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Table of Contents
CASE REPORTS
Year : 2022  |  Volume : 10  |  Issue : 3  |  Page : 192-195

Stanyakshya (insufficient lactation) and its management by an Ayurveda formulation: A case report


Department of Prasuti Tantra & Stri Roga, Dr. S. R. Rajasthan Ayurveda, University, Jodhpur, India

Date of Submission05-Jan-2022
Date of Acceptance13-Aug-2022
Date of Web Publication30-Sep-2022

Correspondence Address:
Upasana Sharma
Department of Prasuti Tantra & Stri Roga, Dr. S. R. Rajasthan Ayurveda, University, Dr. S. R. Rajasthan Ayurveda University, Karwar, Nagaur road, Jodhpur, 342037
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jism.jism_5_22

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  Abstract 

Introduction: Human milk is an indispensable need for infant survival. As it contains thousands of micronutrients, macronutrient, bioactive components, immunological factors that gives immense protection against infection and inflammation. In Ayurveda classics, Stanya (breast milk) has given a very pivotal place for baby. But currently many mothers are not fortunate enough to feed their new born due to deficient support from their health. After reviewing Ayurveda classics, it can be concluded that major cause of lactation insufficiency in Sutikaawastha(puerperium) is Agnimandya and Dhatu/Updhatukshaya. For such conditions, judicial selection of drugs is very important, as in Ayurveda number of Stanyajanana and Stanyavardhaka drugs (galactogogues) are mentioned for initiationand augmentation of milk production. Materials and Methods: Following is a case report of a 32-year-old female who was not able to feed her baby properly even after seven days of normal delivery. She was treated with a simple decoction of DeepenaPaachana drugs; Shatapushpa, Dhanyaka, KrishnaJeeraka etc. Results were assessed on the basis of subjective parameters; mother - Stanyapravriti in a day, baby - Shishurodana, Bharavridhi, Nidra etc. All the medications were given for 42 days and all the parameters were assessed and found with in normal limit. Conclusion: Main cause for insufficient milk production in this case and many more like this is Agnimandya at the level of Jatharagni as well as Dhatwagni also. By correcting condition of Agni,one can easily manage such cases, there is no need to give Stanyavardhana drugs to all the patients.

Keywords: Agnimandya, Deepana, Paachana, Stanya


How to cite this article:
Sharma U, Sharma S. Stanyakshya (insufficient lactation) and its management by an Ayurveda formulation: A case report. J Indian Sys Medicine 2022;10:192-5

How to cite this URL:
Sharma U, Sharma S. Stanyakshya (insufficient lactation) and its management by an Ayurveda formulation: A case report. J Indian Sys Medicine [serial online] 2022 [cited 2022 Dec 8];10:192-5. Available from: https://www.joinsysmed.com/text.asp?2022/10/3/192/357686




  Introduction Top


The World Health Organization (WHO) strongly recommends that all neonates should be breastfed within one hour of birth. It prevents detrimental effects of infections related infant deaths exclusive breastfeeding is the easiest, species specific, cost-effective and life-saving intervention for the health of a new-born.[1]

Stanyais the Upadhatuof RasaDhatu or it is formed by the action of Rasagni over RasaDhatu and itis also named as Jeevanam. AacharyaCharaka and AacharyaKashyap[2] have mentioned that Rasa formed by the diet pregnant lady consumes is utilized for three main functions: Swashariraposhana (nourishment of woman’s own body), Stanya(breast milk) formation and Garbhaposhana(foetal nourishment). So, preparation of milk formation starts from antenatal period according to Ayurveda.

Breast milk is having properties; Madhurarasa, Kashaya anurasa, Sheetaveerya, Pathyam, Jeevanam, Laghu and Deepanam.[3] According to modern science breast milk is said to be species specific but Ayurveda gives strong emphasis on its individual specificity. AacharyaCharaka has advised that breastfeeding should be started from the very first day.[4] And so according to modern medicine, early initiation of breastfeeding and exclusive breastfeeding for the first 6 months of life prevents around 20% new-born deaths and 13% under-five deaths.[5] It also reduces mortality due to different neo- natal infections (sepsis, pneumonia, tetanus, and diarrhoea).[6] The first milk (colostrum) contains bio-active immune factors which protect a neonate against a variety of infections and allergic diseases.[7] According to a study 75% of new mothers start breastfeeding their infants but, a sharp decline occurs with time and by the end of 6 month less than 15% of infants are fully breastfed.[8] In India, only 65% of children are exclusively breastfed for the first 6 months and 45% of children receive breastfeeding within an hour of birth, though breastfeeding is one of the most important interventions of child survival.[9] In the year of 2016, Government of India launched a programme named National Breastfeeding Promotion Programme MAA (Mothers’ Absolute Affection) to ensure generation of adequate awareness among the masses, especially mothers, on the benefits of breastfeeding.[10]

Lactation is controlled by a complex hormonal mechanism; the reproductive hormones act directly on the mammary gland, on the other hand metabolic hormones act indirectly by altering endocrine response and nutrient flux to the mammary gland.

