Sushruta Samhita Nidanasthana Chapter 8 Mudhagarbha Nidanam (Fetal Obstruction)

The 8th chapter of Nidanasthana of Sushruta Samhita is named as Mudhagarbha Nidanam Adhyaya. This chapter deals with Fetal Obstruction.

अथातो मूढगर्भनिदानं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
We will now expound Mudhagarbha Nidanam- diagnosis of fetal obstruction; as revealed by the venerable Dhanvantari.

Nidana: Causes

ग्राम्यधर्मयानवाहनाध्वगमनप्रस्खलनप्रपतनप्रपीडनधावनाभिघातविषमशयनासनोपवासवेगाभिघातातिरूक्ष-कटुतिक्तभोजनशोकातिक्षारसेवनातिसारवमनविरेचनप्रेङ्खोलनाजीर्णगर्भशातनप्रभृतिभिर्विशेषैर्बन्धनान्मुच्यते गर्भः, फलमिव वृन्तबन्धनादभिघातविशेषैः; स विमुक्तबन्धनो गर्भाशयमतिक्रम्य यकृत्प्लीहान्त्रविवरैरवस्रंसमानः कोष्ठसङ्क्षोभमापादयति, तस्या जठरसङ्क्षोभाद्वायुरपानो मूढः पार्श्वबस्तिशीर्षोदरयोनिशूलानाहमूत्रसङ्गानामन्यतममापद्य गर्भं च्यावयति तरुणं शोणितस्रावेण; तमेव कदाचिद्विवृद्धमसम्यगागतमपत्यपथमनुप्राप्तमनिरस्यमानं विगुणापानसम्मोहितं गर्भं मूढगर्भमित्याचक्षते ||३||
Etiological Factors of Mudagarbha – Below mentioned are the causes of fetal obstruction –

Women

• indulging too much in copulation,
• travelling in vehicles, riding on animals,
• long walk,
• jumping,
• falling from heights,
• assaults,
• running,
• injury,
• improper way of sleeping and sitting,
• resorting to fasting,
• suppression of urges of the body,
• use of foods which are very dry, pungent, and bitter;
• sorrow,
• consuming too much of alkali (alkaline foods),
• diseases like diarrhea, vomiting or purgation;
• swinging in a hammock,
• indigestion,
• causing abortion artificially and such other violent- acts

Pathogenesis –

Chronological events in the pathogenesis of Mudha Garbha

(Analogy) Just like a fruit gets detached from its attachment with the tree when it is hit by a stone or sticks or when it is plucked by hands and falls down,
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The fetus too gets detached and hence released from its attachments in the mother’s womb.
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The detached fetus comes out of the liver
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Now it descends in the space between liver, spleen and the intestines and produces movements in the woman’s abdomen.
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Apana Vata activated by such movements in the abdomen begins to move in a wrong way and
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Produces pain in flanks, upper portion of the urinary bladder, abdomen and vagina and also
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Flatulence, urinary obstruction and many such symptoms and
Causes expulsion of the premature fetus along with bleeding and also
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Sometimes, the developed fetus also descends in an irregular way into the birth passage but is not delivered owing to the abnormality of Apana Vata and
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This condition is known as Mudha Garbha

Types of Mudha Garbha

ततः कीलः प्रतिखुरो बीजकः परिघ इति |
तत्र, ऊर्ध्वबाहुशिरःपादो यो योनिमुखं निरुणद्धि कील इव स कीलः; निःसृतहस्तपादशिराः कायसङ्गी प्रतिखुरः; यो निर्गच्छत्येकशिरोभुजः स बीजकः; यस्तु परिघ इव योनिमुखमावृत्य तिष्ठति स परिघः; इति चतुर्विधो भवतीत्येके भाषन्ते |
तत्तु न सम्यक्; कस्मात्? स यदा विगुणानिलप्रपीडितोऽपत्यपथमनेकधा प्रपद्यते तदा सङ्ख्या हीयते ||४||

According to some authorities, Mudha Garbha is of four types. They are –

1. Kila

2. Pratikhura

3. Bijaka and

4. Parigha

But this view is incorrect. The reason is, the fetus which is troubled by abnormal Vata would descend into the birth passage in many ways and not just in four different manners as explained above. In that case, the types of Mudha Garbha too will not be four and the number gets altered, i.e. it will be more than four.

