunate that- Not changing sex- It is about desired sex
• Dietic , psychological , spiritual counselling , and certain drugs
• Timing differ as per different Acharya
• But it is in the first trimester

16. Post conceptional counselling / care – Pumsavana
Karma
• After formation of the Zygote – Labda garba
• Rapid stage of divison
• Moisic errors
• Formation of the Germ layers and its importance
• Care in First trimester of pregnancy
X inactivation – ( Mary – lion hypothesis)
Duct hypothesis – Mullerian duct etc.

17. Punsavana – Care of embryogenesis
• Period of blue print formation
• Period of nureal tube formation - Nureal crest
• Gender identification
• All the cells are rapidly dividing – Should not be any intra uterine infections
• Chances of abortion
• Prevention of medications / Procedures
• No panchakarma procedures
• Process of formation of mid gut – hindgut and the foregut

18. Avyaktha Prakriti and Pre embryonic state -
• What is Ayaktha prakriti –
• Astha prakruthya
• 16 Vikars
• Concept of panchamahabuta
• 4 basic molecules in this universe – C.H. O .N
• Five Tanmatra
• Astha prakriti – Avyaktha prakriti – Mahat – Ahamkara – Pancha Tanmatra
• But they not are capable of acting independently -Karma prerita Vayu organizes this
process.
• This function of formation of Vyatka shareera from a Avyaktha form will be guided by
the six laws of nature called Swabhava , Ishwara Kala , Nyathi and Parinama.

19. Embryonic period and Shad bhavas – Embryonic genetic
modulation
• Genetic expressions from individualized Panchatantra’s - units - Bhavas.
• Embryo get these Panchatantra from – 6 sources called Shad Bhavas
• Mother , Father , Diet , environment , Manas, Atma
• Shad- Bhavas - from basic four sources of genetic material
• All above are modified - influenced - Diet/ life style/ psyche of the of parents
• Even the Genetic expressions of the genes - are evolved from six factors operating in them.
- Light , sound , touch smell - Different types of energies (Shabda, sparsha , Roopa , Rasa ,
Ganda) as per modern physics and mass can be their product
• Precursors of the nucleotides ( DNA) of the individual genes and the Bhavas as their
expressions.

20. Embryonic period and Shad bhavas – Embryonic
genetic modulation
• Matrija bhava – Maternal chromosomes/ Genes playing a vital role in -
Endoderm proliferation
• Pitruja bhava –Paternal genes playing a vital role in Ecto dermal proliferation
• Satmyaja bhava – Environmental ( Intra uterine , extra uterine ,altering and
modifying embryonic growth
• Satwaja bhava – Role of Manas ( of mother ) in rapid cell division and cell
differentiation , high quality neurons and neuron environment .
• Rasaja bhava – Nutritional – including folic acid and other vitamins
• Atmaja bhava – Endowment ( Mahat) factor – which is unique to each embryo

21. Embryonic period and Shad bhavas- Concept of Atamaja
Bhava
• Ayurveda believe that Jeeva escapes from the body by taking the imprints of the life
( genetic material) which is embedded in four mahabutas ( C, H, O, N) along with
Mana ( Energy / vibrations-Mano java)
• Along with minute fourTanmatras from one body to transmigrate to another body as
per deeds of the past life.
• This process is totally microscopic and cant be seen through the naked eye.
• This Atma is omni potent and omni present , and cause for the sustainence of the
body, perform all the action, it is Vishwakarma and Vishwa Roopa.
• It is responsible for life ( Chetana ) and induce the symptoms of life in the body.
• This controls all other tanmatra -stimulate and controls the Indriya and keep them
united and attached- carryout further differentiation.

