|
| |
 |
|
| REVIEW ARTICLE |
|
| Year : 2019 | Volume
: 7
| Issue : 2 | Page : 83-89 |
|
Role of Ayurveda therapeutic procedures in prenatal and postnatal care
Sudha Dansana, Sujata Kadam
Department of Striroga and Prasutitantra, All India Institute of Ayurveda, New Delhi, India
| Date of Web Publication | 21-Nov-2019 |
Correspondence Address:
Dr. Sudha Dansana
Department of Striroga and Prasutitantra, All India Institute of Ayurveda, New Delhi 110076.
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/JISM.JISM_12_19
Background: Pregnancy and childbirth are challenging events in women’s life cycle. Throughout this journey very often a mother faces several health issues, discomforts, and complications increasing the risk for her life. To deal with this situation, modern medicine usually needs help of different medical and surgical interventions but not all medicines and surgeries are effective. Ayurveda has advocated ample of therapeutic procedures that can take care of the safety of woman during the course of pregnancy and childbirth. Such procedures are being discussed in this article. Materials and Methods: Selected Ayurveda classics, electronic databases, namely PubMed, Digital helpline for Ayurveda Research Articles, National Centre for Biotechnology information, and so on are searched to compile the evidence of such therapeutic interventions advocated during obstetrical management. Results: Shodhana therapy (bio-purification procedures) is strictly contraindicated during pregnancy. However, Panchakarma (five cleansing methods) such as Basti (therapeutic enema), Nasya (instillation of herbal oils, juices, or powders through the nasal route), and other Upakarmas (allied therapies) such as Parisheka (pouring medicated liquids), Avagahana (Tub bath with herbal liquids) are prescribed in the classics of Ayurveda in the context of Garbhini Chikitsa (pregnancy management), Prasava Paricharya (intrapartum management), and Sutika Paricharya (puerperal management). These ancient methods of treatment procedures are advised to be used moderately with pleasant manner. Conclusion: Specific Panchakarma therapies are useful in achieving and maintaining normal pregnancy and enable normal labor. Various Upakarmas facilitate healthy growth and development of fetus, prevent minor ailments and complications in intrapartum as well as in postpartum phase. Hence, Ayurveda procedures appear to be the most effective remedial measure in preventing obstetrical complications, promoting maternal and child health, and lowering maternal mortality rate. Keywords: Panchakarma, postnatal care, pregnancy, prenatal care, Upakarma
How to cite this article:
Dansana S, Kadam S. Role of Ayurveda therapeutic procedures in prenatal and postnatal care. J Indian Sys Medicine 2019;7:83-9 |
| Key message: | |  |
- Instead of Tikhna sanshodhana (drastic cleansing therapies), Mridu sanshodhana (mild cleansing therapies) can be applied in pregnancy.
- Upakarmas (allied therapies) are helpful in reducing the minor ailments in pregnancy and childbirth.
- Local procedures such as Yonipichu (vaginal tampon) and Yonidhupana (vaginal fumigation) facilitate labor procedure and reduce postpartum complication.
- Practical modification of therapeutic procedures is carried out so as to bring this in daily practice and maternal-child health-care system.
| Introduction | | |
Pregnancy and childbirth although being a biophysiological phenomenon, but there are risks of complications at all stages due to the altered anatomical and physiological functions of the body. Every day around 150 women die due to causes related to pregnancy and childbirth. Globally, it is estimated that 13% of maternal deaths occurred due to improperly performed procedures and unnecessary interventions.[1] This can be easily preventable. However, with very good prenatal care, the maternal mortality rate is coming down but still we are not reaching the goal. So World Health Organization (WHO) also recommended integrative approach toward the prenatal care for reducing all possible hazards on mother and fetus. Giving specific importance, Acharya Charaka has mentioned that pregnant woman should be treated just like a pot filled with oil as the slightest oscillation of such pot can cause spilling of oil.[2] Similarly, slightest misconduct can cause many complications. To prevent and manage various obstetric complications such as retained placenta, obstructed labor, and safe management of minor ailments in pregnancy such as pain in abdomen and low backache, Ayurveda has described a systematic and planned program for Garbhini (pregnant woman) called Garbhini Paricharya (prenatal care). Apart from these, there are some specific contributory procedures called Upakarmas (allied therapies) and Panchakarma therapies also quoted in Ayurveda text, which are recommended in preconceptional care, prenatal care, as well as care during childbirth and puerperal period. Examples of some allied therapies are Avagahana (tub bath with herbal liquids), Parisheka (pouring medicated liquids), Lepa (herbal paste), Udvartana (massaging the body with herbal powder), and so on. All of these therapies are mentioned with the aim to ensure normal pregnancy and uncomplicated labor with the delivery of a healthy baby from a healthy mother. Aim of this study was to compile information regarding the indications, importance, and role of Panchakarma and Upakarmas described in Ayurveda texts in the contest of Garbhini Paricharya, Prasava Paricharya (intrapartum management), and Sutika Paricharya (puerperal management).
