Garbhasrava, Garbhapata – Meaning, Causes, Ayurveda Treatment

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Garbha Srava is expulsion of fetus up to 4th month of pregnancy. The term ‘srava’ to flow out is given because the products of conception are in liquid form up to 4th month. Master Bhoja opines that the period of garbha srava is up to 3 months.

Garbha = fetus / embryo
Srava = to flow, discharge
Pata = to fall down

Garbha Pata is expulsion of fetus in 5th and 6th months of pregnancy. The term pata – to fall off is given because by this time the products of conception and fetal parts have attained stability and have become solid.

Master Bhoja’s explanation seems to be logical. The expulsion of products of conception usually occurs in pieces up to 3rd month i.e. before complete formation of placenta, amniotic membrane and its fluid. After this period the amniotic bag is completely formed. The mechanism of abortion therefore resembles a miniature labor.
Read – Mudha Garbha – Obstructed Labor, Ayurveda Perspective

Causes

1. According to Master Charaka

Abnormalities in factors responsible for proper growth and development of fetus and delivery of fetus are responsible for abortion or intrauterine death of fetus. These factors include abnormalities of –

  • shukra – semen / sperms
  • asrk – ovum or ovarian hormones
  • atma – life principle
  • ashaya – uterus / womb
  • rtukala – menstrual cycles
  • ahara – congenial dietetics

Abnormalities of semen and vayu are also the causes for abortion or miscarriage.

After 4th month of pregnancy, the below mentioned factors will cause bleeding from the vagina or abortion –

  • anger
  • grief
  • discontentment
  • jealousy
  • fear
  • terror
  • excessive exercise
  • excessive coitus
  • irritation
  • suppression of natural urges
  • sitting, standing or sleeping in abnormal places or in abnormal postures
  • suppression of thirst and hunger
  • use of stale and unwholesome foods
    Read – Essential Elements For Conception – Garbha Sambhava Samagri

2. According to Master Sushruta

Master Sushruta has explained the etiological factors of abortion and obstructed labor together. They are as below mentioned –

  • excessive coitus
  • travelling in carriage for long distances and frequently
  • riding on horse etc
  • traveling on foot – excessive walking
  • staggering / stumbling
  • falling from height
  • compression
  • running fast
  • trauma by weapons, stones or whips etc
  • sleeping or sitting in uneven place
  • fasting
  • suppression of natural urges
  • consumption of excessive dry, hot or pungent foods
  • grief
  • diarrhea
  • excessive use of alkalies, emetics and purgatives
  • swinging
  • indigestion
  • use of abortifacient drugs

Due to the above said factors, the fetus gets detached from its bonds just like a fruit gets detached from its stalk due to trauma. Just like the fruit untimely falls down from the plant due to the effect of insects, wind and injury, the fetus too gets detached due to the influence of all these factors.

Other factors –

  • Physical and psychological disorders of mother
  • Disorders of fetus
  • Conception occurring on 3rd day of menstrual cycle
  • Conception occurring by a man of below 25 years of age
  • Conception occurring in a woman of below 16 years of age
  • Coitus with a pregnant woman troubles the fetus and thus leads to abortion
    Read – Management Of Labor In Ayurveda – Prasava Paricharya

3. According to Master Vagbhata 1 & 2

  • Woman not giving up the contraindicated things
  • Excessive accumulation of doshas
  • Diseases of mother or fetus
  • Influence of deeds of previous life of mother or fetus
  • Nature
  • Use of non-congenial diet, mustard (leaf) etc vegetables
  • Slowly formed curds
  • Place of living
  • Time factor

 (Note – 1 = Master Arunadatta’s opinion)

4. Other opinions

  • All kinds of 20 Yoni Vyapats (vaginal / uterine disorders) can cause abortion (Master Bhela)
  • Vitiated doshas, mainly vitiated vata is responsible for abortion (Master Harita)
  • Garbhanasha (abortion) is one of the 80 disorders of vata i.e. vata is responsible for abortions when it is vitiated (Bhavaprakasha)
  • Aggravated vayu located in semen causes abortion
    Read – Symptoms Of Vata Dosha Increase And Imbalance – Vata Vruddhi Lakshana

5. Causes of Yonivyapat and Jataharini

Etiological factors of Yonivyapat – vaginal / uterine disorders and Jataharini should also be considered among the etiological factors of abortion.

