A Comprehensive Treatise on Prasuti-Tantra: Obstertrics (According to New CCIM Syllabus)

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All the references of Prasuti-tantra mentioned in various contexts and the ailments commonly encountered by obstetricians in day to day practice have been compiled in this comprehensive text.

• All the references of Brhatrayis and Laghutrayiis with their respective commentaries.

• All references from Garbha Upanisad, Yogaratnakara, Bhela Samhita, Harita Samhita .

• Relevant references from Amarkosa, Sabdakalpadruma, Bhagwadgita, Arthasastra, Varahamihira's Brhatjataka, Sahasra yoga, Bhaisajyaratnavali, Manusmrti , Rasaratnasamuccaya, Cakradatta.

• Stanyavahasrotas according to Gananathasen 3 germinal layers from Brhatsariram by P.S. Varier I Anaemia in pregnancy according to Ayurveda I Diabetes mellitus in pregnancy I HIV in pregnancy I TB in pregnancy I Dengue in pregnancy I Medico-legal elements and audit in obstetric practice.

Clinical vignettes-brief description of case studies; R in pregnancy as a ready reckoner for prescribing in pregnancy. Formats of antenatal and postnatal case sheets; Interpretation of ultrasound and partogram are added advantages in this book.

Overall a practical approach is adopted. The presentations have been made simple and effective with flow charts and tables. The language throughout the text is kept as simple as possible with hand drawn schematic sketches. The important points have been highlighted under the heading 'Points to ponder' emphasizing on the hits we generally miss.

Born and brought up in Chennai, Tamilnadu; the author completed her graduation from Venkatramana Ayurveda College, Chennai in the year 1998-99 and post graduation from Govt. Ayurveda College, Thiruvanantbapuram in year May 2002. She has been into clinical practice since then. She had been a meritorious student, a university rank holder and the best outgoing student 1996-97. She is the rust female post-graduate in Prasuti-tantra and Striroga of Tamilnadu origin. She started her academic career as a lecturer at DAMC in 2012 and is at present working as a lecturer in Govt. Ayurveda Medical College and Hospital, Nagercoil (Kanyakumari). She is also interested in sketching, painting, literature. Her articles, poems and essays have been published in many leading magazines, journals and newspapers. She holds British medical journal certificate for diagnostic picture test and has also participated in seminar on hypertension and cardiovascular disease organised by American society of Hypertension. She is actively involved in creating awareness on social issues and health awareness among women through Ayurveda.

The Book 'A Comprehensive Treatise on Prasuti-tantra (Obstetrics)’ produced by the author Dr. Hemalatha Kapoorchand is a comprehensive contemporary treatise on Prasuti- tantra i.e. Ayurvedic Obstetrics dealing with the fundamental concepts, traditional practices and recent advances in this important speciality of Ayurvedic Medicine. The book is divided into 13 chapters. The second and third chapters are related to Sarira considerations of Prasuti- tantra. Garbhavijnana (Embryology) is the subject matter of the fourth chapter. In fifth chapter garbhini vijnaniyam is vividly described. Disorders of Foetus and Pregnancy with management has described in 6th and 7th chapters. Parturition-its management considered in the 8th chapter. Prasavavyapad-disordes of Labour (abnormal labour) has vividly discussed in chapter nine. Normal and abnormal puerperium (Sutika vijnaniyam and Sutikavastayam vyadhayah) are vividly described in chapter 10 and 11. In chapter 12th diseases related to Breast feeding and Lactation (Stanya vijnaniyam) has described. The highlight of the book is the chapter entitled 'Special topics in Obstetrics' i.e. Prasuti tantre visesa prakaranani, describes emergencies in obstetrics, pharmacotherapeutics, MTP Act 1971, PNDT Act 1994, Instruments (yantra and sastra), different Pharmaceutical preparations, Gynaecological problems in Pregnancy, Maternal mortality, Analgesia and Anaesthesia in Obstetrics, Vaccination during Pregnancy, use of Ultrasound and it's interpretation, Medico-legal and Audit in Obstetrics, case taking techniques, Clinical Vignettes, prescriptions in pregnancy and Partogram.

Ayurveda is the most ancient system of care of health and disease based on the holistic principles. The classical Ayurveda is Astanga ayurveda. In Astanga ayurveda 'Prasuti-tantra' has discussed in the subject matter of Kaumarabrithya because the mother and child care are not separable. This is due to the complete dependence of the growing the fetus (child) on the mother.

The Garbha Upanishad states that Human body is composed of pancamahabhuta i.e. five elements. The hard matter in the body is constituted of Prthivi mahabhuta earth, liquid materials is of Jala mahabhuta. Heat and warmth which required for digestion and metabolism is from Agni mahabhuta. The force that which causes movement(s) in the body is from the essence of Vayu mahabhuta and the hollowness in the body is because Akasa mahabhuta. The earth principle provides it with support, the water necessary for assimilation of food, the fire essence for digestion, metabolism and illumination, the wind principle distributes of substances with the body, while ether provides space i.e. room within.

Perception of sense is of panca jnanendriya located ear, skin, eye; tongue, nose. Karmendriya consists of the mouth to speak, hands to lift, feet to walk, guda for excretion, and the genitals for sexual enjoyment. The discrimination of knowledge is due to Buddhi (Intellect), thinking and notions are from Manas (mind). There are five tastes, representing food it needs for development, and these are sweet, saline, bitter, pungent and astringent.