22. Embryonic period and Shad bhavas- Concept of
Atamaja Bhava
According to past deeds the shape ( form ) arises,
Mind from the past mind .
Difference observed in Akrithi and Budhi is due to Raja & Tamas as well as
past deeds( Char , shareera 2 /31-36)

23. Embryonic period
• Garbha is collective out come the Garbhaja bhava like Matruja ,Pithruja , Atmaja,
Rasaja , Satwaja , Saatmyaja which incorporated in these Tanmatras. ( Charaka)
• None of these Bhavas will able to induce the growth in Garbha , only its combined
formulations leads to formation of the physical body.
• Mental activities of a person is inherited through the Satwaja Bhava.( Charaka )
• Genetic coding will be completed at the time of the Zygote itself just like a seed
contain all genetic material for the growth of the tree. ( Shusrutha )
• Example of Bamboo tree and seed of Mango.
• So based on this Astha Prakriti- avyaktha Prakirti – will be Vyaktha prakruthi and later
becomes Shareera . ( Undifferentiation – differentiation )
• These genetic materials in future will produce the actual physical body, after
differentiation.

24. Embryonic Defects
• Genetic disorders and syndromes
• Congenital abnormalities
• Various teratological abnormalities
• Megalocephalic, Marquis monsters (Ramayana and other Dravida books. )
• Externally visible like Cleft lip , Cleft palate, spina bifida , club foot , Tetralogy
of fallot , anal imperforation etc.
• Spherocytosis , hemolytic anemia’s , absence of islets of Langerhans
• errors in metabolism ( enzyme defects described in Ayurveda as Prameha)
• The eight Nindita Purusha – developmental- Hormonal abnormalities
• Medovaha Srotodusti in either of the parents vitiating the genes similar to
Prameha in them.

25. Embryonic Defects
• All congenital abnormalities
• Developmental abnormalities or malformations present at birth
• Malformations at birth (except birth injury)
• Genetic abnormalities ( Beeja dosha )
• Effect of individuals in inauspicious past deeds ( Atma Karma Dosha )
• Environmental factors from uterus( Ashaya Dosha )
• Mental attitude and abnormal deeds during fertile period ( Ritukala) of that
particular cycle in which the women conceives ( When Graffian follicle
develops)
• Vitiation of Doshas from diet, drugs and deeds during pregnancy

26. –
Beeja Dosha-
• Shandi-Klaibya,Double headed sperm gives rise to double headed child –
Mredita ( Garbhopanishad), Anasthi Garba
• Varata , Putipraja . Trina patrika ( Turners etc.)
• Monosomy – Trisomy

27. Ashaya Doshas-
• Yoni Vyapad.
• fibroid uterus , unocornuate uterus , oligohydramnios's etc.
• The fetus gets deformed according to the available irregular and inadequate
space resulting in an uneven developmental abnormality like talipes.
• Vitiation of the Dosha in Shonita ( Arthava) or the Garbhashaya causes
Vikruthi in the Garbha like a tree that gets eroded by the stream of water from
friction of stones water etc.
• IUGR
• Pavithra Garba is one such example which is associated with antenatal
bleeding/ vagina during pregnancy.
• Nagodara garbha
• Leena Garbha

28. Ritu kala Dosha –
1. First 12- 16 days of the cycle is called As Ritu kala
2. Women's Psyche and abnormal deeds will have impact on developing Graffian
Follicles in first 12-16 days of the cycle.
3. Hence certain rules and regulations has been explained. Since there is chance of
ovulation during the orgasm , coronal pleasure is to be avoided during first 7-10
days of menstrual cycle in order to avoid the liberation of ill developed ovum.
4. Ovum liberated in first 2 days gets fails to fertilsation / Nidation
5. Ovum liberated on 3rd day- if gets fertilized then , teratological abnormalities
are seen. Earlier the ovum greater the weakness in fetus.

