੧੫. ਮੂਢਗਰ੍ਭਚਿਕਿਤ੍ਸਿਤਮ੍

Meaning of the śloka

The chapter on the treatment of mūḍhagarbha is introduced. The text says that few tasks are as difficult as removing a fetus obstructed in labour, because intervention must be carried out by touch within a confined region close to the yoni, liver, spleen, intestines, and uterus. It names a range of historical manipulations and, in the case of a dead fetus, destructive procedures, all to be attempted with one hand while seeking to avoid injury to the fetus and the pregnant woman. Because of the extreme danger, the practitioner is told to obtain the ruler’s permission and proceed with the greatest care.

Key terms

mūḍhagarbha

A fetus whose passage in labour is obstructed or whose position is abnormal in the classical account.

śalyoddharaṇa

Removal of an obstructing body; here, the difficult extraction of the obstructed fetus.

sthānāpavartana

Changing the position or orientation of the fetus; the commentary also preserves a variant reading.

ṛjūkaraṇa

Bringing a bent or abnormal position into a straight alignment.

Meaning of the śloka

The text briefly identifies eight patterns of abnormal or obstructed fetal course. It also says that even in the natural course there may be three sites of obstruction, arising from an abnormal or bent position of the head, shoulders, or pelvic region.

Key terms

mūḍhagarbhagati

The course or presentation of a fetus obstructed in labour, classified here into eight patterns.

saṅga

Obstruction or arrest during the course of birth.

vaiguṇya

An abnormality interpreted by the commentary here as crookedness or bending.

jaghana

The front of the waist or pelvic region in the commentator’s explanation.

Meaning of the śloka

When the fetus is alive, every effort is to be made to deliver it from the labouring woman. If extraction cannot be achieved, the text directs that mantras intended to promote delivery be heard. The verses invoke amṛta, Soma, Citrabhānu, the horse Uccaiḥśravas, fire, wind, the sun, Vāsava, and the clouds over the salt ocean, asking them to remain present, bring peace, and release the fetus quickly and safely from every danger, as bonds and the sun’s rays are released.

Key terms

cyāvana mantra

An invocation presented in the text as promoting the fetus’s release or delivery.

amṛta

The nectar said in the commentary to have arisen from the churning of the ocean.

Citrabhānu

A name interpreted by the commentator as the sun.

Uccaiḥśravas

The mythic horse produced from the churning of the ocean and identified as Indra’s mount.

Meaning of the śloka

The text first says to employ the medicines previously prescribed. It then gives a historical account of managing different obstructed fetal positions, especially when the fetus has died, by preparing and positioning the woman and using internal manipulation to bring the fetus into a position for extraction. Six described presentations are approached according to whether the lower limbs or the head can be brought into the birth passage, while the last two of the eight presentations are declared incurable. When extraction cannot otherwise be achieved, the text permits an instrument. It emphatically forbids cutting a living fetus, stating that this would kill both mother and fetus. In an unbearable and otherwise unmanageable condition, it considers loss of the fetus preferable to the death of the pregnant woman and says that the proper time for action should not be missed.

Key terms

apatyapatha

The birth passage, identified by the commentary with the yoni in this context.

śastra

A surgical instrument invoked only after other historical extraction efforts are described as unsuccessful.

asādhya

Declared incurable or not amenable to treatment; applied here to the final two fetal presentations.

garbhapātana

Causing expulsion or loss of the fetus, presented here as a last measure to preserve the mother in an otherwise unbearable condition.

viparyāsa

An adverse reversal interpreted by the commentator in this passage as the pregnant woman’s death.

Meaning of the śloka

After reassuring the woman, the text describes historical extraction when a fetus has died and remains obstructed. It discusses reducing whichever fetal part is impacted and removing it with specially selected instruments, while making the preservation of the mother the physician’s central aim. Because abnormal fetal positions are said to arise in many forms through aggravated anila, the physician must act intelligently and according to the prescribed method. A dead fetus is not to be neglected even briefly, since the text says it can rapidly kill the mother. It warns against a sharply pointed instrument that might injure her and favors an instrument considered safer for internal use. The passage then describes removal of the retained aparā by previously taught measures, followed by warm washing and soothing unctuous care intended to soften the birth passage and relieve pain.

Key terms

mūḍhagarbha

An obstructed or abnormally positioned fetus, the chapter’s classical obstetric subject.

maṇḍalāgra

A rounded-ended cutting instrument described for historical internal obstetric use.

śaṅku

A curved, hook-like grasping instrument in the commentator’s explanation.

aparā

The retained fetal covering or afterbirth, identified by the commentator with jarāyu.

anila

Vāta, whose aggravation the passage associates with varied abnormal fetal positions.

Meaning of the śloka

The text gives several historical medicinal options after management of mūḍhagarbha. Powders, decoctions, or pastes of specified substances are to be administered, with or without an unctuous medium, for promoting the discharge of retained doṣa-related material and easing pain. It then sets out a staged course involving a short initial period, subsequent use of sneha, and a well-prepared āsava or ariṣṭa at night. Water prepared with śirīṣa and kakubha is recommended for cleansing, while any complications are to be treated according to their particular nature. Once fully cleansed, the woman is advised to take small amounts of suitable unctuous food, receive regular sudation and massage, and avoid anger. Milk prepared with vāta-calming substances is prescribed for ten days, followed by meat broth for ten days and thereafter care suited to her condition. After she is free of complications and judged restored, the passage prescribes release from protective restrictions only after four months.