In the Jataharinis like andaghni, durdhara, kalaratri and vasya etc the main clinical features are the expulsion of fetus from very early stage to second trimester.

Similarly the uterine disorders like putraghni, vamini, asraja or apraja too denote repeated abortion.
Read – Multiple Pregnancy, Twins Ayurveda Concept – Bahvapatya, Yugma Garbha

Pathogenesis

The fetus gets detached from its bonds due to exposure to etiological factors. This fetus, exceeding normal limits within the uterus descends downwards in between the hollows of liver, spleen and bowels produces irritation in the abdominal cavity.

Due to this irritation, vayu gets aggravated.

This vayu causes pain in the flanks, lower abdomen, uterus, and neck of urinary bladder, abdomen and vagina along with flatulence or distension of abdomen, retention of urine etc symptoms and troubles the young fetus with bleeding i.e. causes abortion.

Symptoms

Pushpam Pashyet (Cha.Sha.8/24) – bleeding from vagina – is the only symptom explained by Master Charaka.

The symptoms mentioned in pathogenesis of abortion too can be considered as symptoms of abortion.

Other symptoms (Su.Sha.10/57, A.S.Sha.4/3) –

  • Garbhashaya shula – pain in uterus
  • Kati shula – pain in sacral region
  • Vankshana shula – pain in groin region
  • Vasti shula – pain in the region of urinary bladder
  • Rakta darshanam – bleeding from vagina

According to Master Dalhana – the pain is due to vitiation of vayu and bleeding is due to expulsion of ama-garbha and opening of orifices of artava vaha srotas – channels carrying menstrual blood (vaginal and uterine passages).

Prasramsamana Garbha Lakshana – Symptoms of slight descent of fetus for expulsion

  • Pain with burning sensation in flanks and back
  • Excessive bleeding
  • Distension of abdomen
  • Retention of urine

Garbha Sthanantargamana Lakshana – symptoms of displacement of fetus from its original place

When the fetus moves from one place to the other, there is irritation of abdominal cavity and pain.
Read – Monthly Development Of Fetus – Ayurvedic perspective

Sanskrit verses

Terms indicating different types of abortion in Ayurveda

Sl NoAyurveda term denoting abortionModern correlation
1Vyavasthita / Sthiti yogya garbhaThreatened abortion
2Prasramsamana GarbhaInevitable abortion
3Garbha SheshaIncomplete abortion
4Apraja and Putraghni Yoni or JatahariniHabitual abortion
5Anavashesha GarbhaComplete abortion
6Garbha PatanaInduced abortion

Complications

Though Ayurveda texts have not mentioned or enlisted the complications of garbha srava or pata, they have explained the management of few complications. Even during the course of describing certain systemic disorders, abortion has been enlisted as a causative factor or one of the causative factors of those conditions. This makes abortion as the etiological factor for certain diseases and those diseases may be considered as complications of abortion.

  • Shotha – Edema – excessive blood loss during abortion will lead to anemia which further causes generalized edema.
  • Apatanaka – tetanus – Tetanus developing after abortion is incurable. If it is cured, it may leave back a permanent abnormality. Tetanus is one of the complications in induced abortion, which is often life threatening.
  • Piles are also said to develop due to abortion.

Treatments of certain complications have been mentioned while describing the management of abortion. They include –

Prognosis

Abortions up to 3rd month are incurable – If bleeding occurs in 2nd or 3rd month owing to use of non-congenial diet and mode of life, the fetus is not retained because the fetus will not have proper development up to this period – asanjata sara and the fetus is also in amawastha – unripe / unformed state.

Ama garbha is a difficult condition to treat – When the fetus is associated with ama and bleeding starts, up to 3rd month or even afterwards, it usually kills the fetus. This is because of opposite property of treatment. Cold, sweet and soft herbs are needed for stopping the bleeding and for retaining the fetus. These will increase ama due to similar properties. These herbs are also opposite to qualities of artava – menstrual blood / ovum which is hot and fiery in character.

