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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 15  |  Issue : 4  |  Page : 261-267

Efficacy of shatavaryadi ksheerapaka basti in enhancing the maternal nourishment in garbha kshaya along with relieving the pregnancy discomforts


1 Research Officer (Ay.) Regional Ayurveda Research Institute, (C.C.R.A.S., Ministry of AYUSH), Ahmedabad, Gujarat, India
2 Professor and Head, Department of Prasuti Tantra and Stree Roga, I.T.R.A. Jamnagar, Gujarat, India
3 Professor, Department of Obstetrics and Gynaecology, Shri M P Shah Government Medical College, Jamnagar, Gujarat, India

Date of Submission21-Apr-2021
Date of Decision29-Jun-2021
Date of Acceptance18-Sep-2021
Date of Web Publication16-Dec-2021

Correspondence Address:
Suprabha Kunjibettu
Regional Ayurveda Research Institute, Ahmedabad, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_109_21

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  Abstract 


Background: Garbha Kshaya is considered among the abnormalities of fetus (Garbha Vyapads), associated with growth-related disorders, especially due to maternal undernourishment. Garbha Kshaya comprises of diminished fundal height (Anunnata Kukshi) and reduced fetal movement (Garbhaaspandana) possibly due to reduced liquor amni. Ayurveda mentions Ksheera Basti as classical treatment in its management, wherein nourishment is provided through milk-infused medicated enema. Materials and Methods: Pregnant patients fulfilling the inclusion criteria were randomly divided into two groups. Forty-one patients in Shatavaryadi Ksheerapaka Basti group (trial) were administered with Shatavaryadi Ksheerapaka Basti consisting of Bala, Shatavari and Arjuna for a period of 10 days daily once in the morning. Twenty patients in L-Arginine group (control) were administered with L-Arginine 6.5 g sachet BD (in divided dose) with 1 glass water for 10 days. Results: Improvement was observed in the fetal movements (P ≤ 0.001) and maternal wellbeing (P ≤ 0.001) in Ksheerapaka Basti group. Abdominal girth (P ≤ 0.001) and symphysis fundal height (P ≤ 0.001), and maternal weight gain (P ≤ 0.001) showed highly significant results in Ksheerapaka Basti group. Pregnancy related discomforts such as Adhmana (P ≤ 0.001), Anidra (P = 0.002), Aruchi (P ≤ 0.001), Bhrama (P = 0.009), Daurbalya (P ≤ 0.001), Gaurava (P ≤ 0.001), Katishoola (P ≤ 0.001), Malabaddhata (P ≤ 0.001), Padashoola (P ≤ 0.001), Padashopha (P ≤ 0.001), Shrama (P ≤ 0.001), and Uras Daha (P ≤ 0.001) showed significant improvement in Ksheerapaka Basti group. Conclusion: Shatavaryadi Ksheerapaka Basti showed encouraging results in improving the fetal movements, maternal weight, and growth measurements such as abdominal girth, symphisis fundal height. It also showed promising results in overcoming the physiological discomforts of pregnancy and maintaining the overall maternal health.

Keywords: Garbha Kshaya, intrauterine growth restriction, maternal nourishment, pregnancy physiological discomforts, Shatavaryadi Ksheerapaka Basti


How to cite this article:
Kunjibettu S, Dei LP, Anand N. Efficacy of shatavaryadi ksheerapaka basti in enhancing the maternal nourishment in garbha kshaya along with relieving the pregnancy discomforts. J Ayurveda 2021;15:261-7

How to cite this URL:
Kunjibettu S, Dei LP, Anand N. Efficacy of shatavaryadi ksheerapaka basti in enhancing the maternal nourishment in garbha kshaya along with relieving the pregnancy discomforts. J Ayurveda [serial online] 2021 [cited 2022 Jan 27];15:261-7. Available from: http://www.journayu.in/text.asp?2021/15/4/261/332596




  Introduction Top


Maternal nutrition during pregnancy period has a profound effect on the development of fetus. This is rather a critical time for healthy fetal development as fetus relies on maternal nutrient stores for optimal growth and healthy outcome later in life. The improper nutrition during pregnancy may otherwise result in abortion, intrauterine growth restriction (IUGR) or other fetal abnormalities. Proper weight gain is a symbol of healthy pregnancy, which directly effects neonatal birth weight.