| Materials and Methods | | |
Selected Ayurveda classics, modern literature, latest researches, and electronic databases such as PubMed, Digital helpline for Ayurveda Research Articles, and National Centre for Biotechnology information are meticulously reviewed for the establishment of usefulness of Ayurveda therapeutic procedures in obstetric care.
| Results | | |
Ayurveda places an enormous emphasis on the importance of caring for the mother before, during, and after pregnancy. Especially when she approaches full term, critical care is necessary as all the three Doshas (bioenergetics humors) are aggravated and Dhatus (tissue) are displaced.[3] Again her one foot is considered to be lying in this world and other in the world of Yama (the God of death).[3] Keeping all these factors in mind, ancient Acharya have described various Ayurveda therapeutic interventions based on Panchakarma and Upakarmas.
General Rules for Therapeutic Interventions during Pregnancy
A woman during pregnancy should be treated with Mriduaushadha (mild form of medicines), Ahara (diet), and Upachara (therapies).[2]Acharya Charaka suggested that pregnant woman should avoid use of pungent things.[4] Any disease during pregnancy should be treated with drugs, which are soft, easy to consume, and mild in action.[5] So that harmful effects to the fetus are minimized. The embryo either expels prematurely, dries up inside, or even dies inside mother womb.[6] However, if the disease is very serious and the life of woman is at risk, the use of drastic measures to save the life of mother and fetus have to be taken.[7] In such cases, the obstetrician should take note of severity of the disease along with the mother’s health and the stage of the pregnancy and then proceed opting for safer mode so that the treatments do not result in complications to the mother and the fetus.
Panchakarma Therapies in Obstetric Care
Panchakarma is one of the important therapies of Ayurveda, which deals with detoxification of the body, maintenance of Dosha, Dhatu, and Mala (metabolic end products) to prevent diseases, and also promotes Vyadhi kshamatva (resistance to outside pathogens). It includes five therapeutic procedures such as Vamana (emesis), Virechana (purgation), Basti (medicated enema), Nasya (instillation of herbal oils, juices, or powders through the nasal route), and Raktamokshana (bloodletting).[8] Each one of these procedures has to be applied with due consideration of particular type of Doshic disturbances and indications and contraindications of their use.
Pregnancy is one of the states in women where Shodhana therapies such as emesis, purgation, and bloodletting are prohibited.[2]Asthapana (cleansing enema) and Anuvasana Basti (nutritive enema) are also used in specific condition. However, moderate use of these therapies can be carried out in Atyayika Avastha (emergency condition) after eighth month of pregnancy.[2] Commentator Chakrapani quotes Tadarthakari Chikitsa in the management of Garbhini Vyadhi that emphasizes on the use of such other procedures, which gives similar benefits as that of Vamana and Virehana. They suggested use of Nisthibana (spitting) or Phalavarti (suppositories), respectively, instead of Vamana or Virechana.[9] According to Acharya Sushruta, appropriate use of such gentle emetics with purifying measures can be administered, which are congenial to fetus.[10]
Following Panchakarma procedures are described in obstetric care in given specific time and conditions for both achievement and maintenance of pregnancy and prevention of obstetric complications:
- Nasya: Nasal instillation of juice extracted from medicinal plants such as Lakshmana (Ipomoea sepiaria Koen.), Vatasringa (Ficus bengalensis Linn.), Sahadeva (Sida rhombifolia Linn.), and Viswadeva (Sida veronicaefolia Lam.) processed with milk should be administered in either of the nostril for Pumsavana karma (one of the 16 sacraments).[11] This process is beneficial for Garbha Grahana (achieving conception) and Garbha Sthapana (stabilizing the product of conception).[12]
- Asthapana (cleansing enema): Indications of Asthapana Basti are as follows:
- Eighth-month pregnancy: Asthapana Basti by Badari (Ziziphus jujuba Lam.) decoction with the paste of Bala (Sida cordifolia).[13]
- Garbhini Udavarta (an acute condition in the abdomen characterized by the retention of feces): Basti prepared from the decoction of Virana (Vetiveria zizanioides Linn.), Sali (Oryza sativa Linn.), and Sastika (Oryza sativa Linn.) is used.[14]
- Aparasanga (retention of placenta): Asthapana by Suramanda (a variety of alcoholic beverage) is advisable in retained placenta.[15]
- Anuvasana (nutritive enema): Indication of Anuvasana Basti is as follows:
- Ninth-month pregnancy: Oil processed with Madhura aushadha (sweet drug) should be used for Anuvasana Basti.[16]
Upakarmas (Allied Therapies) in Obstetric Care
The other therapeutic procedures that are practiced in conjunction with the five eliminatory procedures or in isolation are termed as Upakarmas in commune.
