Sutika Paricharya W.S.R. To Post-Partum Care- A Samhita Based Review

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P a g e | 194 Review Article ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION International Research Journal of Ayurveda & Yoga An International Peer Reviewed Journal for Ayurveda & Yoga Sutika Paricharya W.S.R. To Post-Partum Care- A Samhita Based Review Dr Sipika Swati 1 ICV-70.44- ISRA-1.318 VOLUME 4 ISSUE 3 1. Assistant Professor, ITRA, Jamnagar Corresponding Author :- Dr Sipika Swati, Assistant Professor, ITRA, Jamnagar Email: drsipikaswatibhu@gmail.com Article received on 21 st Feb 2021 Article Accepted 23 rd March 2021 Article published 31 st March 2021 ABSTRACT: - Background: Puerperium is period following childbirth during which all body tissues revert back to approximately a prepregnant state. All Ayurvedic treatises have given a detailed account for Sutika paricharya. Sutika kala is a period begins after expulsion of placenta. Maternal mortality and morbidity are most challenging problem of our country. A recent survey by BJOG (2004) in certain villages in India mentions incidence of maternal morbidity as high as 52.6%. Prevalence of Puerperal morbidity is at a whopping rate of 42.9%. Methodology: The study is narrative review of therapeutic principles of Sutika Paricharya in various classical texts of Ayurveda . Relevant chapters from Bruhatrayee and Laghutrayee were reviewed with the relevant commentaries. Modern literature on the therapeutic modalities of Sutika Paricharya also reviewed and compared with the ancient texts. Discussion and Conclusion : This period is of happiness & contentment, on one hand and physical & mental fatigue due to delivery, on the other hand, she become weak or emaciated after loss of blood and body fluid during delivery. Frequent postpartum morbidity and its association with adverse perinatal outcomes suggest the need for better post-partum care in developing country like India for both mother and baby. The regimen that helps the woman to regain her lost vitality and helps her body to revert back to prepregnant state is called Sutika paricharya. Ayurvedic post-partum care is based on the therapeutic principles like Garbhashaya shuddhi , Dhatu-paripurnata, sthanyavriddhi , punar navekarana are well established. A stage of Physical, mental and physiological wellbeing is re-stabilized. Key words : Sutika , Puerperium,, sutika paricharya ,maternal mortality

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P a g e | 195 Review Article ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION This work is licensed under a creative attribution -Non-commercial-No derivatives 4.0 International License commons How to cite this article: - Dr Sipika Swati Sutika Paricharya W.S.R. To Post-Partum Care- A Samhita Based Review IRJAY, March: 2021, Vol 4, Issue-3; 194-200, Doi: https://doi.org/10.47223/IRJAY.2021.4328 INTRODUCTION: The word SUTIKA is derived or originated from the basic Sanskrit element ‘Su’ in Sanskrit meaning ‘to produce’ or ‘to yield’. That means after giving birth to the baby the women is called as Sutika. After delivery of child till placenta is not expelled woman cannot be called as Sutika , i.e. Sutika term can be used only after expulsion of placenta [1] This highlights the Ayuverdic principle of mala (morbid matter) expulsion which include expulsion of all the products of conception including the placenta. Prasava (expulsion of fetus / labor) is a strenuous activity which cause a decrease in Dhatu nutrition and function as a result Dhatus become languid or unsteady, body muscle mass and strength decreases. In order to regain all the lost vital elements in the female body a certain time period is required which is the period of Sutika avastha (Puerperium). In this period the Sutika regains all the anatomical and physiological changes that have occurred due to pregnancy and labor. According to Ayurveda this period varies from 10 days to 6 months. Period Of Sutika Avastha Found In Different Ayurvedic Texts: a) According to Acharya Vagbhatta, period of Sutika in days depends on the period of gestation in months, therefore the parturient with normal labour should follow Sutika paricharya for at least 10 days [2] b) According to Sushrutacharya dietary and daily routine management should be strictly followed for 1 ½ months, after that she may start her regular diet and routine life style gradually [3] c) According to Bhavamishra the period of Sutika is described as of 1 ½ month or till the re-occurrence of menses [4] d) Kashyapa suggested that total six months period is required to regain Raktadi Dhatu to their original status. So Kashyapa expects Sutika to follow puerperal management at least for 6 months [5] Sutika Griha Sutikagriha which is explained in ancient text is a special aseptic room constructed only for puerperal women. It was made compulsory in ancient days to stay for women in Sutikagriha for at least 10 days Sutika is properly bathed after 10 days and then she is allowed to come out of Sutika griha . In Kashyapasamhita , Sutika is compared with an old cloth and an old house that can be collapsed at any moment [4] It is therefore essential for a parturient to follow Sutika Paricharya. [6] Sutika Paricharya : Ayurveda considers Sutika Paricharya an integral part of reproductive health, it is highlighted by the fact that every classical treatise of Ayurveda described it and explained it. Moresoever, Kashyapa detailed Sutika Paricharya in the socio-cultral contexts of Desha (Geographical area of the birth of