29. Ritu kala Dosha
If women indulges Effects
Excessive sleep- Child born will be sleepy
Application of Annjana to the eyes Child may have the visual problems
If sorrowful and weeps Child will have Vikrutha dristi
If does Snana , Anulepa Dukha sheelata in Child
Oil massage Child may have the kusta
Cutting the nails Child may become Kunakhi
Running excess/ alike conditions Child becomes chanchala ( Fluctuating mind)
Laughing Child has black lips, palate tongue &teeth
Excessive talking Child may be talkative
Hears the violent sounds Child may be deaf
Combing the hair Child may be bald.
Severe physical and mental excretions and exposed
to violent winds
Child develop the impolite behavior, Unmatta or
aggressive disorders, Autism spectrum disorders.
Vykulita mana/ mind in Ritukala Blindness ,Khanja , Humpback or dwarfism
Whooms so ever the women sees/ thinks ( animal Born child will have similar characters of attributes of

30. skin
Salt Premature grey hair and bald head in child
Acrid substances – Kshara, katu , Pungent Destroy the Testis, resulting in Azzopsermia.
Madya May cause feeble and ubsteady mind in child ( Alcohol
spectrum disorders)
Fish Child looses blinking power in eye lids
( Myasthenia)
If there is Vitiation of Vayu which later reaches the
Uterus
Jadata, Bhadirata, Mookata , Minminata , Ganndgada ,
Khanjata , Kubjata, Vamanata , Heenangata( Amyelia/
Adactylia) and Adhikangata( Polydactyly). Vata which is
vitiated may also cause,, anala atresia, Biliary atresia.
If there is vitiation of the Pitta- Khalita, Phalita, Smasru heenata , anga , ankha, kseha ,
pangulayta
If there is vitiation of the Kapha Kustha, Kilasa , sadanta Janma etc
If Doshas accompanies Tejo Dhatu in the eye- Vikruthaksha , Pingalaksha , Suklaaksha
Drugs given during the pregnancy especially before 3
months -
May leads to neural tube defects ,
Exposure to radiation / eclipse etc during the
pregnancy
Abnormalities of the fetus.

31. What is Jataharini ….?
• Jataharini is the word which is only mentioned in Kashyapa Samhita
• Jataharini is nothing but Transformation of the Revati
• All other authors mentioned Revati as Graha while Kashyapa explained under
Graha and Jataharini .
• Revati is considered as Sarva lokha Bhyanakari.
• Story of entry of Revati …

32. Causes which make the
female Prone to Jatha harini
• Abnormal , illegal sexual relationship of the female with husband and also other
than husband
• Sexual hygiene between husband and wife
• Contact with husband who has illegal sexual relationship
• Not following the rules of Naisthika and Vaivahika Brahmacharya
• Not following Rajaswala, Ritumati , paricharya

33. General features of the Torch Infections
a) Risk of congenital anomalies due to torch infection is high during 1st trimester
b) General magnification in Antenatal period – Abortions ( syphilis) , IUGR, Intra
uterine death , prematurity
c) In the neotala period ( if infection is very severe) - Jaundice, hepatosplenomegaly,
thrombocytopenia (these symptoms may be also seen in thyroid problems , sepsis –
sepsis is very important )
• First law- As the gestational age advance the risk of transmission increases, with
the exception of rubella
 If mother get CMV or Toxo – In the first trimester – then baby getting infection is
10%
 If in the second trimester = 40-50%
 In the third trimester = 90%
 Exception is rubella- Rubella in first trimester -80%, 2nd = 36% and 3rd – 90%

34. Second law- As the gestational age advances the
severity of the disease decreases
1. Mother got Torch infection during the first trimester – then chance of baby
getting the same is 80%.
2. And suppose baby has Rubella then the symptoms in the baby are – deafness,
cataract, and heart defect.
3. Suppose mother getting Rubella in second trimester – then chance of baby
having only few symptoms like deafness and chance of cataract and heart defect
will be less.
4. Because internal ear development completes by 18th week of pregnancy

35. Second law- As the gestational age advances the
severity of the disease decreases
1. Mother with rubella in 3rd trimester – chance is 90% but baby will be
absolutely normal, because all the organs are already formed ( it contains
antibody titer , but baby is safe)
2. Similarly, in CMV or Toxo – if occur in 10th week – severity will be more
although baby has got only 10% chances.
3. Because it is occurring in embryogenesis state. Similarly in third trimester
more percentages of baby is affected but baby is safe in spite of Torch
Positive because organogenesis is already happened.

