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Therapeutics During Pregnancy

The physical and psychological disorders of a pregnant woman are no different from any other individual as the doshas and dooshyas of the body remain the same. However, the principles of management differ as teekshna, katu and strong medicines would harm the foetus. Thus the choice of drugs for the disorders occuring during pregnancy should be restricted - they must be mrudu (mild), sheetha (cold) madhura (sweet) and hrudya (pleasing). But when mother's life is in danger then she should be saved by the use, if necessary of drastic measures and pungent drugs, even if it may be harmful to the foetus (Ash. San. Sha. 2/62-63). If the disease is acute and/or serious emetics can be given followed by the use of sweet and sour substances mixed with anulomaka drugs (carminatives). All the pacifying drugs should be mrudu, (i.e.) mild and be given along with food or drinks. In short, in the words of Charaka, the pregnant woman should be treated with all the care as when carrying a pot filled with oil. Just as the slightest oscillation of the pot causes spilling of oil, the slightest excitement to the pregnant woman can initiate complications like abortion etc. (Cha. Sam., Sha. 8/22).
The treatment in a pregnant woman depends on the month of gestation as well as the severity of the disease.

Conditions during Pregnancy and their treatment

  1. Body pain and joint pain
  2. Dizziness
  3. Weakness (Paandu roga/anemia)
  4. Nausea, vomiting, morning sickness
  5. Swelling / oedema
  6. Night blindness
  7. Blurred vision
  8. Worms
  9. Piles
  10. Constipation
  11. Diarrhoea
  12. Fever
  13. Jaundice
  14. Measles
  15. Itching in the vulva
  16. Excessive vaginal discharge (white/red)
  17. Burning sensation while urinating
  18. Convulsions
  19. Pain in the abdomen
  20. Head ache
  21. Insomnia
  22. Kikkisa (Striae gravidarum)

We have made an attempt to outline some of the most common conditions and diseases that are encountered during various stages of pregnancy. We have also tried to give the causes, treatments and preventive measures for the various conditions.

Some of the medications* which can be administered in the common ailments of pregnant women

  1. Body pain/Joint pain
    External application of Dhanvantra thaila, Sahacharadi thaila, Visha garbha thaila, and other Vaatha hara thailas is recommended.

  2. Dizziness
    The suggested medicine is the swarasa of shathaavari (Asparagus racemosa). However it is essential that the root cause of dizziness should be detected and treatment given, as it may have various causes, like paandu, general weakness or toxaemia.

  • The medications given here are based on the suggestions made by Aayurvedic Vaidyas in a meeting held at Aalandi (see Appendix II). The reader is advised to consult an Aayurvedic Vaidyas, for any ailment. This is NOT meant to be used as a "manual" for treatment.

  1. Paandu rogaOne of major disturbing conditions during pregnancy is paandu, or anemia during pregnancy. Aayurvedic aachaaryaas have recognised this condition and prescribed adequate medication, also taking care not to cause any side effects which are often seen during the administration of iron supplement in the form of ferrous sulphate and folic acid. This iron supplement does not find a good compliance with the pregnant woman as it increases the vomiting sensation and nausea and also causes constipation in many women. To avoid such reactions it is advised to take the necessary iron supplement in a form that is most suitable for her body and also in combination with other drugs which help in controlling such reactions.

Some of the combinations in practice are:

  1. Lohasavam with Draksharishtam (Draksharishtam acts as a mild laxative)

  2. Dhaatri loha - In this preparation, there is lot of aamalaki (Phyllanthus emblica) which controls the nausea and constipation. There is also some yashtimadhu (Glycyrrihiza glabra) and guduchi (Tinospora cordifolia) which also help in alleviating the side effects

  3. Punarnava mandooram - Punarnava (Boheavia diffusa) acts as diuretic and hence helps to prevent any retention of urine or oedema which if often seen in pregnant woman especially at the end of the second trimester and in the third trimester

  1. Nausea and vomiting
    All the classics have mentioned excessive salivation and nausea etc. morning sickness) as symptoms of normal pregnancy. Sushrutha has included pregnancy also while describing the nidaana of chardiroga (i.e). Vommiting. Madhukosha commentary says that vaayu being pushed upward by foetus gets provoked and causes vomiting.