Key terms

aparā

The afterbirth or fetal covering whose removal precedes the regimen in the commentary.

sneha

An unctuous substance or oleation regimen used in the staged aftercare.

āsava / ariṣṭa

Prepared fermented medicinal drinks prescribed historically for nighttime use.

kṛṣṇā

Identified by the commentator as pippalī.

upadrava

A complication arising during recovery, exemplified here by vāta disorder or fever.

Meaning of the śloka

The passage describes Balātaila for historical use in nourishing the birth passage, massage, drinking, basti, and food, with the aim of restraining aggravated anila. It lists decoctions of balā root and daśamūla, a decoction of yava, kola, and kulattha, milk, oil, salt, and numerous aromatic and medicinal substances, and says the carefully prepared oil should be stored securely in a vessel of gold, silver, or clay. It attributes to this oil relief of vāta disorders and recommends a quantity suited to the strength of a postpartum woman. The text also extends its use to a woman seeking pregnancy, a man with depleted śukra, and people weakened by vāta, injured at a marma, churned or struck, fractured, or exhausted. It further attributes benefit in ākṣepaka and other vāta disorders, hiccup, cough, adhīmantha, gulma, difficult breathing, and antravṛddhi, and makes broad historical claims concerning renewed tissues, stable youthfulness, and use by kings and other prosperous or delicate people.

Key terms

Balātaila (balātaila)

The complex balā-based medicated oil described in this passage.

sūtikā

A woman in the postpartum period, for whom a strength-adjusted amount is mentioned.

marma

A vital anatomical point or region described here as injured.

kālānusārivā / kṣīraśuklaka

Alternative ingredient readings preserved by the commentator.

antravṛddhi

A classical condition whose prognosis the commentary distinguishes according to whether it has reached the kośa.

Meaning of the śloka

The text describes another historical balā oil preparation. Oil is obtained from sesame seeds repeatedly impregnated with balā decoction and is then said to be cooked one hundred times with that decoction. A quantity suited to the person’s strength is used in a quiet, draft-free dwelling. After it has been digested, the person is directed to eat unctuous ṣaṣṭika rice with milk. Following this regimen until a droṇa of the oil has been used, the prescribed food is continued for twice that period. The passage attributes strength and complexion to the regimen and makes traditional claims of freedom from wrongdoing, a hundred-year lifespan, and a further hundredfold increase with each successive droṇa.

Key terms

śatapāka

A preparation described as being cooked or processed one hundred times.

bhāvita

Impregnated or treated repeatedly with a liquid, glossing pītebhyaḥ here.

ṣaṣṭikaudana

Cooked ṣaṣṭika rice prescribed with milk after digestion of the oil.

droṇa

A large classical measure used to state the cumulative amount in the regimen.

madhura-gaṇa

A group of medicinal substances that one interpretive tradition carries over from the preceding formula.

Meaning of the śloka

Following the method prescribed for Balā oil, an informed physician is to prepare oils using Atibalā, Guḍūcī, Ādityaparṇī, Saireyaka, Vīrataru, Śatāvarī, Trikaṇṭaka, Madhuka, and Prasāriṇī.

Key terms

balākalpa

The preparation method previously prescribed for Balā oil and extended here to other substances.

Ādityaparṇī (ādityaparṇī)

A named substance identified by the commentator as Sūryāvarta.

Vīrataru (vīrataru)

A named substance whose identity is disputed in the commentary: some say Arjuna and others Kokilākṣa.

kvātha-kalka

Decoction and paste, proposed in one interpretation as being made from each named substance itself.

Meaning of the śloka

The physician is told to cook Nīlotpala and the root of Varī in cow's milk, and then to prepare sesame oil through a hundred cookings with that milk preparation, adding the well-ground paste ingredients prescribed for Balā oil. The physician should understand the applications of all these oils and, in particular, their properties as corresponding to those of Balā oil.

Key terms

Nīlotpala (nīlotpala)

A named substance included in the milk preparation described by the verse.

Varī (varī)

The plant name clarified by the commentator as Śatāvarī.

śatapāka

A preparation characterized in the text by one hundred cookings.

Balātaila (balātaila)

Balā oil, whose paste ingredients, applications, and properties provide the comparison for these oils.

Meaning of the śloka

Thus ends the fifteenth chapter of the Cikitsāsthāna in the Sushruta Samhita, entitled ‘Treatment of Mūḍhagarbha.’

Key terms

Cikitsāsthāna (cikitsāsthāna)

The section of the Sushruta Samhita concerned with treatment.

mūḍhagarbhacikitsita

Treatment of mūḍhagarbha; the title of the completed chapter.

Nibandhasaṅgraha (nibandhasaṅgraha)

The title of the commentary identified in the commentary colophon.

Dalhaṇa (dalhaṇa)

The commentator named in the colophon, with an uncertain or variant spelling in the supplied source.