- Abhyanga (oil massage): Abhyanga is the process of anointing of the body with oils and with mild massage. Indications of Abhyanga are as follows:
- Garbhapushti (for fetal nourishment): Frequent massage with Lakshadi Taila (an oil formulation) to the pregnant woman is a good nourishing agent to her fetus.[17]
- Kikkisa (striae gravidarum): Massage with oil prepared of Karavira (Nerium indicum Mill.)[18] and Karanja (Pongamia glabra Linn.)[19] is advised.
- Leena garbha (intrauterine growth restriction): Repeated oil massage over abdomen, pelvis, sacral region, flanks, and back should be carried out with lukewarm oil.[20]
- Asannaprasava (first stage of labor): Gentle massage with lukewarm oil over flanks, back, sacrum, and thighs should be carried out and its continuation is advised till the expulsion of fetus.[21] As per Acharya Bhavamishra, oil should be massaged all around the vaginal canal.[22]
- Udvartana: The method of massaging the body with medicated herbal powders is termed as Udvartana.[23] Indication is as follows:
- Pumsavana karma: Udvartana by drugs of Jeevaniya gana (antiaging group of herbs) has been mentioned.[24]
- Mardana: Rubbing of medicated herbal paste or powder in body parts is called Mardana.[25]
- Kikkisa (striae gravidarum): Kalkas (herbal pastes) and powders made up of Chandana (Santalum album Linn.), Nimba (Azadirachta indica A. Juss.), and Shirisha (Albizia lebbeck L. ) should be rubbed over abdomen and breast applying gentle pressure.[18]
- Avagahana: Immersing the body parts in a bath tub filled with liquid media such as medicated oil or herbal decoction or milk or simple water up to the umbilicus level is called Avagahana.[26] Indication is as follows:
- Garbhasrava (miscarriage) and threatened abortion: Avagahana by cold water is advised.[27]
- Snana (bathing): Bathing with warm water or water processed with various medicinal plants has been recommended for pregnant women in following conditions:
- In normal pregnancy: The cold decoction of pulp of Vilva (Aegle marmelos Corr.), Karpasa (Gossypium herbaceum Linn.), Pichumarda (Azadirachta indica A. Juss.) and pounded leaves of Eranda (Ricinus communis Linn.) or the water prepared with Sarvagandha (aromatic) drugs should be used for bathing in pregnancy.[28],[29]
- Pumsavana karma: Taking bath of water processed with Jeevaniya gana drugs is recommended for the women going for Pumsavana karma.[24]
- Mritagarbha (intrauterine fetal death): Snana by Ushnambu (lukewarm water) is advised.[30]
- Nagodara and Upavisthaka (intrauterine growth retardation): Avikshna avamarjanam (frequent light bath) is recommended.[31]
- Parisheka: Pouring of medicated liquids or oils on a diseased part or the whole body is called by the name Parisheka.[32]
- Aparasanga: Irrigation with latex of Mahavriksha (Euphorbia neriifolia Linn.) over head is indicated in retained placenta.[15]
- Garbhasrava: Cold cow’s milk, decoction of Yastimadhu (Glycyrrhiza glabra Linn.), and Nyagrodha (Ficus bengalensis Linn.) should be poured over infraumbilical region.[33],[34]
- Asannaprasava: Woman in labor should be given massage with lukewarm oil followed by irrigation with lukewarm water.[35],[36]
- Mani Vandhana/Dharana (tying of amulet):
- The pregnant women should wear the amulet made of Trivrit (Operculina turpethum Linn.) at the region of waist.[37]
- Garbhasanga (obstructed labor): Amulet of root of Suvarcala (Gynandropsis pentaphylla), Vishalya (Gloriosa superba Linn.) should be tied in the arm or leg of mother.[38]
- Prajasthapana (for maintenance of pregnancy): Mother should tie the amulet of Prajasthapana gana drugs in her right hand and head.[39]
- For prevention of Garbhasrava (miscarriage): Root of Kankati (Abutilon indicum Linn.) knotted with thread should be tied in the waist of pregnant woman.[40]
- Lepa: Mere smearing of the medicated oil or the paste of medicinal plants added with oil is considered as Lepa.[41]
- Aparasanga (retention of placenta)/Mritagarha: Paste of Langali (Gloriosa superba Linn.) root should be applied over abdomen,[42] palm, and sole.[15]
- Garbhasrava: Anointment of Shatadhouta or Sahasradhouta Ghrita over infraumbilical region prevents Garbhasrava.[33],[34],[43]
- Yonipichu (vaginal tampon): Yonipichu is the application of sterile swab soaked in medicated oil or decoction into the vagina.
- Ninth month pregnancy: Vaginal tampon with oil is advised in the ninth month of pregnancy.[29],[44],[45]
- Garbhasrava: Tampon soaked with ghee prepared of Yastimadhu (Glycyrrhiza glabra Linn.) and extremely cold water should be placed in vagina.[33]
- Aparasanga: Tampon soaked with oil prepared with Madanphala (Randia spinosa Poir.), Shatapuspa (Anethum sowa Kurz.) and so on is recommended.[46]
- Yonipurana (vaginal packing): Filling of medicaments in the form Kalka (paste), Churna (powder), or Vesavara (minced meat or solid oleo mixed with certain drugs) in vagina is called Yonipurana.