There are three specific causes for thisgarbhaja chardiroga

  1. Vaatha Vaigunya

  2. Dauhrida - avamaanana or non fulfillment of dauhrudya

  3. Garbha nimittha or due to the foetus

Power of laaja (puffed rice) with honey can be given, as it is the best among anti-emitics. However the cause for vomiting is to be checked, since vomiting may be a symptom for some other disease.

  1. Sopha (Oedema/Swelling)
    This is another common condition. The treatment here is two fold - oral medication : Decoction of roots of varshabhoo (Boheavia diffusa) mixed with paste of devadaaru (Cedrus deodara) and moorva (Mardensia tenacissima) or only devadaaru with honey can be given.
    External application - Sudation/fomentation with hot water should be done. A paste of chandana (Santalum album), madhuka (Glycyrrhiza glabra), usheeram (Vetiveria zizanioides), naaga puspha, tila (Sesamum indicum), ajasringa, manjishta (Rubia cordifolia), root of ravi and Punarnava (Boehavia diffusa), is beneficial

  1. Night blindness
    Flowers of agasthi (Agathi grandiflora) can be given. Nutritive food also should be given.

  1. Blurred vision
    This generally occurs as a secondary symptom in conditions of paandu, so it can be cured by treating paandu. Some "Loha" preparation should be given.

  1. Worms
    Vidanga (Emblica ribes) in the dose of 3 grams with honey is suggested Pregnant women are prone to have worm infestation because they have dowhrudya which often results in the desire for mud, ash etc.

  2. Piles
    Untreated constipation may also be one of the causes for piles in pregnant woman. Preparation like Abhayarishtam and Dantyaarishtam are advised. If constipation is the cause then it should be rectified. Siddha vaidyas advise Nathai odu bhasma or Nathai kari lehyam (The preparations of snail shell and snail flesh)

  3. Constipation
    Constipation is another common condition during pregnancy. If the constipation is mild, draaksha (Vites vinifera) and dry rose buds can be given. If the constipation occurs due to Udavartha during the eighth month of pregnancy and is not relieved either by use of anuvaasana basthi(oils medicated with the drugs of madhurangana) or by intake of substances which are unctuous and vaathahara, then it should be considered as incurable. Nirooha basthi is given as a next step of treatment.
    Constipation may be caused due to the iron supplement. So while administering any loha preparation, we have to augment it with drugs or preparations which would prevent constipation.

  • Udavartha is a variety of vaatha raga where in the vaayu (flatus), faeces and urine have an upward movement (unlike the normal movement which is downwards0, this is due to downwards), this is due to prathiloma (moving in the opposite direction) of vaatha. This is generally caused due to vegadhaarana (control of urges)

  1. Diarrhoea
    Diarrhoea or athisaara can be due to a number of reasons. This can be due to the use of incompatible foods, eating before the digestion of the previous meal, over eating, indigestion, vega dhaarana (control of urges), consumption of hard or solid substances (eg. seeds, uncooked pulses and grains), excessives tharpana (satiation) and langhana(emaciation), eating uncooked roots and tubers, polluted water, water, heavy and abhishyandhi dravyas, and also hunger, grief or fear. In conditions of aama, paachana drugs (like Ashta choornam) should be given (Kas. Sam., Khi 10). A decoction of bilwa (Aegle marmalos), mustha (Cyperus rotundus), dhaanyaka (Corriandum sativum)and jeeraka (Cuminum cinimum)can be used.

  2. Fever
    This is the most troublesome diseases in a pregnant woman. The foetus is also affected due to transfer of heat of fever from the mother to the foetus. Fever may be due to - excessive hunger, exertions, abhyanga, massage, dryness, heat, retention of normal faeces, improper use of snehana, swedana and agni karma psychological strain, climbing on mountains and smell of grass and flowers (pollen).
    Before the fourth month, the lady is advised a fast for one day (fasting is contraindicated in pregnancy as a general rule, but during jwara (fever) it can be advised for a day), followed by liquid diet (rice gruel) free from fat and salt. After the doshas have subsided, cereals with soups should be prescribed. advised meat soups and milk. Pungent diet and drinks, exercise and sudation should be avoided. No medicine need be given.