Treatment of Garbhasrava

Treatment of abortion of ama-garbha – immature fetus

A. Treatment before expulsion of fetus

1. Use of dry and cold substances

2. Duralabhadi Kashayam – Decoction prepared with the below mentioned herbs shall be prescribed after the woman has observed fasting –

  • Duralabha – Fagonia cretica
  • Amrta – Tinospora cordifolia
  • Ushira – Vetiveria zizanioides
  • Parpataka – Fumaria officinalis
  • Ghana – Cyperus rotundus
  • Sandalwood
  • Ativisha – Aconitum heterophyllum
  • Bala – Sida cordifolia
  • Katwanga – Oroxylum indicum
  • Coriander

3. Peya – For preparing gruel or solid diet, Trna Dhanya – grains, shali – rice / paddy or shashtika shali – paddy grown in 60 days shall be used.

4. Yusha – Soup prepared with green gram etc should be prescribed in the diet for digestion of ama. After dealing with ama, unctuous measures along with cold measures or only unctuous measures shall be used.

B. Treatment after expulsion of fetus

1. Madhya Pana – Wine should be administered after the products of conception have been expelled. This would cleanse and evacuate the uterus in totality and relieves pain. Wine should be given considering the strength of the woman.

2. Ruksha Peya – Dry i.e. fat-free potion / gruel medicated with Laghupanchamula should be given after the woman has consumed wine.

3. Tila Uddalaka Yavagu – This recipe should be prescribed for the women who do not consume wine. It is a gruel which is free of fat and salt and prepared with tila = sesame and uddalaka = Cordia dichotoma mixed with digestive herbs. Alternatively a drink prepared with sesame, Cordia dichotoma or rice processed with decoction of Brihat Panchamula and medicated with paste of Panchakola should be given. This dietetics should be given in the number of days corresponding to the number of months of pregnancy. This means to tell that if the pregnancy was of 2 months, the dietetic regimen mentioned shall be given only for 2 days.

4. Dipaniya Peya – Light to digest potion / gruel prepared with appetizing herbs and devoid of fat and salt should be used.

5. Venugranthyadi Kashayam – Decoction prepared from Venugranthi – , Kulattha – horse gram and Haridra – turmeric should be prescribed in abortions of very short duration.

6. Swedana – Administration of sudation is beneficial.

7. Purana Guda – Old jaggery mixed with appetizing herbs or Abhayarishta and other fermented bevereges should be prescribed for relief of pain in abdomen and bladder.

8. Snehapana – After complete expulsion of immature fetus oral use of medicated oil and ghee (oleation), enemas and diet consisting of appetizing, digestive, jivaniya i.e. life prolonging, sweet and vata alleviating things should be prescribed.

Note – Oleation should not be given to a woman who had aborted. If oleation is given, blood, moisture and impurities get stagnated in the uterus. These produce various kinds of incurable disorders. Therefore the woman should be given with digestive (ama digesting) and dry substances / herbs for 10 days. Later oleation should be given in a methodical way.

Treatment of Pariharya Garbhasrava – Threatened Abortion

Ayurveda texts have not clearly described anything while describing the treatment of abortion that the below mentioned explanation could be categorized under ‘treatment of threatened abortion’. Still based on the predominance of herbs having sweet, cold and soft qualities in the formulations and taking clues from Master Charaka’s statement telling ‘the method for stability of fetus is being told, by this her abortion is prevented’ the below explained treatment strategies may be considered to be those mentioned for stabilizing the fetus i.e. treatment of threatened abortion. The treatment should be started immediately after evidence of bleeding from vagina.

The woman should be made to sleep on a soft, comfortable and cool bed having head end lower than the foot end.

A. Principles of treatment

The woman should be treated with –

  • Cold baths
  • Showering of medicaments / irrigation
  • Tub bath / immersions
  • Unction / application of medicinal pastes
  • Drinking of milk boiled with Jivaniya group of herbs

The treatment should be prescribed in accordance of the predominant dosha.

Treatments prescribed for raktapitta – bleeding disorders, with the exception of purifying therapies shall be used in this condition also.