- Mudhagarbha (obstructed labor): Yonipurana by ghee processed with Dhanva (Grewia tiliaefolia Vahl.) and Salmalipicha (milky sap of Salmalia malabarica Schott.) should be carried out for the expulsion of impacted fetus.[47]
- Mritagarbha (intrauterine fetal death): Ghee processed with Salmali (Salmalia malabarica Schott.) and Atasi (Linum usitatissimum Linn.) should be filled inside the vagina followed by recitation of sacred hymns meant for the expulsion of dead fetus with fetal membranes.[48]
- Yonidhupana (vaginal fumigation):
- Garbhasanga: Yonidhupana with Sarpanirmoka (slough of snake) or Pinditaka (Randia spinosa Poir.) is indicated.[38]
- Mritagarbha and Aparasanga: Yonidhupana with Bhojapatra (Betula utilis D. Don), Sarpanirmoka (slough of snake), and Kachamani (quartz) is indicated.[46]
- Uttarbasti: Insertion of medicated oil or decoction into intrauterine cavity through vagina is called Uttarbasti.
- Aparasanga: Uttarbasti by oil prepared of Sidhharthaka (Randia spinosa Poir.) is recommended for the expulsion of retained placenta.[15]
| Discussion | | |
Maternal health problems and various obstetric complications hinder in normal pregnancy outcome. The holistic interventions advised during various stages of pregnancy and childbirth comprising selective bio-purification therapies and allied therapies. This could play a significant role in increasing chance of normal pregnancy, prevention of obstetric complications, protecting the health of mother and baby as well as providing simple, healthier, and effective cures for common ailments. This preventive and promotive therapies could be applied considering the stage of pregnancy (which trimester?), existing type of complications, type (Vamana, Virechana, Basti, Nasya, and Raktamokshana), and form of therapies (Mridu, Madhyama, and Tikhna).
Among five Panchakarma procedures, indications of Nasya and Basti are directly quoted in the text, whereas in preference to Vamana and Virechana, gentle procedures such as Nisthibana and Phalavarti are narrated, respectively.
- Nasal administration of medicated oil that reaches to Shringataka Marma (a vital anatomical point of head exactly in middle cephalic fossa)[49] eliminates morbid Dosha and ultimately stimulation of Hypothalamic-pitutary-ovarian axis promotes the normal physiological function of ovarian hormones.[50] Thus it helps in achieving conception and preventing recurrent miscarriage or abortion. Nasya also assists in Pumsavana karma activating anti-Mullerian hormones that inhibit formation of Mullerian ducts activating the formation of testis.[51]
- Basti given through rectal route relieves constipation, normalizes Apana Vayu so as to create base for uterine contraction, ultimately leading to Sukhaprasava (normal delivery).[13]Basti shows effect on gut-brain axis stimulating enteric nervous system, which in turn generates stimulatory signal for central nervous system activating hypothalamus and posterior pituitary for secretion of oxytocin hormone that initiates uterine contraction.[50] Hence, Basti is having aid on effect on initiation of labor and expulsion of retained placenta.
Apart from Panchakarma, other allied therapies also have crucial role in alleviating physiological and pathological discomforts of pregnancy and labor.
- Abhyanga is advised in abdominal and pelvic region for the purpose of suppression of Vata resulting in Srotas-shudhikarana (purification of channels) and Srota-vivrutikarana (dilatation of channels) in Leena garbha.[52]Prasava vedana (labor pain) can also be minimized as massage provides relaxation, inhibits pain signals, or improves blood flow and oxygenation of tissues.[53]
- Abhyanga is said to be Dhatupustikara (promotes excellence of body tissue) in nature.[54] Prenatal massage therapies reduce the rate of premature delivery and low birth weight baby. Increased vagal activity due to massage therapy decreases heart rate, blood pressure level, and cortisol level in mother, reducing prenatal depression and anxiety in mother. Thus, reducing excessive fetal movement was noted in fetus of depressed women.[55]
- Udvartana and Mardana like gentle pressure massage may facilitate the opening of circulatory channels. Massaging with medicated oil, powder, or paste has properties of Twak-prasadana (maintains luster and softness of skin) and Kandughna (antipruritic)[56] that prevents epidermis from drying, over stretching, and reliefs itching in striae gravidarum.