Sufficient milk production requires an adequate mammary tissue, intact and well-coordinated ductal and neurological pathways, and appropriate concentrations of hormones including reproductive hormones (estrogen, progesterone, placental lactogen, prolactin, and oxytocin) and metabolic hormones (glucocorticoids, insulin, growth hormone, and thyroid).[11]


  Case Study Top


Patient information

A 32 years old female consulted us during her puerperium (7 days after her normal delivery, a male child of 2300 grams) for complaint of absence of sufficient milk production. Patient was a teacher by profession in government school and from upper middle class. She was not able to feed her baby, along with complaint of fullness of breast along with pricking sensation and pain. Complaints in the child were continuous crying (Rodana), weight loss, reduced frequency of urination were also present. She was prescribed some modern medicines and tablet “lactare” at the time of discharge from hospital.

H/O present illness

Patient had a Full-Term Normal Delivery with Episiotomy of a male child weighing 3kg. She was not able to feed her baby due to insufficient milk production and so the baby was on top feed.

Past medical and surgical history- not significant

Obstetric history- G1P1L1A0D0

LMP: 27/07/2020

Date of delivery – full term normal delivery with episiotomy 30/05/2021

History of past illness: patient was asymptomatic during antenatal period but she gained 16 kg wt. during this period.

Clinical findings

Her general condition was fair, anxious due to her complaint, complete blood count, ESR, urine examination, were with in normal limit. Her LFT values were slightly elevated. She was experiencing loss of appetite, disturbed sleep, and constipation also.

Diagnostic assessment[12] – according to special scoring system based upon symptoms in Sutika and Balaka[Table 1][Table 2][Table 3][Table 4][Table 5][Table 6][Table 7].
Table 1: Grading of Stanayormlanata(Laxity of breast)

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Table 2: Grading of Stanyapramana(Lactation)

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Table 3: Grading of Mala pariksha (Consistency of stool)

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Table 4: Grading of ShariraBharavruddhi (increase in Baby weight)

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Table 5: Grading of Rodana (Cry of baby)

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Table 6: Grading of Nidra (Sleep of baby)

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Table 7: Drugs used

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  Symptoms inSutika Top





  Symptoms in Baby (Balak) Top





  Therapeutic Intervention Top


Patient was advised to follow appropriate nipple care along with following medicines.

Patient was advised to take decoction 20 ml of above-mentioned drugs, twice daily before meal along with mentioned Sutikaparicharya. These herbs were collected in raw form from local market and Kwatha was prepared by patient at home only.


  Follow-up and Outcome Top


By the end of first week patient felt a little improvement in features; fullness of breast and pricking sensation but the other symptoms did not change at all but patient was quite happy as she relieved by pain so, she was advised to continue the treatment for next two week and examined again after two weeks. Stanyapramans, Baby weight, Rodans, Nidra all were found with in normal limit. Treatment was continued for 42 days(AdhyardhaMasa) along with Sutikaparicharyaandfollow up was done fortnightly. All the parameters in mother and baby as well were within normal limit after completion of treatment.


  Discussion Top


Normal breast feeding in Ayurveda

After digestion of Aahara (food) by Jatharagni and Dhatwagni, Rasa is formed, sweat essence part of Rasa is circulated by VyanaVayu through entire body and when it reaches to breast named as Stanya.AacharyaHarita, states that ingested food by female travel through Sira of chest (oesophagus) getting mixed with Pitta reaches to Jathara (stomach). Here it gets metabolized by Jatharagni (digestive fire) after that again metabolized and processed by Pitta, reaches to Siras or breast and ultimately discharged. Milk is ejected by thought, sight, touch of child and also with physical contact of baby (suckling). For proper flow, uninterrupted affection for the child is essential. Ayurveda classics described a specific diet and mode of life for puerperal women, as all the Dhatus decrease and become languid due to development of fetes, body becomes empty due to labour pains and excretion of moisture and blood. Her digestive power, muscle mass and strength also decrease. In Sutikaparicharya all the Acharyas have advised DeepnaPaachanaChikitsa along with Snehapaana.