Milk is beneficial and shall be prescribed.

Use of hot water is contraindicated.
Read – Benefits Of Drinking Hot Water, Contra Indications

B. External medicines for threatened abortion

1. Shatadhauta / Sahasradhauta Ghrta – Ghee washed for 100 or 1000 times shall be anointed on the abdomen below the navel.

2. Madhuyashti-Ghrita yoni dharana – Tampon soaked with paste of licorice and ghee and kept immersed in extreme cold water should be placed inside the vagina. Alternatively ghee prepared with licorice shall be used in the same method.

3. Nyagrodhadi Gana Siddha Pichu – Tampon soaked in one of the below mentioned should be placed in the vagina –

  • Ghee extracted from the milk processed with leaf buds of Nyagrodhadi gana group of herbs
  • Ghee prepared with Nyagrodhadi Gana group of herbs
  • Milk processed with Nyagrodhadi Gana group of herbs
  • Juice of Nyagrodhadi Gana group of herbs
  • Oil prepared with Nyagrodhadi group of herbs

4. Kshiri Vrksha Kashaya Pichu Dharana – Tampon or cloth soaked in juice or decoction of leaves or stem bark of latex yielding trees or plants having astringent property should be placed inside the vagina.

5. Sevyadi kalka pichu dharana – Tampon anointed with paste of Sevya – Vetiveria zizanioides, Ambhoja – Nelumbo nucifera / Salix tetrasperma, Hima and Kshiri Vrksha – stem bark of latex yielding plants should be placed in the vagina or over the region of urinary bladder.

6. Avagaha – tub bath with sufficiently cooled water should be given.

7. Parishechana – one of the below mentioned shall be poured / showered over the abdominal area, especially below the umbilicus –

  • Cold cow’s milk
  • Decoction of Licorice
  • Decoction of herbs of Nyagrodhadi group of herbs

8. Lakshadi Taila Abhyanga – Massage should be repeatedly done with Lakshadi Taila oil. It is nourishing to her fetus.

9. Root of Kankati – Abutilon indicum knotted with a thread which is having the length identical to the height of pregnant woman, spined by a young virgin, should be tied to the waist of pregnant woman. This prevents abortion.

C. Internal Medicines for Threatened Abortion

1. Garbhasthapana herbs – herbs which stabilize the fetus / embryo are useful.

2. Jivaniya group of herbs

Jivaniya Gana siddha Ksheera – Milk processed with Jivaniya group of herbs or mixed with paste of shali rice

Baladi Peya – Liquid / drink prepared with below mentioned herbs prevents abortion –

  • Bala – Sida cordifolia
  • Vrshatparni
  • Shalaparni – Desmodium gangeticum
  • Pomegranate
  • Bilva Shalatu – unripe young fruits of Aegle Marmelos

Nyagrodhadi Yusha – Soup prepared with tender leaves of mixed with pomegranate and ghee –

  • Nyagrodha – Ficus bengalensis
  • Udumbara – Ficus racemosa
  • Aswattha – Ficus religiosa
  • Plaksha – Ficus lacor
  • Trivrit – Operculina turpethum
  • Palasha – Butea monosperma
  • Kamala patra – leaves of lotus

Kasherukadi Kashayam – Decoctin prepared with the below mentioned herbs should be given with honey and sugar –

  • Kasheru – Scirpus grossus
  • Mrunala – Nymphaea stellata
  • Srngataka – Trapa bispinosa
  • Kashmari – Gmelina arborea
  • Parushaka – Grewia asiatica
  • Draksha – Vitis vinifera
  • Sariva – Hemidesmus indicus
  • Prapaundarika – Nelumbo nucifera
  • Ananta – Hemidesmus indicus
  • Utpala – water lily
  • Kadamba bija – seeds of Neolamarckia cadamba

Lajjalvadi Churna – Powder of the below mentioned should be given mixed with honey –

  • Lajjalu – Mimosa pudica
  • Dhataki – flowers of Woodfordia fruticosa
  • Water lily
  • Lodhra – Symplocos racemosa

Aparajita Churna – powder of Clitoria ternatea with honey should be taken with goat’s milk