Other types of Mudagarbha

तत्र, कश्चिद्द्वाभ्यां सक्थिभ्यां योनिमुखं प्रतिपद्यते; कश्चिदाभुग्नैकसक्थिरेकेन; कश्चिदाभुग्नसक्थिशरीरः स्फिग्देशेन तिर्यगागतः; कश्चिदुरःपार्श्वपृष्ठानामन्यतमेन योनिद्वारं पिधायावतिष्ठते; अन्तःपार्श्वापवृत्तशिराः कश्चिदेकेन बाहुना; कश्चिदाभुग्नशिरा बाहुद्वयेन; कश्चिदाभुग्नमध्यो हस्तपादशिरोभिः; कश्चिदेकेन सक्थ्ना योनिमुखं प्रतिपद्यतेऽपरेण पायुम्; इत्यष्टविधा मूढगर्भगतिरुद्दिष्टा समासेन ||५||

Fetus descends into the vaginal orifice with different presentations. Below mentioned are the other types of Mudha Garbha –

1. Descending with both legs or with one leg

2. Descending with one leg bent

3. Descending with both legs and body bent with butts placed horizontally

4. Descending with chest flanks and back obstructing the orifice

5. Descending with head bent towards the flanks while one arm is protruding

6. Descending with head bent inwards into the flanks and with one arm protruding out,

7. Descending with middle portion of the body along with arms, legs and head bent inwards,

8. Descending with one arm protruding through the vaginal orifice and the other arm through the anus

Thus, in brief, the movements of Mudha Garbha is of eight kinds as mentioned above.

Prognosis of Mudagarbha

तत्र द्वावन्त्यावसाध्यौ मूढगर्भौ, शेषानपि विपरीतेन्द्रियार्थाक्षेपकयोनिभ्रंशसंवरणमक्कल्लश्वासकासभ्रमनिपीडितान् परिहरेत् ||६||
The last two kinds of muda Garbha are incurable among the lot.

The other kinds of Muda Garbha also become incurable if the woman has developed the below mentioned symptoms –

• Viparita indriyartha – Improper understanding of sense objects
• Akshepaka – Convulsions
• Yoni bramsha – Vaginal prolapse
• Yoni samvarana – Contraction of vaginal passage
• Makkalla – postpartum pain
• Shwasa – Dyspnoea
• Kasa – cough
• Bhrama – giddiness

In these conditions treatment should not be done.

भवन्ति चात्र-

कालस्य परिणामेन मुक्तं वृन्ताद्यथा फलम् |
प्रपद्यते स्वभावेन नान्यथा पतितुं ध्रुवम् ||७||
एवं कालप्रकर्षेण मुक्तो नाडीनिबन्धनात् |
गर्भाशयस्थो यो गर्भो जननाय प्रपद्यते ||८||
कृमिवाताभिघातैस्तु तदेवोपद्रुतं फलम् |
पतत्यकालेऽपि यथा तथा स्याद्गर्भविच्युतिः ||९||
आचतुर्थात्ततो मासात् प्रस्रवेद्गर्भविच्युतिः |
ततः स्थिरशरीरस्य पातः पञ्चमषष्ठयोः ||१०||

Some verse here:-

Analogy 1 – The fruit naturally gets detached from its stalk due to maturity / change in time and not by any other reason. Similarly, the fetus also gets detached from its attachments and gets freedom from its bindings in the womb (uterus) in due course of time (maturity of time) and comes out to get delivered at proper time.

Apart from this, the fruits also fall prematurely being afflicted by worms, breeze or assault. Similarly, due to different causes, the fetus also falls off prematurely.

Garbha Srava – is a condition in which the uterine material flows out before the fourth month of pregnancy (abortion).

Garbha Pata – is a condition when the contents of the uterus in the form of a stable body (formed fetus) come out / expelled in the fifth and sixth months.

Asadhya Laksana: Fatal prognosis

प्रविध्यति शिरो या तु शीताङ्गी निरपत्रपा |
नीलोद्धतसिरा हन्ति सा गर्भं स च तां तथा ||११||
In the presence of the below mentioned signs / symptoms, either the woman kills the fetus or the fetus kills the woman –

–        Woman shaking her head vigorously
–        The body of the woman becomes cold
–        She loses the sense of shyness
–        Blue colored prominent veins on her body

Mrta Shishu Laksana: Signs of fetal death

गर्भास्पन्दनमावीनां प्रणाशः श्यावपाण्डुता |
भवत्युच्छ्वासपूतित्वं शूलं चान्तर्मृते शिशौ ||१२||
मानसागन्तुभिर्मातुरुपतापैः प्रपीडितः |
गर्भो व्यापद्यते कुक्षौ व्याधिभिश्च प्रपीडितः ||१३||
Below mentioned are the signs indicating the death of fetus inside the womb –

–        Loss of movements of the fetus
–        Cessation of labor pain
–        Bluish or whitish discoloration of the woman’s body
–        Bad smelling breath
–        Pain in abdomen

Death of fetus inside the womb also happens when the mother is afflicted by –

–        diseases of mind
–        troubles caused by external factors like injuries etc. or
–        many other diseases

Atyayika Kriya: Emergency treatment

बस्तमारविपन्नायाः कुक्षिः प्रस्पन्दते यदि |

तत्क्षणाज्जन्मकाले तं पाटयित्वोद्धरेद्भिषक् ||१४||
Just like a goat has been killed by strangulating its neck, when the woman (pregnant) too is dead but there are throbbing movements in the abdomen then the physician should immediately cut open the abdomen of the woman and save the child.

इति सुश्रुतसंहितायां निदानस्थाने मूढगर्भनिदानं नामाष्टमोऽध्यायः ||८||
Thus ends the Eighth chapter by name Mudhagarbha nidana in Nidana Sthana of Susrurta Samhita.