36. Organogenesis- concept of Douhrida – Importance
of Douhrida care

37. Intrauterine growth
• It is clear that psychological development takes place with the interaction of Natural
endowment and the environmental factors ( Satmya)
• As per Ayurveda -every individual will have his own constitutional set up - which is
also called as Prakrithi or Avyaktha prakruthi and which is also called as Endow
ment.
• Characters of the previous life - concept Punarjanma and concept Atma entering in
to new body with his previous deeds.
• Observing individuals talents -Music, Mathematics, Arts , Painting etc.
• This endowment is called as Avyakta prakriti- and its immediate next presentation
is Mahat tatwa ,
• This is the - first factor produced in creation of man / Embryo during
reproduction.
• This endowment or Mahat - contains certain inherited reservoir of individualized
but unorganized drives called as ID or it is also called as Ahamkara.

38. What is Id and its interpretation -
• Id is impulsive part of the our psyche which responds
• Directly and immediately to the basic urges and the desires,
• operates on pleasure and pain principles ( S. Freud)
• which is the idea that every wishful impulse should be satisfied immediately
regardless of the consequences.
• Id is the most basic part of the personality
• Represents the most animalistic or primitive urges like food , security , sex .
• It seeks instant gratification for our wants and desires .
• If these desires are not met then the person becomes tense, angry anxious
• Id is immoral , illogical , lacks unity of purpose and gets expression in the later part
of the life through the indriyas.

39. What is Id and its interpretation
• This ID is nothing but the Ahamkara in Ayurveda
• These are instinct , unorganized drives – Some are stabilizing , some are
provocative while few are physiological
Rightly Ahamkara in Ayurveda is classified in to Rajasika , Tamasika and
• Some of the Drives may be good and some of the drives may not be logical and
some may illegal with total loss of morality.
• In Ayurveda it is clear that -
• To develop the baby with good morality , behavior and personality , you need to
interfere at this level of fetus / embryo so that formation of the id modified and
all such desires are effectively fulfilled.
• Of course the exact factors which governs this Psychological development is not
very clear in Ayurveda ( But they have tried to do it post marital and
intrauterine )

40. What is Id and its interpretation
• This ID is nothing but the Ahamkara in Ayurveda
• These are instinct , unorganized drives – Some are stabilizing , some are
provocative while few are physiological
Rightly Ahamkara in Ayurveda is classified in to Rajasika , Tamasika and
• Some of the Drives may be good and some of the drives may not be logical and
some may illegal with total loss of morality.
• In Ayurveda it is clear that -
• To develop the baby with good morality , behavior and personality , you need to
interfere at this level of fetus / embryo so that formation of the id modified and
all such desires are effectively fulfilled.
• Of course the exact factors which governs this Psychological development is not
very clear in Ayurveda ( But they have tried to do it post marital and
intrauterine )

41. How to develop the Ahamkara/ Id in positive way?
• If partners desires a baby who should be famous ,
 Well versed in science
 Popular speaker ( Upanishad- Brihadaranyaka )
 Both partners should take boiled rice with the meat and butter and wife and
husband both should take it for few days before coitus daily.
 Should follow Rajaswala Paricharya (Strict rules and regulations)
 Ritumati paricharya
 Should indulge in religious activities
 Look and memorize holly things etc
 Quality of the fetus also depends on marriage rites /methods followed/ and
psychological and emotional status of both partners

42. Development of Id and maternal factors –In Ayurveda
• Maternal emotional state -circulating hormonal levels -influence the Id (
Nelson)
• Emotions of the partners -role in child psychology ( Premarital , precoital , and
preconceptinal )
• Desires of the mother -Are the Id drives ( Ahamakara) of the fetus
• If not fulfilled -
• Developmental problems like- Dwarfism , crippling, Deafmutism ( Vamana ,
Pangu , Mooka) –
• DouHrida Avamanajanya Roga Not respecting the Id (Ahamkara expressions )
of the fetus.