- Snana has the properties of Shramahara (removes fatigue), Ojaskara (increase vitality),[57]Raktaprasadana (pacifies blood), and Sarvendriya-vivodhana (arouses all sensory areas).[58] Science proves that bathing can relieve muscle tension, dilate blood vessel, and slow heart rates.[59] Hence, herbal bath is helpful in the growth and development of fetus alleviating pregnancy exhaustion and improving uterine blood circulation. Irrigation of medicated water over head might have some reflex action or through psychological effect might influence posterior pituitary via hypothalamus for secretion of oxytocin hormone that stimulates myometrial contraction, resulting in placental separation and expulsion.[60]
- Tying of amulet made up of medicinal plant reflects pharmacological activity in body through its Prabhav (specific action) in various obstetric conditions as mentioned earlier. Vishalya may enhance uterine contraction by virtue of its Prabhav and thus helps in the expulsion of obstructed fetus. Amulet of Prajasthapana gana counteracts the effect of Garbhopaghatakara bhava (factor harmful to pregnancy).[61] It has rejuvenating, immunomodulating, and phytoestrogenic properties. These specific actions promote strength and vitality of mother and baby, help in conception, and maintain the pregnancy.
- Lepa of Langali Kalka over infraumbilical area, palm, or sole may stimulate Manipura nadi chakra and induce reflex action, influencing posterior pituitary via hypothalamus for the secretion of oxytocin that increases myometrial contraction.[60] Recent study explained the oxytocic and early abortifacient activity of Gloriosa superba, which may be due to the presence of alkaloids such as colchicines in its aqueous extract.[62]
- Vaginal tampon with medicated oil destroys pathogenic bacteria present in vaginal canal, softens the passage, and prevents puerperal sepsis. Stretching effect in cervix due to Yonipichu generates local production of prostaglandin, which in turn enhances uterine contraction, leading to initiation of labor and expulsion of retained placenta. Study shows the collagenolytic activity at cervix, which promotes cervical ripening.[63]
- Yonidhupana has Vatanulomana (downward movement of Vata) property. It may enhance uterine contraction, dilate blood vessel, and help in oxidation of blood and adequate tissue perfusion.
- Usna veerya (hot potency) oil used in Uttarbasti may stimulate myometrium for contraction, leading to expulsion of placenta.
As a whole, the therapeutic procedures such as Panchakarma and Upakarmas are advocated for following things:
- For the achievement and maintenance of normal pregnancy
- To reduce some symptoms such as striae gravidarum and minor ailments of pregnancy
- To facilitate delivery of a healthy baby from a healthy mother
- To prevent and reduce complications in pregnancy, labor, and postpartum stage
| Conclusion | | |
There are various Ayurveda therapies described in Samhita to support the woman for safe pregnancy and childbirth. The role of holistic procedures in different stages of pregnancy and childbirth are collectively described under the heading of Panchakarma and Upakarmas in this study. These therapeutic procedures are suggested to ensure optimum quality of obstetric care that includes achievement of conception, maintenance and management of pregnancy, and prevention of obstetric complications. Though these procedures are time tested, they have limited scientific evidences. There is a need to initiate systematic studies such as quantitative and qualitative assessment of these therapies along with its efficacy, so that main streaming of these simple but effective procedures in maternal and child health-care system can be possible and ultimately helpful in fulfilling the goal to of reducing the maternal and child mortality rate.
Acknowledgements