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P a g e | 196 Review Article ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION baby), sex of the child etc. Sutika Paricharya can be widely seen as preventive treatment by which we protect the women to become ‘ Dushprajata ’(women with adverse reproductive outcomes). It is very important to provide her proper diet and rest as well as physical and mental restoration of her health. For this purpose Acharya of different treaties have described Sutika Paricharya [7] . Table 1: Principles Of Sutika Paricharya Balavariddhi To increase the maternal strength Agnisandukshan To increase the metabolism and appetite for repairs Vatashaman To neutralize aggravated Vata Garbhashaya Shodhana For involution of uterus and cleansing Stanya pravartana To increase quality of lactation. Kumarbharanartha For wellbeing and nourishment of baby Sutika Paricharya can be classified as 1. General Measures of Post-partum care- Samanya Sutika Paricharya 2 Specific Measures of Post-partum care- Vishista Sutika Paricharya Table 2: Sutika Ahara Paricharya (Dietary Regimen) according to different Schools of Ayurveda Caraka [8] Sushruta [9] Vagbhata [10] Kashyapa [11] Ahara Upto 7 days Snehapana (Pippalyadi Dravyas ) ↓ Yavagu Pana (Pippalyadi Dravyas) Vatahara Ausadha Kwatha Pana and Ushna Gudodaka (Pippalyadi Gana Dravyas) 2-3 days. ↓ Sneha or Ksheera Yavagu Vidarigana Sadhita Dravyas) Snehapana (Pippalyadi Dravya with saindhava) ↓ Ushna gudodaka/ Vatahara Kwatha 2-3 days ↓ Vatahara Ausadha Peya ↓ Ksheera Yavagu / Yavagu Pana (Pippalyadi Mandapana ↓ Hita Bhojana 3-5 days. ↓ Sneha Pana ↓ Sneha Yavagu Pana (Pippali, Nagara Yukta and Lavana Rahita) 5 th -7 th day.