Causes of Stanyakshaya

Anger(Krodha), fear(Bhaya), stress(Chinta), absence of affection for child, fasting, excessive exercise, consumption of food and drinks free from oil or dry, emaciation, excessive use of purifying measures and re-pregnancy are the common cause described in Ayurveda classics for Stanyakshaya.[13]

Samprapti of Stanyakshaya (pathogenesis):

In Sutikathere is overall Dhatukshayaawasthadue to development of foetus, Pravahana, vedana(labour pains and bear down efforts) and loss of Raktaand Kledaduring Prasava cause a certain emptiness. So, women get deprived in maamsa, bala(strength), agni(digestive power). Again, this state is complicated by Apathyasewana(atyaapatarpana, rukshaanna, shoka, bhaya, krodha). As a result, there is Vata-pradhana-tridosha-prakopaleading to RasaDhatukshayaand consequently Upadhatukshaya(Stanyakshaya).

In Rajasthan, a specific decoction made with Shatpushpa, Dhanyak, Jeerak, Methikais being used inpuerperal period as a tradition in many families. So, here in this article an effort has been made to understand its probable mode of action of this formulation based upon its ingredients, their Ras, Guna,Veerya, Vipaka, Karma individually and combined.


  Probable Mode of Action of Above Mentioned Drugs Top


Shatpushpa[14] is having properties likeDeepan, Paachan, Stanyajanan, Shothhar, Kaphaghna, Jwarnashan, Vranpaachanby having all these properties is was helpful in relieving pain, fullness of breast and insufficient milk production. Specially like this particular case now adays female are also in a state of over nutrition which is more dangerous scenario than the malnutrition because then we have to be very judicious about our selection of drugs that they should not be having brihman properties like many stanyajanan drugs do at the same time must be having Vatashamn properties too.

Dhanyaka[15] is Deepan, Jwaraghna, Trishnashaman, Mutrajanan, VedanasthapanKrishna jeerak[16] is also having Deepan, Paachan, Kaphavatashamak, vatanuloman, Shothhar, Stanyajanan property so it was helpful again in correction of Agni, along with maintenance of normal puerperal physiology by having Garbhashayashodhakguna. Methika[17] is again Stanyajanan, balya, Angmardprashaman, Vedanahar, Shothnaashan, Sutikadoshanaashan.

Shunthi[18] is mentioned as a great Aampaachak drug in our classics. puerperal period is a state of Kledadhikya so by having such property it will reduce the condition of Kleda along with due to having teekshnaguna it will also clear the srotas. It is also having Vatavyadhinaashan, Jwaraghnaaashaproperties so it will help in relieving other symptoms also. So firstly, selection of drugs was made which were having deepanpaachan properties as our main emphasis was given on AgnivardhanChikitsa (Jatharagniand Rasdhatvagni) because Sutikaawastha is a state of Dhatwagnimandya itself. Secondly Aampachanchikitsa with mainly Kaphavatashamak drugs was done to eradicate (Aam) Stanavahasrotoavrodha and to control Rasa Dhatukshaya (Vataprakopa due to Aavaran) and lastlyto control psychological factors (Shokabhaya-avaatsalya) patient was advised to follow Sutikaparicharya and explained about the importance of proper breast feeding.


  Conclusion Top


Agnivardhanchikitsa by Deepan and Paachan drugs should be the first and foremost line of treatment for insufficient milk production. In present era, most of the time during antenatal period females adopt sedentary life style and eventually it results in kledadhikyaawastha, agnimandya, during antenatal as well as post-natal period. So, before running after drugs having only galactogenous (stanyajanan) effects we should focus on samprapti-vighatan first. As in this case simple decoction came out as a very effective drug because patient was treated as per SampraptivighatanChikitsa sutra only. Many times during puerperal period patient is not comfortable in having multiple drugs so same treatment plan may not be helpful in each and every patient of Stanyakshaya. In case of different samprapti(pathogenesis) different medicines will require to break process of samprapti. No adverse effects were observed in mother and baby during treatment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Chessa L World Health Organization (WHO). Early Initiation of Breastfeeding: The Key to Survival and Beyond. WHO Secretariat; 2010. p. 1–7. https://iris.paho.org/handle/10665.2/53924.  Back to cited text no. 1
    