43. Development of Id and maternal factors –In Ayurveda
• Development of Indriyas- After 3 month , later Id of the fetus is extensively
expressed and it enjoys its drives .
• So a pregnant women during 3-4 the onwards express the special desires - of
having some thing, eating something , looking some thing
• It is not the wish of the mother rather it is id of the fetus , which has to be
fulfilled .
• If Id of the fetus is not fulfilled , fetus will be under stress, anxiousness, angry
, frustrated -adverse effects on development of the child.

44. Douhrida stage –Douhrida Avamana
• Stage is called - Douhridha stage , insulting such desires is called as Douhrida Avamana.
• Pregnant women is desire of
• Seeing the king/ rulers , gives birth to child with prosperity and fortune ,
• women interested in decoration during pregnancy give birth to elegant and lovely child.
• Women showing undue interest in praying , visiting the temple etc give birth to baby with
good moral values.
• Mother want to see a horror movie during her pregnancy - suggest some mischievous behavior
of the child .
• Women with interest of eating the lizard meat ( Godha) is likely to give birth to a sleepy and
firm child .
• Interest in cows meat suggests - child with hairy , red colored , valiant ( courage /
determination) eye child

45. What happens to ID or the Ahamkara later ?-
(After birth )
• After birth there will be interaction of the ID with environmental factors of the
Race and the family , religion , stimulus , satisfaction of the needs and parental
love.( Charaka used the words - Anoka)
• So now these instincts drives ( ID) of baby is modified as per the environmental
factors in and around and now this will likely to take two important pathways –

46. What happens to ID or the Ahamkara later ?- (After
birth )
• After birth there will be interaction of the ID with environmental factors of the
Race and the family , religion , stimulus , satisfaction of the needs and parental
love.( Charaka used the words - Anoka)
• So now these instincts drives ( ID) of baby is modified as per the environmental
factors in and around and now this will likely to take two important pathways –

47. Krodha -( Aggression)- in excess- Negative
development
Little or normal aggression – Acts as stimulus for better psychological construction
with latent abilities and the potentialities .
Excess aggression in a child due to
• Very stringent rules
• Strict punishments
• Scary talks , abusing
• Leads to -More energy on aggression and little energy is left for Libido.
• Leads to poor and abnormal development of learning ,behavior and
personality
• Krodha and the Harsha are inversely proportional.

48. Out come of more aggression ?
• The inadequate Harsha with more aggression like Kama , Krodha etc are
characteristics of the Rajoguna( Susruta)
• When child fails to get what he desires ( Kaama) the aggression
increases.
• Krodha leads to indiscrimination in perception of good and the bad and
grief of troubles( Geeta)
• Stability of mind lost due to more Rajo dosha

49. Earliest way of assessing and modulating development
is -
• Is by study of - Libido and Aggression in relation to himself and the others.
• Same is mentioned as Harsha and Krodha in Ayurveda
• Both Satisfaction and Frustration are normally seen in growing child .
• There should be equal mixing of these two in normal growing child .
• This is what -explained in Ayurveda ( Kashyapa )
• A well growing child - – becomes angry , Cry , Sleep , Wakeup , show signs of
satisfaction, aggression , evacuate the bowels and urine normally and takes the feed
in normal course and digest it properly
• Thus it is obvious that any psychological disturbance has got its effects on
disturbance of feeding and the excretory functions.
• So tension of the child should be kept under the normal limits and child with
unhurted

50. Development of Ego and Super-ego in child
• What is EGO-
• The personality which develops from Interaction of the ID and the
environment is called as Ego.
• This Ego may be influenced greatly by –
• The mother as she is in close contact with baby and baby depends on her
for basic requirements .
• Even Dhatri or wet-nurse may also influence the baby , so before
appointing a wet-nurse thorough examination should be done