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P a g e | 197 Review Article ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION Sutika Vihara (Post -Partum Life style Management) Abhyanga : Massage for Parturient and Post -Partum In Bruhatrayi and Kashyapa Samhita it is mentioned that the women after delivery should be massaged whole body. Sushruta (prescribed Bala Taila [12]. Vagabhatta advised massage to yoni (reproductive tract) also and Harita [13] endoresed yoni purana i.e. retention of oil in the reproductive tract. The lady is made to lie down in Nyubja position (prone position), Abhyanga, Samvahana is done over Udara, Pristha and Katipradesha , using Sarpi or Taila or Yamaka Sneha (combination of ghruta and oil ). This Udara Peedana helps in removing the Pravartita Garbha Dosha. Massaging back [14] flanks and abdomen helps in redirection of vitiated Apana vayu, stimulates muscles and relieves pain developed during and after prasava . It also helps in expulsion of residual clots retained in the uterine cavity [15] Abhyanga of yoni helps to tone the vagina and perineum. Udara Vestana : Sthanika Abhyanga is followed by Udara Vestana (Abdominal strapping) using a big clean cloth. Tying it around Kukshi Parshva helps Udara or Garbhashaya to be in its Swasthana, as it maintains the tone of muscles of abdominal wall.It also prevents the accumulation of Vayu in Udara (abdominal cavity), hence, avoiding vitiation of vayu. Ushna Bala Taila Purita Charmavana Asana - Leather bag is prepared and Sutika is made to sit over that Asana. This will help in Yoni Prasadana . [16] Ushnambu Snana and Seka (Irrigation): It is advisable for Sutika followed by Yoni Dhupana (local fumigation) using Kustha ( Saussurea lappa .), Guggulu ( Commiphora wightii ), Agaru ( Aquilaria agallocha) ,Ghrita etc. [17] All these therapies are followed by adequate rest which helps in Klama Nirharana All these procedures are mainly to suppress or control the vitiated Vata i.e. for Vatanulomana. 4 th -6 th day or Vidarigana Dravya) 4 th-7 th day Ahara 8 th -11 th day Apyayana and Swasthavritha Palana Jangala Mamsarasa Siddha with Yava, Kola, Kulatha Yusha, and Shaali Bhojana. Jeevaneeya Madhura, Bruhmaniya, Balya, Vatahara Dravya Sadhita Annapana Yavagu Pana (Lavana, Sneha Aushadha Yuktha) Ahara 12 th day onwards Jangala Mamsarasa Kulattha Yusha, Jangala Mamsarasa . Gritha bharjita Shaka (Kushmanda, Mulaka, Earvaruka); Ushna Jala Sevana 1 month

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P a g e | 198 Review Article ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION Vishista Sutika Paricharya [18] This particular regimen is explained by Kashyapa based on the particular type of Desha , in which Sutika is residing. a) Anoopa Desha - In this Desha the Sootika should use Manda (Boiled rice water) which is processed with Agnibala Vardhaka drugs. Nivata Shayana , Svedana and use of only Ushna Dravya is beneficial. All Sneha Dravyas (fats and oils) and Abhishyandi Ahara (foods which tend to obstruct the channels) should be avoided. b) Jangala Desha - Here Sneha Upachara is advised to Sutika Stree specially. The Sootika in this Desha should be given with Ghrita, Taila etc. Snehapana or Yavagupana for at least 3 or 5 days is beneficial, then followed by using Snigdha Anna and Samsarjana krama. Ushnodaka Parisheka is also advised. c) Sadharana Desha - For the Sutika from this kind of land, usage of neither too Sneha nor too Ruksha Dravyas is said to be beneficial. One should advise for Sadharana vidhi. d) Videsha Jaati - The Sutika Stree of Mlechha Jaati should use Rakta, Mamsarasa Niryuha, Kandamula and Phala in their Paricharya. Kashyap also has given use of Taila and Ghrita in case of delivery of male and female child respectively followed by Yavagu Pana processed with Deepaneeya Dravya . Puerperal Management according to the sex of child [19] In case of delivery of male child, oil should be given to the Prasoota, and Ghrita in case of female child. After proper digestion of fat, rice gruel ( Yavagu ) with Deepaneeya drugs should be given for 5-7 days, then, Mandadi should be used in a gradual manner. General indications ( Pathya ) [20] According to Bhaishjya Ratnawali a sutika should follow: • Langhan - Light and easy to digest diets and Purana Madya (Aged wines and ferments), Shastika-Shaali (Aged rice for gruels and broths). • Mridu Sweda - Light to medium fomentation • Abhyanga- Comforting Massage • Tailapana - Internal use of medicated oil • Aushadha : Katu-Teekshna-Ushna Sevana ,Deepana-Paachana • Brihmana: Restorative and nourishing diet 7 days postpartum including Mamsa Sevana after 12 days post partum period. General Contraindications (Apathya) — Krodha, Maithuna, Diwaswap, Uchhe Sambhashan, Yanayanen, Chir Asana ,Chir Utishta, Atyamala Upabhoga, Vayu Sevana, Aatapa Sevana, Virudha Ahara, Adhyashana, Asatmya Bhojana, Sheetala Jala [21] DISCUSSION Sutika avastha is a very special period in women’s life. In this Sutika avastha , Sutika should be treated with extreme care, because of improper management of the diseases and indiscretionary life styles during this vital period may cause the woman to get afflicted with numerous disorders which are often difficult to treat and sometimes may become incurable. A brief regimen of each and every step in paricharya is elucidated in classical treatises [22] . The paricharya can be integrated in the normal post-partum care at institutional as well as domestic level. Sutika Paricharya is part of the social cultural milieu and widely accepted but due to modernization and westernization its roots are getting weakened. Sutika paricharya must be promoted through