On this occasion of successful accomplishment of my article, I offer my salutation to the Almighty for building my confidence and patience till the end of work. I am very much thankful to my guide Prof. (Dr.) Sujata Kadam for her valuable, invincible guidance, and friendly cooperation in completing this article. My thanks to Dr. Galib (Associate professor, Department of Rasa Shastra and Bhaishajya Kalpana, AIIA, Newdelhi) and Dr. Anil (Rsearch Adviser, AIIA, Newdelhi) in adding colours to the script.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al: Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter- Agency Group. Lancet. 2016;387:462-74.  |
| 2. | Agnivesa Caraka. Sharira sthana, Jatisutriya adhyaya-8/verse 22. In: Rajeswar DS, editor. Caraka Samhita. Varanasi, India: Chaukhambha Bharati Academy; 2013. p. 930. |
| 3. | Vriddha Jivaka. Sharira Sthana, Jatisutriya Adhyaya. Varanasi, India: Chaukhambha Sanskrit Sansthan; 2015. p. 125. |
| 4. | Agnivesa Caraka. Sutrasthana, Yajjapurusheeyadhya-25/verse 40. In: Rajeswar D S, editor. Caraka Samhita. Varanasi, India: Chaukhambha Bharati Academy; 2013. p. 469. |
| 5. | Srimadvagbhata. Sharira sthana, Garbhavakranti shariradhyaya-1/verse 49. In: Brahmanand T, editor. Astanga Hridayam. Delhi, India: Chaukhambha Sanskrit Pratisthan; 2014. p. 346. |
| 6. | Srimadvagbhata. Sharira sthana, Garbhavakranti shariradhyaya-1/verse 47. In: Brahmanand T, editor. Astanga Hridayam. Delhi, India: Chaukhambha Sanskrit Pratisthan; 2014. p. 346. |
| 7. | Vriddha Vagbhata. Sharira sthana, Garbhavakranti shariradhyaya-2/verse 59. In: Shivprasad S, editor. Astanga Samgraha. 3rd ed. Varanasi, India: Chaukhambha Sanskrit Series; 2012. p. 284. |
| 8. | Srimadvagbhata. Sutrasthana, Dvividhopakramaniyadhyaya-14/verse 5. In: Brahmanand T, editor. Astanga Hridayam. Delhi, India: Chaukhambha Sanskrit Pratisthan; 2014. p. 191. |
| 9. | Agnivesa Caraka. Sharirasthana, Jatisutriya shariradhyaya-8/verse 22–24. In: Yadavjitrikamji A, editor. Caraka Samhita. Chakrapani Tika. Varanasi, India: Chaukhambha Surbharati Prakashan; 2016. p. 344. |
| 10. | Maharsi Susruta. Sharirasthana, Garbhinivyakarana shariradhyaya-10/verse 71. In: Kaviraj AS, editor. Susruta Samhita. Varanasi, India: Chaukhambha Sanskrit Sansthan Publisher; 2011. p. 113. |
| 11. | Maharsi Susruta. Sharirasthana, Sukrashonitasuddhi shariradhyaya-2/verse 34. In: Kaviraj AS, editor. Susruta Samhita. Varanasi, India: Chaukhambha Sanskrit Sansthan Publisher; 2011. p. 19. |
| 12. | Maharsi Susruta. Sharirasthana, Sukrashonitasuddhi shariradhyaya-2/verse 32. In: Yadavjitrikamji A, editor. Susruta Samhita, Nimbandhasangraha of Dalhana. Varanasi, India: Chaukhambha Surbharati Prakashan; 2016. p. 347. |
| 13. | Maharsi Susruta. Sharirasthana, Garbhinivyakarana shariradhyaya-10/verse 5. In: Kaviraj AS, editor. Susruta Samhita. Varanasi, India: Chaukhambha Sanskrit Sansthan Publisher; 2011. p. 99. |
| 14. | Agnivesa Caraka. Sharirasthana, Jatisutriya shariradhyaya-8/verse 29. In: Rajeswar DS, editor. Caraka Samhita. Varanasi, India: Chaukhambha Bharati Academy; 2013. p. 935. |
| 15. | Maharsi Susruta. Sharirasthana, Garbhinivyakarana shariradhyaya-10/verse 23. In: Kaviraj AS, editor. Susruta Samhita. Varanasi, India: Chaukhambha Sanskrit Sansthan Publisher; 2011. p. 104. |
| 16. | Agnivesa Caraka. Sharirasthana, Jatisutriya shariradhyaya-8/verse 32. In: Rajeswar DS, editor. Caraka Samhita. Varanasi, India: Chaukhambha Bharati Academy; 2013. p. 939. |
| 17. | Pandit Sarngadharacharya. Madhyam khanda, Snehapaka vidhi- 9/verse 98. In: Brahmanand T, editor. Sarngadhara Samhita. Varanasi, India: Chaukhambha Surbharati Prakashan 2004. p. 231-2. |
| 18. | Agnivesa Caraka. Sharirasthana, Jatisutriya shariradhyaya-8/verse 32. In: Rajeswar DS, editor. Caraka Samhita. Varanasi, India: Chaukhambha Bharati Academy; 2013. p. 938. |
| 19. | Vrddha vagbhata. Sharirasthana, Garbhopacaraniyadhyaya-3/verse 9. In: Shivprasad S, editor. Astanga Samgraha. 34th ed. Varanasi, India: Chaukhambha Sanskrit Series Office; 2012. p. 284. |