51. Superego.
• As child grows in the society , he gradually understands the code of
conduct to be followed in the society when he moves in-between , code
of conduct and disciplinary methods , which is right or which is wrong ,
and valve system and the ideals etc and this is called as Superego.
•

52. Development of powerful super ego- Unique
concept of Ayurveda
• So Ayurveda always advocate that - Educate the child as per the order
or class to which he belongs at befitting age .
• For better construction of the ego - He should be always thought
With moral valves( Darmaya) and moral obligations ,
Of performing once own duties in the society ( Vinaya)
• Great importance has been given in Indian books for –
• Teaching the child the right path that is for better construction of ego
and the Super ego

53. How to develop the super ego-?
• The child who is upholder and virtutous is the upholder of the religion ( good
value) is the upholder of the fame
• In developing ego - Mother plays a vital part and in developing the superego -
father plays a vital part.
• Father is responsible for crimes of the child
• When child is able to take food –
• It should be taught that should be taken from right hand ,
• When he is able to speak , told to speak bold and clearly ,
• Toilet training should be practiced ,
• Interaction with society should be encouraged
• Like this good properties should be cultivated

54. How to develop the super ego-?
• At 6 years they are taught with numbers and names of the cardinal points .
• At seven year when one is conscious about the sex-
• boys and girls are not allowed to occupy the same mat and sit and eat
together.
• At 8 years they are required to follow the elders .
• They are taught to obey the teaching of elders.
• At 9 years are they are taught to number the days (Role of Upanayana ,
Vidhyarambha samskara )
• Chanakya’s explanation
•

55. Super ego- How to develop the super ego-?
• By tenth year-
• boy is sent to a master outside to stay with him over night and learn polite
conversation .
• At the age of 13 they are able to learn the music, dance and repetition of the
stanza
• He learns the Archery and the chariot driving at the age of 20 .
• And by 30 he will have a wife
• Similarly for the girl child the teaching will be different
• One must not sit down on a coach where the superior occupy the seat.
• He should rise and meet a superior and salute him

56. How to develop the super ego-?
• How to respond when some body meet -Brahmin -Kushala , Kshatriya -
Anamaya , Vaishaya -Kshema , and Shoodra with Annarogya
• It is told that Following the Adharma - Unrightfulness will not produce the
effects immediately but advancing slowly, Though not the offender himself ,
the punishment falls on his son or the grandson.
•
• A mistake committed will not go back with out paying or showing its effect
(May be in this generation or next generation)- Hence inculcating the moral
valves is very important

57. Third Trimester care of fetus and pregnant lady
• Varana Bandha with Matangi Homa
• This is the special procedure explained in Kashyapa Samhita
• keeping interest fetal development and hazards of premature delivery.
• This procedure is aimed to prevent premature delivery and in turn reducing the
neonatal mortality.
• Hence, the active person in this procedure is the pregnant women who carries
fetus.
• This is explained in Revati Kalpa Adhyaya of Kashyapa Samhita.

58. Third trimester care-–
Smeenathopanayana Samskara
1. Semmanta is the vertical line that separates the hairs on head in two halves of a
women.
2. During pregnancy as one of the pigmentary changes a line with dark color
appears from below the umbilicus to symphysis separating the lower abdomen
usually in to two parts as right and left.
3. This line is called Linea nigra or the Seemanta.
4. With growth of the fetus , uterus comes in to lie on the abdomen from intra pelvic
cavity and Linea nigra becomes prominent and elevated. Word meaning of
Unnayana is elevation.

59. Smeenathopanayana Samskara – Third trimester care
• Thus if the fetus is growing normally and properly in size ,with required
amount of nutrition there will be proper elevation of the abdominal region ,
which is nothing but Unnayana .
• This also helps to identify the uterine abnormalities like bicornuate uterus.
• Nutritional supplements are very much requited in second phase of pregnancy
especially in the second and third trimester.( Compared to first trimester)
• This is the basis of Seemanthounnayana samskara which is done by husband
only.
• This samskara is performed only once during first pregnancy, as refinement in
Garbhini.