Utilization of Ayurvedic preparations and herbal formulations are beneficial in the safe pregnancy outcome with appropriate maternal and fetal weight gain with minimal pregnancy discomforts.[1] The ideal treatment for fetal growth-related disorders should be comprised of drugs which not only give complimentary nutrition to the fetus but also break the etiopathogenesis. Supplementing appropriate drugs having anabolic, tissue building etc., properties proves to be effective in increasing the maternal as well as fetal growth parameters.

Shatavaryadi Ksheerapaka Basti consists of combination of Shatavari,[2] Bala,[3] Arjuna[4], and Ksheera. It is endowed with rejuvenating and immunity-boosting (Rasayana), pregnancy maintaining (Garbhaposhaka), strengthening (Balya), nourishing (Pushtidayaka), nootrophic (Medhya Guna), Vata alleviating (Vata Shamaka), vitality enhancing (Ojo Vardhaka), fetus sustaining (Prajasthapana), anabolic (Brumhana), healing (Sandhanakara), debility and emaciation mitigating (Kshata Kshaya Hara), and blood quality improving (Shonita Prasadana) properties.[5] This Ayurvedic formulation is administered in Ksheerapaka Basti (medicine-induced milk enema) form as advised in the classics in the management of Garbha Kshaya.[6] Drugs given in Basti form have specific target action and quick absorption. Ksheerpaka form makes it the preferred choice of the drug delivery system in pregnancy, as pregnant ladies have low tolerance to various dosage forms and at the same time provide added nourishment, having a positive influence on the development of growth retarded fetus.

Aim

This study aims to evaluate the clinical efficacy of Shatavaryadi Ksheerapaka Basti in Garbha Kshaya w. s. r. to the maternal nourishment and in relieving the pregnancy discomforts.


  Materials and Methods Top


Study design

The present study was a randomized open labeled interventional comparative clinical trial. Randomization was done using the lottery method. Ethical clearance was obtained from IEC of I. P. G. T. and R. A., G. A. U., Jamnagar; Vide Ref-No. PGT/7/-A/2015-16/2625 dated: 11/12/2015. This study was registered in CTRI; www.ctri.nic.in, vide CTRI/2016/02/006595 dated 02/02/2016. A multi-linguistic informed written consent was obtained from all the patients included in the clinical trial.

Source of patients

Pregnant women fulfilling the diagnostic criteria of Garbha Kshaya/IUGR and completing 7th month of pregnancy were selected from the O. P. D./I. P. D. of Prasuti Tantra and Stree Roga department, I. P. G. T. and R. A., Jamnagar.

Source of drugs

The trial drug (mixture of Shatavari, Bala and Arjuna) [Table 1], in powdered form, was obtained from the Pharmacy of G. A. U. Jamnagar. Milk (Ksheera) was taken from the PG Hospital, Jamnagar. Shatavaryadi Ksheerapaka for Basti was prepared every day for each patient.
Table 1: Ingredients of Shatavaryadi Ksheerapaka Basti

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Selection of patients

Diagnostic criteria

Symphysis fundal height and abdominal girth less than the period of gestation (Minimum difference of 2 weeks); reduced movement of the fetus as appreciated by mother or through USG; pregnant women with no or minimum weight gain in successive 2 weeks of pregnancy; Lag in fetal growth (growth less than 10th percentile) diagnosed by USG through fetal biomety.

Inclusion criteria

Cases diagnosed as Garbha Kshaya (IUGR) by clinical features/ultrasonography; Women with known last menstrual period in the age group of 20–37 years; Singleton pregnancy with gestational age between 32 weeks and 36 weeks; both primi- and multigravida; IUGR associated with oligohydraminos, anemia, mild pregnancy-induced hypertension also included.

Exclusion criteria

Congenital anomalies of fetus; pregnancy complicated with multiple gestation, abruptio-placenta, placenta previa, gestational diabetes, positron emission tomography, eclampsia; Systemic diseases such as diabetes mellitus, HIV, cardiovascular disorders, tuberculosis, and hepatitis B.

Investigations

USG for fetal biometry, amniotic fluid index, estimated fetal birth weight. Investigations were carried out before and after the treatment.