The human being goes through six stages life-from existence in its life, and these are creation as foetus, birth, growth, maturity, decay and death. The human body develops six 'Chakras (wheels)' -muladhara, svadhisthana, manipuraka, anahata, visuddhi and ajna. Then six gunas and seven notes of sounds, which are combined to form sounds, some acceptable and some non-acceptable.

According to Garbhopanisad seven colour constituent elements (dhatus) are there in the bod viz. white, red, opaque, smoke colored, yellow, brown and pale colored. From white which is food ahara rasas (juice, sap, essences) develops the blood (red), out of blood develops the flesh (opaque), from flesh develops the fat (smoke colored), from fat develop the bones (yellow), inside bones develops the bone marrow (brown), and from marrow develops the semen (pale colored). From the union of sukra-semen from the male and sonita- the female gamete develops the human embryo.

The Garbhopanisad provides details about how the conception takes place in the womb and how it develops over a period of nine months. The union of sukra and sonita in a specified time i.e. rtu kala, proceeds the growth of the body. The embryo on the first day is a 'nodule'. It becomes a 'bubble' by the seventh night; in 15 nights it becomes a 'lump'; in a month's time the embryo becomes hard; by the end of two months, head is formed; parts of the feet appear by three months; stomach, the hips and ankle appear by the fourth month; the vertebral column shapes up by the fifth month. The face, nose and ears appear by the sixth month whereas in seventh month Jiva or soul (Atman) imbibed with fetus, in the eighth month has all body parts, and fully developed in the ninth month. The fetus grows and is nourished by what the mother eats and drinks, through a vein.

The Garbhopanisad emphasizes its theory for the gender of the child, birth defects and the birth of twins. It states that domination of male semen results in a male child while a female child is born when there is excess of female or mother's semen. When semen of both male and female are equally strong birth of a hermaphrodite occurs. Birth defects are asserted to result when either parent is suffering from anxiety and trauma at the time of conception. Twins of same gender develop when the sukra and sonita burst into two; however, when only sukra bursts into two or when the parents copulate often, then twins of mixed gender may be formed. Development and birth of a single embryo is most common among humans. However, up to Quintuplets are observed among humans, declares this prehistoric text.

As stated in Garbhopanisad, in eighth month, the fetus knows its past birth, meditates and perceives Om, gains the intuitive knowledge of good and bad. Further it is stated that in the last weeks of its development, the fetus remembers the good and bad karma and being born anew through many births, resolves to remember Mahesvara (Siva) and Narayana (Visnu), resolves to study and practice Samkhyayoga after birth because all these bestow the reward of liberation. Further the fetus resolves to meditate on Brahman after birth. However, during the process of birth the fetus is to forget its resolutions due to the squeezing out of the womb.

As the advancements are happening in all the fields of science, Ayurveda is not an exceptional one. The classical Astanga ayurveda has expanded into Sodasanga ayurveda.

Though Acarya Harita includes the garbha upakrama, sutika upakrama in Bala cikitsa speciality, it is need of time to expand and to devolop Prasuti-tantra i.e. Ayurvedic obstetrics as a separate speciality and the same has happened nearly 2 decades ago. It is the time of need to write the Comprehensive Treatise on Prasuti-tantra (Obstetrics) and I feel the author, Dr. Hemalatha Kapoorchand has succeeded in this regard. As this book is written in accordance with the new curriculum of CCIM for UG course which includes both Ayurveda and Modern concepts. The subject has explained innovatively with about 200 hand-drawn illustrations. Dr. Hemalatha has taken care in discussing the various references related to Prasuti-tantra in this book not only from classical ayurvedic treatises, viz. Brhatrayi, Laghutrayi including commentaries, Bhela Samhita, Harita Samhita, but also from Yogaratnakara, Sahasrayoga, Bhaisajyaratnavali, Rasaratnasamuccaya, Cakradatta, Vamgasena Samhita. Further to add that the appropriate references from Amarakosa, Sabdakalpadruma, Garbhopanisad, Bhagavadgita, Arthasastra, Varahamihira's Brhajjataka were discussed at appropriate places. The concept of stanya vaha srotas, germinal layers are also mentioned which are contributions from the recent ayurvedic stalwarts Sri Gananath Sen, P.S. Warier. Most highly prevalent and important common clinical condition Anemia in pregnancy-Garbhini pandu and its management has discussed very well. Diabetes mellitus in pregnancy, HIV in pregnancy, TB in pregnancy, Dengue in pregnancy and Medico-legal elements and audit in obstetric practice.

The other specialty of this treatise is to evoke clinical and practical approach the Clinical vignettes brief description of case studies are added, which will enable the students and practitioners to get acquainted with clinical skills. Case sheet formats such as Case taking in obstetrics, ante-natal as well as post-natal are highly helpful not only for students of Ayurveda but also for practitioners. Application and understanding of Ultrasound in obstetrics and how to plot Partograms are highly useful.

This book is highly valuable especially for students who are preparing their examinations as the important points have been highlighted under the heading of 'Points to ponder' at the end of chapters wherever possible.

I trust that writing a book encompasses a continuous learning process. As a teacher, I have known Dr. Hemalatha for many years since her U.G. studies at the Tamil Nadu, Dr. M.G.R. Medical University, Chennai, Tamil Nadu. Her interest in the subject grew further when she became teacher. I wish a great success for this new publication and hope that many more such books will be produced by this emerging author. I congratulate my student Dr. Hemalatha Kapoorchand for making a commendable contribution to the contemporary literature of Ayurveda.