60. Smeenathopanayana Samskara – Third trimester care
• In successive pregnancies Semmanthonnayana is masked by earlier color
changes and the abdomen is not that much tight as to exhibit its prominence.
• In preparation to this function sprouts of Yava are made to raise.
• On an auspicious day the couple perform Ganesh pooja and sacred water is
sprinkled on them.( Punya vachana with Kusha)
• Husband takes boars thorn , deer's horn and three small bundles of Darbha
together and rotates them from umbilicus of woman to the cranial ( scalp)
Seemanta , and throw them away in the west and touches the water.
• They listen the Veena music and then the sprouts are placed over head and tied.
• The wife keeps silence till night. Two are three ladies are given food.
• Pregnant lady is offered various sweet meats and fruits.

61. Fetal circulation – Applied aspects
• Oxygenated blood from maternal side mixes with deoxygenated blood of
the fetus and gets further deoxygenated in five points
• Umbilical vein blood mixes with blood in the sinusoids
• Ductus venosus blood mixes with inferior vena cava
• Blood of inferior vena cava mixes with deoxygenated blood from lower
extremities.
• This blood further mixes, with blood from the superior vena cava in right atrium
• This blood further mixes with blood in the left atrium through pulmonary veins.

62. Three shunting of blood in fetal circulation
1. Ductus venosus connects the umbilical vein and Inferior vena cava
2. Shunting of blood through right atrium and left atrium through Foramen ovale
3. Shunting of blood from pulmonary trunk and Aorta through ductus arteriosus.

63. Changes occur immediately after the birth
• Now oxygenated blood in the left atrium is pushed in to Left ventricle and then enters in to
the Aorta with high pressure
• When this oxygenated blood reaches the junction of Ductus arteriosus, there will be
constriction of Ductus arteriosus due to following reasons.
• Smooth muscles of Ductus arteriosus are very sensitive to oxygen , and high oxygenated
blood enters it cause constriction of the smooth muscles
• High oxygen stimulates the Baro receptors and in turn leads to closure of Ductus Arteriosus.
• There is no more production of prostaglandins from Ductus arteriosus which was helping to
maintain the patency of vessel , hence it constricts.

64. Changes occur immediately after the birth
1. Now as there is constriction of ductus Arteriosus , there is no mixing of pulmonary and
aortic blood ( or Impure and pure blood)
2. Blood from the aorta supplies to all the body parts of the baby returns backs to inferior vena
cava and in to the right atrium.
3. There is no blood entering in to the umbilical arteries / or the placenta, as umbilical cords
have been cut and baby is separated.
4. Thus within 1-2 minutes the adult type of circulation begins.

65. Formation of new structures from remnants
 Left Umbilical veins –Ligamentum Teres
 Ductus Venosus- Ligamentum Venosus
 Foramen ovale – Fossa ovalis ( Cup shaped depression in Atrial septum)
 Ductus Arteriosus - Ligamentum Arteriosum
 Right and left Umbilical arteries – Median Umbilical ligaments

66. Applied aspects – Patent Ductus Arteriosus (PDA)
1. Physiological closure of Ductus Arteriosus – By 15 hours after the birth in healthy AGA
Newborn. It may be delayed in preterm or LBW.
2. Anatomical closure of Ductus Arteriosus –The true anatomical closure will takes place after
2-3 weeks.
3. The ductus arteriosus is a large vessel found normally in all the mammalian Fetus
connecting the main pulmonary trunk with left sided descending Aorta about 5 to 10 mm
distal to origin of the subclavian artery.
4. The diameter of this vessel is equal to descending aorta while length may varies. During the
normal embryological development the sixth pair of the embryonic aortic arches persists as
the proximal branch pulmonary arteries and distal portion of the left sixth arch persists as
ductus arteriousus.
5. Connecting the main pulmonary trunk with left dorsal Aorta. Normally the distal sixth arch
degenerates.