    During and after the fourth month medicines should be given only after considering the month of pregnancy and the doshas involved and their degree of vitiation. Lekhana karma and other such measures which make the body light should be done after considering properly - the complications of the disease, stamina and tolerance of the woman and the month of gestation.
    A decoction of mustha (Cyperus rotundus), parpataka (Mollungo pentaphylla), chandana (Santalum album) and sunti (Zingiber Officinallis) can be given.

  • For details on Aama please refer section on aama Chapters III, Aayurvedic Principles of Food and Nutrition Part I, LSPSS Monograph II

  1. Jaundice
    For treating jaundice the juice of bhooaamalaki (Phyllanthus nirun) with honey and sugar can be given or guduchi (Tinosposa cordifolia), katuki (Pipcorrhiza kurrpa), chirata (Swertia chirata) and daaruharidra (Berberis aristata) are given in the form of decoction.

  2. Measles
    A decoction of nimba(Melia azadirachta), dhaanyaka (corriandrum sativum), guduchi(Tinosposa cordifolia) and patola (Trichosanthus dioica) should be given.

  3. Itching in the Vulva
    A paste of haridra (Curcuma longa), nimba (Azadirachta Indica) and chandanam can be applied twice daily.

  4. Excessive vaginal discharge
    Some amount of discharge (Both as mucous and bleeding)is normal during pregnancy but when it is recurrent and excessive, medical advice is to be taken immediately. The case for the discharge should be properly investigated and required treatment should be given. The flowers of silk cotton tree (Bombax malabaricum) should be fried in ghee and taken with sugar early in the morning.

  5. Burning sensation during micturition
    Gokshuradi choornam with warm water, or just the decoction ofgokshura be should given.

  6. Convulsion (aakshepa)
    Convulsions may occur as a complication of garbhajanya vishamayatha. She should be given internally, a mixture of lime juice, bida lavana (rock salk) and saindhava lavana or a decoction of agnimantha (Premna latifolia) and varuna (Crataeva nurvala). It can also be treated according to the doshic predominance In the later stages of pregnancy ghrutha seka (sprinkling with ghee) is advised. The seka can be hot or cold according to the condition of the disease.

  7. Pain in the abdomen
    Pain in the abdomen may be to various reasons, the actual cause should be detected and treatment given. The decoction of yashtimadhu (Glycyrrhiza glabra), shunti (Zingiber officinale) and devadaaru (Cedrum deodara) can be given to give relief. If the pain is due to accumulation of gas, then she is given garlic boiled in milk or Hingwashtaka choornam orLavana Bhaskaram. She can also use more of asafoetida in her diet to avoid accumulation of gas.

  8. Headache
    A paste of dhaanyaka (Corriandrum sativum) in milk is applied externally Here also the causative factors should be detected and avoided.

  9. Insomnia
    Buffalo's milk can be given and externally abhyanga over the head can be done.

  10. Kikkisa (Striae gravidarum)
    Stiriae gravidarum is defined as the lines which appear on the abdominal skin, especially around the umblicus due to the stretching of the skin caused by the growing foetus.

    The Aayurvedic view is that the growing foetus displaces all the doshas upwards and reaching the chest region produces burning and itching sensations. The result of this itching are the linear lines on the abdomen. Internally she can be frequently given butter treated with themadhura gana drugs, in the dose of 10 ml (approximately). Externally, the paste of chandana (Santallum album) andusheera (Vetiveria zizanioides) or the paste of kutaja bark (Holarrhena antidysentrica), seeds of arjaka (Orthosiplion pallidus), mushta (Cyprus rotundus) andharidra (Curcuma longa) can be applied. Irrigation of the abdomen and breasts should be done with decoction of patola (Trichosanthes dioica), nimba (Azadirachta indica), manjishta(Rubia cordifolia) and surasa (Occmim sanctum).

    One should avoid scratching to avoid disfigurement of the stretching skin. If the itching becomes irresistable then the powders ofkutaja, arjaka mustha, haridra, patola, nimba manjishta, surasa etc. should be rubbed or paste of chandana should applied will suppress itching sensation due to its coolness.