| 20. | Agnivesa Caraka. Sharirasthana, Jatisutriya shariradhyaya-8/verse 28. In: Rajeswar DS, editor. Caraka Samhita. Varanasi, India: Chaukhambha Bharati Academy; 2013. p. 934. |
| 21. | Agnivesa Caraka. Sharirasthana Jatisutriya shariradhyaya-8/verse 38. In: Rajeswar DS, editor. Caraka Samhita. Varanasi, India: Chaukhambha Bharati Academy; 2013. p. 942. |
| 22. | Bhavamishra Purvardha. Garbhaprakaranam-3/verse 347. In: Brahmasankara M, Rupalalji V, editor. Bhavaprakash Nighantu. Varanasi, India: Chaukhambha Sanskrit Bhawan; 2015. p. 95. |
| 23. | Srimadvagbhata. Sutrasthana, Dinacharyadhyaya-2/verse 15. In: Sadasiva SP, editor. Astanga Hridayam, Ayurveda Rasayana of Hemadri. Delhi, India: Chaukhambha Surbharati Prakashan; 2016. p. 28. |
| 24. | Srimadvagbhata. Sharirasthana, Garbhavakranti shariradhyaya-1/verse 42. In: Brahmanand T, editor. Astanga Hridayam. Delhi, India: Chaukhambha Sanskrit Pratisthan; 2014. p. 345. |
| 25. | Acharya GS. Mardana. In: Panchakrma Illustrated. 1st ed. Delhi, India: Chaukhambha Sanskrit Pratisthan; 2006. p. 167. |
| 26. | Maharsi Susruta. Chikitsasthana, Swedavacharaniya chikitsyadhyaya-32/verse 13. In: Kaviraj AS, editor. Susruta Samhita. Varanasi, India: Chaukhambha Sanskrit Sansthan publisher; 2011. p. 174. |
| 27. | Maharsi Susruta. Sharirasthana, Garbhinivyakarana shariradhyaya-10/verse 62. In Kaviraj AS, editor. Susruta Samhita. Varanasi, India: Chaukhambha Sanskrit Sansthan publisher; 2011. p. 110. |
| 28. | Vrddha vagbhata. Sharirasthana, Garbhopacharaniya Adhyaya: chapter 3, verse 13. In Shivprasad S, editor. Astanga Samgraha. 3rd ed. Varanasi, India: Chaukhambha Sanskrit series office; 2012. p. 286. |
| 29. | Srimadvagbhata. Sharirasthana, Garbhavakranti shariradhyaya-1/verse 68. In: Brahmanand T, editor. Astanga Hridayam. Delhi, India: Chaukhambha Sanskrit pratisthan; 2014. p. 350. |
| 30. | Srimadvagbhata. Sharirasthana, Garbhavyapad shariradhyaya-2/verse 24. In Brahmanand T, editor. Astanga Hridayam. Delhi, India: Chaukhambha Sanskrit pratisthan; 2014. p. 360. |
| 31. | Agnivesa Caraka. Sharirasthana, Jatisutriya shariradhyaya-8/verse 27. In: Rajeswar DS, editor. Caraka Samhita. Varanasi, India: Chaukhambha Bharati Academy; 2013. p. 933. |
| 32. | Agnivesa Caraka. Sutrasthana, Swedadhyaya-14/verse 44. In: Rajeswar DS, editor. Caraka Samhita. Varanasi, India: Chaukhambha Bharati Academy; 2013. p. 292. |
| 33. | Agnivesa Caraka. Sharirasthana, Jatisutriya shariradhyaya-8/verse 24. In: Rajeswar DS, editor. Caraka Samhita. Varanasi, India: Chaukhambha Bharati Academy; 2013. p. 931. |
| 34. | Vrddha vagbhata. Sharira sthana, Garbhavyapad Adhyaya-4/verse 3. In Shivprasad S, editor. Astanga Samgraha. 3rd ed. Varanasi, India: Chaukhambha Sanskrit series office; 2012. p. 291. |
| 35. | Maharsi Susruta. Sharirasthana, Garbhinivyakarana shariradhyaya-10/verse 10. In: Kaviraj AS, editor. Susruta Samhita. Varanasi, India: Chaukhambha Sanskrit Sansthan publisher; 2011. p. 102. |
| 36. | Vrddha vagbhata. Sharira sthana, Garbhopacharaniya Adhyaya-3/verse 17. In: Shivprasad S, editor. Astanga Samgraha. 3rd ed. Varanasi, India: Chaukhambha Sanskrit series office; 2012. p. 287. |
| 37. | Vrddha Jivaka. Khila sthana, Antarvartni chikitsitadhyaya-10/verse 181. Varanasi, India: Chaukhambha Sanskrit Sansthan; 2015. p. 464. |
| 38. | Maharsi Susruta. Sharirasthana, Garbhinivyakarana shariradhyaya-10/verse 13. In: Kaviraj AS, editor. Susruta Samhita. Varanasi, India: Chaukhambha Sanskrit Sansthan publisher; 2011. p. 102. |
| 39. | Agnivesa Caraka. Sharirasthana, Jatisutriya shariradhyaya-8/verse 20. In: Rajeswar DS, editor. Caraka Samhita. Varanasi, India: Chaukhambha Bharati Academy; 2013. p. 927. |
| 40. | Indradev T, Dayashankar T. Yogaratnakara. Strigarharoa chikitsa/verse 36. 4th ed. Varanasi, India: Chaukhambha Sanskrit Series Office; 2013. p. 820. |