2.
Shri Satyapal Bhishagacharya with Hindi commentary Vidyotini, In: Samhita K, ed. Choukhmbha Sanskrit Series, Chapter-18/6–7. Varanasi: Sutra Sthan; reprint edition 2000. p. 145.  Back to cited text no. 2
    
3.
Ambikadutta S Suhrut Samhita Sutra Sthan, Chapter 45/47. Varanasi: Chaukhambha Sanskrit Sansthan; reprint edition 2010. p. 223.  Back to cited text no. 3
    
4.
Tiwari P Text Book of Ayurvediya Streeroga Avam Prasutitantra, part I, chapter 10; reprint edition 2014. p. 627.  Back to cited text no. 4
    
5.
Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS; Bellagio Child Survival Study Group. How many child deaths can we prevent this year? Lancet 2003;362:65-71.  Back to cited text no. 5
    
6.
Mullany LC, Katz J, Li YM, Khatry SK, LeClerq SC, Darmstadt GL, et al. Breast-feeding patterns, time to initiation, and mortality risk among newborns in southern nepal. J Nutr 2008;138:599-603.  Back to cited text no. 6
    
7.
Chae A, Aitchison A, Day AS, Keenan JI Bovine colostrum demonstrates anti-inflammatory and antibacterial activity in in vitro models of intestinal inflammation and infection. J Funct Foods 2017;28:293-8.  Back to cited text no. 7
    
8.
Australian Health Ministers. Australian national breastfeeding strategy 2010–2015. Canberra, Australia: Australian Government Department of Health and Aging. Australian Institute of Family Studies; 2009. (2008). Growing up in Australia: The longitudinal study of Australian children. Canberra, Australia: Author. Centers for Disease Control and Prevention. (2010). Centers for disease control and prevention breastfeeding report card – United States, 2010, Atlanta, GA.  Back to cited text no. 8
    
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Ministry of Women and Child Development. Rapid Survey on Children. India Factsheet. Provisional. Government of India. Available from: http://wcd.nic.in/sites/default/files/State%20RSOC.pdf. [Last accessed on 29 Aug 2015]. 2013–2014.  Back to cited text no. 9
    
10.
Mothers’ Absolute Affection (MAA) | National Health Mission | Government Of Assam, India [Internet]. [cited 2022 Sep 21]. Available from: https://nhm.assam.gov.in/frontimpotentdata/mothers%E2%80%99-absolute-affection-maa.  Back to cited text no. 10
    
11.
Czank C, Henderson JJ, Kent JC, Lai CT, Hartmann PE Hormonal control of the lactation cycle. In: Hale TW, Hartmann PE, editors. Hale & Hartmann’s Textbook of Human Lactation. 1st ed. Amarillo, TX: Hale Publishing; 2007. p. 89-111.  Back to cited text no. 11
    
12.
Bhujbal VV, Shelar SM A Case Study of Ayurvedic Management in Stanyakshaya (Lactation in- sufficiency). International Journal of Research in Ayurveda and Medical Sciences 2020;3:227-31.  Back to cited text no. 12
    
13.
Tiwari P Text Book of Ayurvediya Streeroga Avam Prasutitantra, part I, chapter 10; reprint edition 2014. p. 653.  Back to cited text no. 13
    
14.
Pandey G Dravyaguna Vijana. Vol 2. 3rd ed. Varanasi: Chaukhamba Krishna Das Academy; 2005. p.403-5.  Back to cited text no. 14
    
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Vaidya Banwari Lal Mishra, Dravyaguna – Hastamalaka, Publication Scheme, 4th ed.; 2004. p. 53.  Back to cited text no. 15
    
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Pandey G Dravyaguna Vijana. Vol 2, 3rd ed. Varanasi: Chaukhamba Krishna Das Academy; 2005. p. 368.  Back to cited text no. 16
    
17.
Pandey G Dravyaguna Vijana. Vol 2, 3rd ed. Varanasi: Chaukhamba Krishna Das Academy; 2005. p. 825.  Back to cited text no. 17
    
18.
Pandey G Dravyaguna Vijana. Vol 2, 3rd ed. Varanasi: Chaukhamba Krishna Das Academy; 2005. p. 334.  Back to cited text no. 18
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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Abstract
Introduction
Case Study
Symptoms inSu...
Symptoms in Baby...
Therapeutic Inte...
Follow-up and Ou...
Discussion
Probable Mode of...
Conclusion
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