Local Traditions
It is interesting to note that rural and tribal people are not only competent enough in diagnosis and care during pregnancy but are equally good in the management of diseases and conditions during pregnancy. A comprehensive list of conditions encountered during the various stages of pregnancy and their treatment have been given earlier. All the conditions (barring a few) are managed by them with locally available drugs. While most of their practices are healthy and should be encouraged, some are irrational and risky and should be discouraged. Some others are interesting and need further study.

Oil massage and hot water bath is advised for body pain in Tamil Nadu, Kerala and Karnataka. The report from Uttar Pradesh advises fomentation with hot water boiled with ajamoda (Apium graveolens). In Gujarat it is reported that warm water with leaves of shigru (Moringa olifera) is more useful. Dizziness and nausea are managed by oral administration of powder of dhanyaka Corriandrum sativum) with sugar in Uttar Pradesh and Tamil Nadu. Similarly juice of tulasi (Ocimum Sanctum) is also used with sugar. Lemon juice is widely used in Tamil Nadu and Karnataka. Some people in Tamil Nadu also take ginger in the form of chutney.

Weakness and anemic conditions are managed by intake of powder of badam (almonds) with milk. Ghee, milk, fruits and nourishing food is also advised in Uttar Pradesh, Tamil Nadu, Gujarat. Decoction of cardomom seeds and aniseeds, chutneys and pickles made of gigner, mint leaf and leaves ofthiruvatchi (Bauhinia Tomentosa) were also given. Siddha Vaidyas prescribed the chutney made of thiruvatchi leaves in conditions where the pittham is vitiated and also when there is nausea and anorexia (9). Barley water and tender leaves oftaadphal tree (Borassus flabelifer) with palm jaggery is advised for oedema in Tamil Nadu. Both of them are mutrala (diuretics) and help to reduce the fluid retention. For conditions like night blindness and blurred vision there were no significant responses. In conditions of worm infestation the woman is given a decoction of jyothismathi (Cordiospermum lelicacabum), in Tamil Nadu and Karnataka.

Piles was treated by intake of flesh of snails in Tamil Nadu. Siddha vaidyas widely used preparations of the flesh of snail and the shell of snails. The general advise for relief from constipation is to include green and leafy vegetables and fruits like plantains (8). While in parts of Kerala and Tamil Nadu oral dehydration is resorted to in diarrhoea, in Tamil Nadu it was also reported that milk boiled with garlic (in the form of lasuna ksheera paakam) is given. Also butter milk rice is given and chillies and greens are avoided. Lasuna ksheera paaka acts as a good aama paachana/ and agni deepana drug. The practice of avoiding chillies and leafy vegetables is good.

Decoctions of Trikatu (Gingiber offcinale, Piper longum and Piper nigrum) and Tulsi are given in Kerala and Tamil Nadu for fever.Jaundice seems to be very common and field groups were well experienced in treating it.Bhooamalaki (Phyllanthus niruri) used in Tamil Nadu and Karnataka. Also ghruthakumari (Aloe vera) and bringaraja (Eclipta alba) are used in Orissa and Tamil Nadu

Washing with salt water, decoction of haritaki (Terminalia chebula) or plain hot water is advised for itching in the vulva in Kerala and Tamil Nadu. In Orissa it is advised to apply ghee locally. For excessive vaginal discharge a decoction of ani seeds and tender coconut was advised in Tamil Nadu. The woman was advised to drink barley water and decoction ofgokshura (Tribulus terrestris), in conditions of burning sensation while micturition. Gokshura being mutrala (diuretic) relieves the burning sensation.

Pain in the abdomen is teated by giving decoctions of dhanyaka or decoction of fresh ginger with palm jaggery. Externally castor oil or coconut oil is applied over the abdomen. In cases of head ache, a paste of tender coconut and breast milk is applied on the forehead in Kerala and Tamil Nadu. The woman is advised to take more milk (preferably buffalo's milk) at night, apply lime juices or oil on the head, in Tamil Nadu to get relief from insomnia. Buffalo's milk being "guru" induces sleep. Applying lime juice and oil cools then system and induces sleep.

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