| 41. | Acharya GS. Lepa. In: Panchakrma Illustrated. 1st ed. Delhi, India: Chaukhambha Sanskrit Pratisthan; 2006. p. 181. |
| 42. | Vriddha Vagbhata. Sharira Sthana, Garbhopacharaniya Adhyaya-3/verse 30. In: Shivprasad S, editor. Astanga Samgraha. 3rd ed. Varanasi, India: Chaukhambha Sanskrit series office; 2012. p. 288. |
| 43. | Srimadvagbhata. Sharirasthana, Garbhavyapad Shariradhyaya-2/verse 3. In: Brahmanand T, editor. Astanga Hridayam. Delhi, India: Chaukhambha Sanskrit pratisthan; 2014. p. 357. |
| 44. | Agnivesa Caraka. Sharirasthana, Jatisutriya shariradhyaya-8/verse 31. In: Rajeswar D, editor. Caraka Samhita. Varanasi, India: Chaukhambha Bharati Academy; 2013. p. 939. |
| 45. | Vrddha vagbhata. Sharira sthana, Garbhopacharaniya Adhyaya-3/verse 11. In Shivprasad S, editor. Astanga Samgraha. 3rd ed. Varanasi, India: Chaukhambha Sanskrit Series; 2012. p. 286. |
| 46. | Agnivesa Caraka. Sharirasthana, Jatisutriya shariradhyaya-8/verse 41. In Rajeswar DS, editor. Caraka Samhita. Varanasi, India: Chaukhambha Bharati Academy; 2013. p. 945. |
| 47. | Vrddha vagbhata. Sharira sthana, Garbhavyapad Adhyaya-4/verse 36. In: Shivprasad S, editor. Astanga Samgraha. 3rd ed. Varanasi, India: Chaukhambha Sanskrit Series; 2012. p. 296. |
| 48. | Srimadvagbhata. Sharirasthana, Garbhavyapad Shariradhyaya-2/verse 25. In: Brahmanand T, editor. Astanga Hridayam. Delhi, India: Chaukhambha Sanskrit pratisthan; 2014. p. 360. |
| 49. | Sangeeta HJ, Toshikhane HD. A critical evaluation of the concept of “ Nasa Hi Shiraso Dwaram” (nasal route entry for the cranial cavity). Pacific J Sci Technol 2009;10:338-41. |
| 50. | Donga KR, Donga SB, Dei LP. Role of nasya and matra basti with narayana taila on an ovulatory factor. Ayu 2013;34:81-5. [ PUBMED] [Full text] |
| 51. | Usha VNK. Pumsavana: chapter 2. In: Prasutitantra. 1st ed. Delhi, India: Chaukhambha Sanskrit Pratisthan; 2012. p. 364. |
| 52. | Maharsi Susruta. Sharirasthana, Garbhinivyakarana shariradhyaya-10/verse 57. In: Yadavjitrikamji A, editor. Susruta Samhita, Nimbandhasangraha of Dalhana. Varanasi, India: Chaukhambha Surbharati Prakashan; 2016. p. 394. |
| 53. | Field T. Massage therapy research review. Complement Ther Clin Pract 2016;24:19-31. |
| 54. | Maharsi Susruta. Chikisasthana, Anagatavadhapratisedha adhyaya-24/verse 30. In: Kaviraj AS, editor. Susruta Samhita. Varanasi, India: Chaukhambha Sanskrit Sansthan; 2011. p. 133. |
| 55. | Field T. Pregnancy and labor massage. Expert Rev Obstet Gynecol 2010;5:177-81. |
| 56. | Maharsi Susruta. Chikisasthana, Anagatavadhapratisedha-24/verse 52–54. In: Kaviraj AS, editor. Susruta Samhita. Varanasi: Chaukhambha Sanskrit Sansthan; 2011. p. 135. |
| 57. | Agnivesa Caraka. Sutrasthana, Matrashiteeyadhaya-5/verse 94. In: Rajeswar DS, editor. Caraka Samhita. Varanasi, India: Chaukhambha Bharati Academy; 2013. p. 130. |
| 58. | Maharsi Susruta. Chikisasthana, Anagatavadhapratisedha-24/verse 57–58. In: Kaviraj AS, editor. Susruta Samhita, Varanasi, India: Chaukhambha Sanskrit Sansthan; 2011. p. 135. |
| 59. | Franchimont P, Juchmes J, Lecomte J. Hydrotherapy—Mechanisms and indications. Pharmacol Ther 1983;20:79-93. |
| 60. | Premvati T. Prasav Vijnaniya, Aparapatana vidhi. In: Ayurvediya Prasutitantra. 2nd ed. Varanasi, India: Chaukhambha Oriental Publishers; 2011. p. 465. |
| 61. | Agnivesa Caraka. Sharirasthana, Jatisutriya shariradhyaya-8/verse 20. In: Acharya Y, editor. Caraka Samhita, Chakrapani Tika. Varanasi, India: Chaukhambha Surbharati Prakashan; 2016. p. 344. |
| 62. | Malpani AA, Aswar UM, Kushwaha SK, Zambare GN, Bodhankar SL. Effect of the aqueous extract of Gloriosa superba Linn (Langli) roots on reproductive system and cardiovascular parameters in female rats. Trop J Pharm Res 2011;10:169-76. |
| 63. | Anubha C. Effect of anuvaasana vasti ( matravasti) and yonipicchu on phenomenon of labor. Int Ayurvedic Med J [online] 2016;4. |
|
Search Pubmed for