67. Applied aspects – Patent Ductus Arteriosus (PDA)
1. The microscopic structure of the ductus arteriosus is quite different to that of the adjacent
pulmonary trunk / aorta.
2. All though the wall thickness is similar, media layer of DA consists largely smooth muscle
cells instead of elastic fibers.
3. Contraction of these smooth muscle cells leads to narrowing of the lumen and shortening of
the DA.
4. DA is patent in fetus –because of exposure of low partial pressure of Oxygen ( 18mmhg) ,
locally produced prostaglandins and local nitic oxide production by endothelial cells of DA.
5. Vaso- dilator prostaglandins, especially the Prostra glandin E2 mainly a play part in
maintaining the patency.
6. Inhibition of prostaglandin synthesis through inhibition of enzyme Cyclo- oxygenase results in
its constriction in fetal life.
7. After birth the PPGe2 is metabolized in the lungs and its concentration rapidly fall within few
hours. ( 3 hours)The immature ductus ( Preterm) produces more prostaglandin and more
sensitive to relaxant effects of PGE2.

68. Mechanism of normal closure –
• In full term neonate the closure takes place in two phases-
• Smooth muscle constriction produces the functional / physiological closure in
few hours after birth
• Anatomical closure takes place few weeks after the birth
• Steps in conversion of Ductus Arteriosus in to Ligamentum Arteriosum
• There is increase in the Arterial oxygen concentration
• More oxygen in the blood ( After movement of blood in to lungs) leads to
drop in circulating PGE2 level in the blood with the lumen of DA
• Mean time there is stimulation of baroreceptors

69. Mechanism of normal closure –
a) All these events leads to constriction of DA which is called a functional /
Physiological and occurs with in 3 hours after birth .
b) The Loss of luminal blood flow leads to zone of hypoxia in the muscle media layer of
DA, leading irreversible anatomical closure
c) There is death of smooth muscle cell death due to hypoxia due to hypoxia inducible
growth factors
d) These Growth factors leads to proliferation of intima layer resulting in thickening.
e) Mean time profound endothelium also inhibit the prostaglandin secretion and nitric
oxide release, and permanently present the remote chances of reopening .
f) There will be fibrosis and permanent seal, which produce a fibrous band called
Ligamentum Arteriosum with in 2-3 weeks marking the Anatomical closure.

70. Patent Ductus Arteriosus
• Incidence of PDA in term babies 1 in 2000
• 5 to 10% all congenital heart problems.
• Female male ratio- 2;1
• In preterm sit is developmental immaturity
• PDA in Term results in significant structural problems
• This is common in certain genetic conditions like , chromosomal aberrations , single gene
mutations , multi factorial inheritance
• Congenital rubella and maternal medications

71. Clinical manifestations
a) Progressive cardiac failure ( by 8to 10 weeks)
b)Smaller shunts – may survive up to 3rd decade before developing CCF
c) Murmur in both phases of cardiac cycle – Train in Tunnel / Machinery murmur
d) Pulse is rapid- bounding
e) Breathing difficulty, Refusal to feed , Dyspnea during feeding
f) Hepatomegaly

72. Diagnosis-
 Echo cardiogram
 Color Doppler
• Principles of management –
 Surgical closure or Tran catheter closure
• Prostaglandin inhibitors like Indomethacin

73. Closure of Fossa Ovalis
a) In the fetal heart the foramen ovale ( Foremen Bottai , ostium secondum of
born) allows the blood from right atrium in to left atrium directly. This shunt
closes after the birth with help pf septum prima and septum secondum and cup
shaped depression remains called as Fosa Ovalis.
b)In 25% cases the Foramen ovale doesn’t close completely remains as small
patent Foramen ovale.
c) Individual will not have any problem, asymptomatic throughout the life.
• This may remain as undiagnosed Atrial sepal defects