Intervention

The study consisted of 61 patients randomly divided into two groups. Considering the very low incidence of Garbha Kshaya patients flow to the hospital in this area, this sample size was planned. Forty-one patients were administered Shatavaryadi Ksheerapaka Basti consisting of Bala, Shatavari and Arjuna [Table 2] soon after the commencement of 32 weeks of pregnancy for 10 days daily once in the morning and 20 patients were administered with L-Arginine 6.5 g sachet BD (in divided dose) with 1 glass water for 10 days.
Table 2: Drug intervention details of both groups

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Procedure of preparing Shatavaryadi Ksheerapaka Basti

Fine powder of Shatavari, Bala and Arjuna in equal quantity of 10 g each (total 30 g) is boiled with 15 parts of milk Ksheera (450 ml) and 15 parts of water (450 ml) until only milk part remains. The above procedure was carried out under Mandagni (mild fire). Thus obtained Ksheerapaka[7] was filtered and used for the Basti procedure.

Procedure for taking L-arginine powder

L-Arginine powder is poured into 1 glass of water, stirred well and taken ½ sachet in the morning and the other half at night after food.

Assessment criteria

Maternal nutrition parameters were assessed based on pregnancy weight gain, measurement of mid-upper arm circumference, abdominal girth, and symphysio-fundal height in centimeters. Pregnancy-related discomfort such as bloating (Adhmana), sleeplessness (Anidra), anorexia (Aruchi), giddiness (Bhrama), debility (Daurbalya), heaviness of the body (Gaurava), backache (Katishoola), constipation (Malabaddhata), pain in legs (Padashoola), pedal edema (Padashopha), pallor (Pandu), fatigue (Shrama), and heartburn (Urasdaha) along with improvement in fetal movements and maternal wellbeing were assessed by scoring.

Scoring pattern

Scoring pattern for the subjective parameters related to various maternal discomforts are illustrated in [Table 3]. The scoring pattern was developed and validated mainly based on the commonly experienced physiological discomforts of pregnancy.
Table 3: Scoring pattern for pregnancy discomforts

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Statistical analysis

The data generated in the clinical study was analyzed by applying Student's t-test using Statistical software-Sigma stat 3.5. The results were interpreted at P < 0.05, P < 0.01 and P < 0.001 significance levels.


  Results Top


Among 64 registered patients, 41 completed the study in the trial group and 20 patients in the control group. Two patients in Group Ksheerapaka Basti and one patient in Group L-Arginine group could not complete the treatment course due to their personal reasons.

Maternal feeling of well-being and fetal movements showed highly significant result in group Ksheerapaka Basti with 92.40% and 97.82% improvement, respectively. However, L-Arginine group showed deterioration by 33.33% and 5.88%, respectively [Table 4].
Table 4: Comparing the effect of therapies on fetal movement and feeling of maternal well being

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Maternal measurements such as abdominal girth and symphysis fundal height showed 3.20% and 7.96% of improvement, respectively, and 3.72% in maternal weight showing highly significant results in Ksheerapaka Basti group. In L-Arginine group, 1.41% and 3.53% changes were seen in abdominal girth and symphisis fundal height, and maternal weight showed only 1.22% improvement. Mid-arm circumference showed nonsignificant results in both the groups [Table 5].
Table 5: Comparing the effect of therapies on maternal measurements

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Amniotic fluid index showed 22.89% increase in KB group; however, AG group had further deterioration in liquor amount by 15.09% [Table 6].
Table 6: Comparing the effect of therapies on amniotic fluid index

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Relief in maternal pregnancy discomfort such as Adhmana (96.58%), Anidra (90.90%), Aruchi (87.87%), Bhrama (100%), Daurbalya (84.78%), Gaurava (86% relief), Katishoola (100%), Malabaddhata (95.83%), Padashoola (97.47%), Padashopha (95.23%), Shrama (75.36%), and Urasdaha (82.85%) showed significant improvement and Pandu (11.53%) showed nonsignificant result in Ksheerapaka Basti group. However, in the L-Arginine group, there was further aggravation of discomforts in Gaurava by 20% and Katishoola by 21.05%, Padashopha and Padashoola worsened by 45.45% and 40%, respectively, Urasdaha and Adhmana symptoms increased by 50% and 60% respectively. Other parameters in L-Arginine group showed nonsignificant results [Table 7].
Table 7: Comparing the effect on discomforts of pregnancy

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  Discussion Top


The above significant improvement is offered by the efficient nutritional supplement provided by the Ksheerapaka drugs bestowed with the attributes that enhances growth and nourishment to all the major structural components of the body (Saptadhatu). The increase in weight is mainly due to the nourishing, strengthening, rejuvenating and immune-modulating properties of the drugs.[8] Good quality Ahara Rasa is formed resulting in the nourishment of consecutive body tissues by the enhancement of digestive fire by the virtue of its stomachic property.