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P a g e | 199 Review Article ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION IEC, Mass communication and integrated in MCH and RCH programs for better outcomes. CONCLUSION To sum up, the post-partum care regimen as prescribed by Ayurveda represents holistic approach which takes care of the physical, mental, social health and addresses various physiological, nutritional, emotional needs of the body consequent upon the birth of a baby. [23] The highlight of Sutika Paricharya is Naveekarana (rejuvenation) of women i.e. preparing her for socio-economical, cultural and reproductive functions and restoring her vigor and vitality. This shuld be seen as a primary prevention against various local and systemic morbidities which may arise out of the physiological process of Birth. Acharya Kashyap has described nearly 35 types and 64 types of Sutika Roga [24] Twenty-five diseases are common at both the places, most of these are difficult to treat or incurable. Therefore, Sutika Paricharya is a part and parcel of every Prasava and every woman during ante-natal care should be educated about it. Acknowledgment: Nil Financial Support: Nil. Conflict of Interest: Nil REFERENCES 1 Omidvar, S., Amiri, F. N., Bakhtiari, A., & Begum, K. (2018). A study on menstruation of Indian adolescent girls in an urban area of South India. Journal of family medicine and primary care , 7 (4), 698–702. 2 Hong Ju, Mark Jones, Gita Mishra, The Prevalence and Risk Factors of Dysmenorrhea, Epidemiologic Reviews , Volume 36, Issue 1, 2014, Pages 104–113. 3 Agarwal, A. K., & Agarwal, A. (2010). A study of dysmenorrhea during menstruation in adolescent girls. Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine , 35 (1), 159–164. 4 Bernardi, M., Lazzeri, L., Perelli, F., Reis, F. M., & Petraglia, F. (2017). Dysmenorrhea and related disorders. F 1000 Research , 6 , 1645. 5 Harada T. Dysmenorrhea and endometriosis in young women. Yonago acta medica , (2013). 56 (4), 81–84 6 Harel Z. Dysmenorrhea in adolescents and young adults: an update on pharmacological treatments and management strategies. Expert opinion on pharmacotherapy , (2012). 13 (15), 2157–2170. 7 Ko, Hyun & Le, Sam & Kim, Sang Dol. (2016). Effects of Yoga on Dysmenorrhea: A Systematic Review of Randomized Controlled Trials. Alternative & Integrative Medicine (2016). 5(4), 8 Premvati tewari, Ayurvediya Prasutitantra evam Striroga, Part-1, Prasutitantra, Chapter-9,Sutika vigyaniya, Published by Chaukhambha Orientalia, Varanasi, 2 nd Edition, Reprint 2009, , Page No. 547. 9 P.V.Tewari, Kasyapa–Samhita or Vrddhajivkiya Tantra, Edited by Prof. P. V. Tewari, Translation And Commentary by Prof. P. V. Tewari, Chapter –11, Sutikopakramaniya adhyaya of Khila Sthana, Verse 23,Publisher –Chaukhambha Visva