Nilotpaladi Churna – Powder of the below mentioned should be given with rice water or juice of Adhatoda vasica –

  • Nilotpala – Nymphaea alba
  • Durva – Cynodon dactylon
  • Red clay of potter’s kiln
  • Chandanadi group of herbs

Vrddhyadi Churna – Powder of the below mentioned herbs should be served mixed with milk –

  • Vrddhi – Habenaria edgeworthii
  • Vidari – Pueraria tuberosa
  • Jivanti – Leptadenia reticulata

Dhatakyadi Churna – Powder of the below mentioned should be given with honey –

  • Dhataki – Woodfordia fruticosa
  • Gairika – Purified red ochre
  • Sarjarasa – Vateria indica
  • Rasanjana – Extract of Berberis aristata

Sharkaradi Churna – Powder of Sharkara – sugar, Bisa – lotus and black sesame should be given with honey.

Powders of any one of the below mentioned should be given with honey in case of excessive bleeding –

  • Clay of house of an insect named koshtagarika
  • Samanga – Mimosa pudica / Biophytum sensitivum
  • Flowers of Dhataki – Woodfordia fruticosa
  • Gairika – ochre
  • Sarjarasa – Vateria indica
  • Rasanjana – extract of Berberis aristata

Paste of one of the below mentioned should be given –

  • Utpaladi group of herbs
  • Kasheru – Scirpus grossus, Shringataka – Trapa bispinosa and Saluka – lotus rhizome
  • Shali rice with honey and sugar along with sweetened decoction of fruits of Udumbara – Ficus racemosa or Udaka kanda – rhizomes of aquatic plants like lotus etc
  • Tender leaves or stem bark of Nyagrodhadi group of herbs with or without milk
  • Saffron of Padma – Nelumbo nucifera, water lily and Kumuda – Nymphaea alba should be given with either only honey and sugar or by adding ghee extracted from milk

Other oral formulations

  • Use of milk
  • Feces of pigeon with juice of betel leaves
  • Clay of potter’s hands dissolved in water
  • Blood of rabbit, ena (species of deer or antelope) and deer with honey
  • Meat soup of quail, sparrow, antelope, rein-deer, rabbit, deer and black tailed deer mixed with ghee with cooked shali rice
  • Soft, cool, cooked rice incensed with fragrant articles should be mixed with milk. This book should have been boiled and processed with roots of Bala – Sida cordifolia, Atibala – Abutilon indicum, Rice, Shashtika – paddy grown in 60 days, sugarcane and kakoli – Lilium polyphyllum. This rice should be given with honey or sugar. The same rice should be served with meat soup of wild animals or birds having cold potency.
  • Only ghee extracted from milk is beneficial.
  • Ghee extracted from milk medicated with leaf buds of Nyagrodhadi group of herbs should be given.
  • Oral or nasal instillation of juice of Lakshmana should be done.
  • Sringhataka – Trapa bispinosa, Kasheru – Scirpus grossus and Pushkara bija – seeds of Inula racemosa should be prescribed for eating.

D. Treatment of recurrent bleeding – Milk medicated with Utpaladi group of herbs should be administered in case of recurrent bleeding.

E. Treatment after stability of fetus – cow’s milk medicated with unripe young fruits of Udumbara – Ficus racemosa shall be prescribed.

F. Mode of life – The woman should avoid anger, grief, getting exhausted, coitus and excessive exercise. She should be made cheerful by pleasing and desired stories.

Treatment of Complications of Abortion

1. Excessive quivering of fetus – Milk medicated with Utpaladi group of herbs should be given.

2. Treatment of excessive pain –

Mahasahadi Kshira – Milk medicated with the below mentioned shall be given mixed with honey and sugar –

  • Mahasaha – Teramnus labialis / Barleria prionitis
  • Kshudrasaha – Phaseolus trilobus
  • Licorice
  • Swadamshtra – Tribulus terrestris
  • Kantakari – Solanum xanthocarpum

Kaservadi churna siddha kshira – Milk mixed with sugar and decoction or powder of the below mentioned should be given –

Kushadi Kshira – Milk treated with roots of the below mentioned should be given mixed with sugar –

  • Kusha – Desmostachya bipinnata
  • Kasha – Saccharum spontaneum
  • Castor
  • Gokshura – Tribulus terrestris

3. Treatment of retention of urine

  • Milk prepared with Darbhadi group of herbs mixed with honey or sugar should be given.
  • Milk treated with Trnapanchamula group of herbs is beneficial.