Soon after the administration of the Basti, active fetal movements were observed likely as a response to the filling of the intestines with Basti. Its quality to enhance the Rasa Dhatu aided in the replenishment of diminished amniotic fluid thereby easing the movement of the fetus in utero. The trial drug endowed with Balya, Brumhana and Rasayana properties was efficient to cope up with the nutritional drain caused by the growing fetus relieving Shrama, Daurbalya and Bhrama. Anga Gaurava being an indicator of Ama, was reduced considerably by the stomachic and carminative action of the drugs which initiates the digestion of Ama and boosts digestive fire, thereby reducing the heaviness of the body. Diminished gastrointestinal activity during pregnancy leads to disturbance in the Agni causing diminution of digestive fire and anorexia (Aruchi, Agnimandhya). Deepana, Pachana Agnivardhaka, Vatanulomaka Guna enhanced the digestion and absorption capacity, subsiding the symptoms. Heartburn in pregnancy is anticipated as a result of the regurgitation of contents of stomach caused by the relaxation of duodenal sphincter under the influence of pregnancy hormones.[9] Cold potency and Pitta relieving (Shitavirya, Pitta Shamaka) properties alleviated Pitta vitiation reducing the chest burn and acidity (Urasdaha, Vidaha).

Complain of occasional pain in the lower abdomen (Udarashoola) due to fetal movements, irritability of the abdomen or due to other gastrointestinal related disturbances were also relieved by the increase in the liquor quantity, maintenance of the intrauterine environment, and stability of the gastrointestinal system respectively by the action of Shatavaryadi Ksheerapaka Basti drugs.

Katishoola and Padashoola are mainly due to the weight of the growing fetus on the maternal back and due to the vitiation of Vata. Since analgesic and Vata alleviating (Vedanasthapana, Vatahara) property is chiefly present in the trial drug by means of Madhura Rasa and Vipaka, it mitigates the Vata, thus relieving the pain. Bala and Ksheera endowed with Balya Guna, strengthen the bones and muscles, easing backache. Shotaharaguna and diuretic properties present in the trial drug decreased the incidence of development of Padashopha even after 7th month whereas in the L-Arginine group, pedal edema had significantly increased. The lightness of the body, stress-relieving, calming action of the drugs along with subsidence of discomfort in abdomen, pain in legs and backache; promoted sound sleep reliving Anidra. Constipation in pregnancy is caused by atonicity of the gut and diminished peristalsis.[10] Vitiation of Vata in Koshta, Pakwashaya and Guda also results in constipation. Vatashamaka and Vatunolmana property along with Kshira being laxative might have contributed in subsiding the constipation. However, Basti procedure itself clears the bowel.

Raktaprasadana action helped in maintaining the iron needs by increasing the Rasadhatu and Raktadhatu. Prajasthapana, Garbhasthapaka properties along with the Glycoside Shatavarin1 and alcoholic extract of Shatavari[11] produce a specific block of Pitocin-induced contraction which acts as uterine sedative inhibiting any premature uterine contraction, ensuring continuity of pregnancy up to the term. Relief in pregnancy discomforts assisted in the maternal feeling of well-being. Basti expels morbid wastes in the intestines and boosts the absorption of Ksheerapaka Basti ingredients. Basti ensures Vatanulomana and lubricates the birth passage facilitating in easy delivery.[12] Shatavari being galactagogue aids in uninterrupted lactation postdelivery.[13]


  Conclusion Top


Shatavaryadi Ksheerapaka Basti proved to be efficient in increasing the maternal weight, promoting the growth of the fetus, improving the amniotic fluid index; thereby increasing the size of the maternal abdomen. Fetal wellbeing well established by the normalcy of fetal movement and fetal growth. Along with achieving the primary outcome of improving the maternal nourishment, the drug formulation also played vital role in fulfilling the secondary outcome of overcoming the physiological discomforts of pregnancy thereby contributing in the maternal wellbeing. It can be safely administered to pregnant patients in the management of Garbha Kshaya without any untoward effects.


  Acknowledgment Top


Thankful to I.T.R.A., Gujarat Ayurved University, Jamnagar.

Financial support and sponsorship

I.T.R.A., Gujarat Ayurved University, Jamnagar.

Conflicts of interest

There are no conflicts of interest.





 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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