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P a g e | 200 Review Article ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION Bharati Varanasi, Edition Reprint 2013, Page No. 578. 10 .P.V.Tewari, Kasyapa–Samhita Or Vrddhajivkiya Tantra, Chapter –11, Sutikopakramaniya adhyayaof Khila Sthana, Verse 32-33, Publisher – Chaukhambha Visva Bharati Varanasi, Edition Reprint 2013, Page No. 579 11 Gonçalves, A. V., Barros, N. F., & Bahamondes, L. (2017). The Practice of Hatha Yoga for the Treatment of Pain Associated with Endometriosis. Journal of alternative and complementary medicine (New York, N.Y.) , 23 (1), 45–52. 12 Nag, Usha, Kodali Madhavi, Meditation And Yoga As Alternative Therapy For Primary Dysmenorrhea. International Journal of Medicine and Pharmaceutical Sciences (India), (2013) 3(7), 39-44. 13 Premvati tewari, Ayurvediya Prasutitantra evam Striroga, Part-1, Prasutitantra, Chapter-9,Sutika vigyaniya, Published by Chaukhambha Orientalia,Varanasi, 2 nd Edition, Reprint 2009, , Page No. 547. 14 P.V.Tewari, Kasyapa–Samhita or Vrddhajivkiya Tantra, Edited by Prof. P. V. Tewari, Translation And Commentary by Prof. P. V. Tewari, Chapter –11, Sutikopakramaniya adhyaya of Khila Sthana, Verse 23,Publisher –Chaukhambha Visva Bharati Varanasi, Edition Reprint 2013, Page No. 578. 15 P.V.Tewari, Kasyapa–Samhita Or Vrddhajivkiya Tantra, Chapter –11, Sutikopakramaniya adhyayaof Khila Sthana, Verse 32-33, Publisher – Chaukhambha Visva Bharati Varanasi, Edition Reprint 2013, Page No. 579 16 Gonçalves, A. V., Barros, N. F., & Bahamondes, L. (2017). The Practice of Hatha Yoga for the Treatment of Pain Associatedwith Endometriosis. Journal of alternative and complementary medicine (New York, N.Y.) , 23 (1), 45– 52. 17 Nag, Usha, Kodali Madhavi, Meditation And Yoga As Alternative Therapy For Primary Dysmenorrhea. International Journal of Medicine and Pharmaceutical Sciences (India), (2013) 3(7), 39-44. 18 Premvati tewari, Ayurvediya Prasutitantra evam Striroga, Part-1, Prasutitantra, Chapter-9,Sutika vigyaniya, Published by Chaukhambha Orientalia,Varanasi, 2 nd Edition, Reprint 2009, , Page No. 547. 19 P.V.Tewari, Kasyapa–Samhita or Vrddhajivkiya Tantra, Edited by Prof. P. V. Tewari, Translation And Commentary by Prof. P. V. Tewari, Chapter –11, Sutikopakramaniya adhyaya of Khila Sthana, Verse 23,Publisher –Chaukhambha Visva Bharati Varanasi, Edition Reprint 2013, Page No. 578. 20 P.V.Tewari, Kasyapa–Samhita Or Vrddhajivkiya Tantra, Chapter –11, Sutikopakramaniya adhyayaof Khila Sthana, Verse 32-33, Publisher – Chaukhambha Visva Bharati Varanasi, Edition Reprint 2013, Page No. 579 21 Gonçalves, A. V., Barros, N. F., & Bahamondes, L. (2017). The Practice of Hatha Yoga for the Treatment of Pain Associatedwith Endometriosis. Journal of alternative and complementary

P a g e | 201 Review Article ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION medicine (New York, N.Y.) , 23 (1), 45– 52 22 P.V.Tewari, Kasyapa–Samhita Or Vrddhajivkiya Tantra, Chapter –11, Sutikopakramaniya adhyayaof Khila Sthana, Verse 32-33, Publisher – Chaukhambha Visva Bharati Varanasi, Edition Reprint 2013, Page No. 579 23 Gonçalves, A. V., Barros, N. F., & Bahamondes, L. (2017). The Practice of Hatha Yoga for the Treatment of Pain Associated with Endometriosis. Journal of alternative and complementary medicine (New York, N.Y.) , 23 (1), 45–52. 24 Nag, Usha, Kodali Madhavi, Meditation And Yoga As Alternative Therapy For Primary Dysmenorrhea. International Journal of Medicine and Pharmaceutical Sciences (India), (2013) 3(7), 39-44.

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