4. Treatment of flatulence

Milk medicated with the below mentioned shall be prescribed with or without sugar and honey –

5. Treatment of pain without bleeding

a. Madhukadi Ksheera – Milk medicated with –

b. Ashmantakadi Ksheera – milk medicated with –

c. Milk medicated with Vidarigandhadi group of herbs

d. Milk or ghee medicated with juice of Swadamshtra – Tribulus terrestris

e. Ghee treated with juice of onion and mixed with honey

f. Brihatidwayadi Kshira – Milk medicated with the below mentioned should be given –

6. Treatment of burning sensation etc

  • Unctuous and cold herbs and measures should be done
  • Milk processed with Trna panchamula group of herbs should be given

7. Treatment of fever due to complication of abortion

Fevers occurring as a complication of abortion shall be treated on the basis of predominant dosha or doshas causing the fever and after considering their symptoms.
Read – Ayurveda Lifestyle and Diet For Fever – 45 Important Things To Know

Month-wise treatment of Abortions

Powder or paste of the herbs mentioned in the month-wise treatment of abortions shall be given with milk.

1st month of pregnancy – Madhukadi churna / kalka

2nd month of pregnancy – Ashmantakadi churna / kalka

  • Ashmantaka
  • Sesame
  • Tamravalli
  • Shatavari – Asparagus racemosus

3rd month of pregnancy – Vrukshadanyadi churna / kalka

  • Vrkshadani – Dendrophthoe falcata
  • Payasya – Lilium polyphyllum
  • Priyangu – Callicarpa macrophylla
  • Utpala – Water Lily
  • Sariva – Hemidesmus indicus

4th month of pregnancy – Anantadi churna / kalka

5th month of pregnancy – Brihatidwaya churna / kalka

  • Brihati – Solanum indicum
  • Kantakari – Solanum xanthocarpum
  • Kashmarya – Gmelina arborea
  • Kshiri shunga – tender leaves of latex yielding plants
  • Kshiri twacha – bark of latex yielding plants
  • Ghee

6th month of pregnancy – Prishniparnyadi churna / kalka

7th month of pregnancy – Shringatakadi churna / kalka

  • Shrngataka – Trapa bispinosa
  • Bisa – Nelumbo nucifera
  • Raisins
  • Kasheru – Scirpus grossus
  • Licorice
  • Sugar
  • Bala – Sida cordifolia

8th month of pregnancy – Kapitthadi churna / kalka

9th month of pregnancy – Anantadi churna / kalka

  • Ananta – Hemidesmus indicus
  • Sariva – Hemidesmus indicus
  • Payasya – Lilium polyphyllum
  • Madhuyashti – Glycyrrhiza glabra

10th month of pregnancy – Shuntyadi churna / kalka

  • Ginger and Payasya – Lilium polyphyllum
  • Ginger, Licorice and Suradaru – Cedrus deodara
  • Only Payasya – Lilium polyphyllum

11th month of pregnancy – Kshirikadi churna / kalka

  • Kshirika – Manilkara hexandra
  • Utpala – Water Lily
  • Samanga – Mimosa pudica
  • Shiva – Aegle marmelos

12th month of pregnancy – Sitadi churna / kalka

Treatment of Garbha Chalana

Garbha Chalana means abnormal movement of the fetus. Month wise treatment of this condition explained in Ayurveda hints towards Garbha Chalana being a possible explanation of threatened abortion or excessive quivering. The treatment for the same also may be considered in treatment of abortions.

Varana Bandha / Prajavarana Bandha

Master Kashyapa has described Varana Bandha – type of mantra for preventing abortion. It shall be applied before 8th month of pregnancy.

Click to Consult Dr Raghuram Y.S. MD (Ayu)

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