E-ISSN:2456-3110

Case Report

Parushaka Twak Lepa

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 8 September
Publisherwww.maharshicharaka.in

The effect of Parushaka Moola Twak Lepa in Sukha Prasava - A Case Study

Meghana M.1*, Rachana H.2
DOI:

1* MN Meghana, Post Graduate Scholar, Department of Prasuti Tantra and Stree Roga, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India.

2 HV Rachana, Professor, Department of PG Studies in Prasuti Tantra and Stree Roga, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India.

Background: Child birth is a physiological natural process, where woman experiences the most severe and agonizing pain. Ayurvedic science has vast description on Prasava Paricharya and mentioned several drugs for accomplishing Sukha Prasava. Acharya Vangasena mentioned about Parushaka Moola Twak for Sukha Prasava. Aim and Objectives: To achieve normal vaginal delivery with in normal duration and without any complications. To evaluate the efficacy of Parushaka Moola Twak Lepa in Prasava. Materials and Methods: The Lepa was applied when the patient was in active first stage of labor. Repeated application of Lepa was done throughout the process of labor Result: Hastens the duration of stages of labor helps for cervical dilatation, effacement, consistency and normal process of labor by changing in the cervical position and head station. Conclusion: Parushaka Moola Twak Lepa was effective in reducing the duration of labor, progress of labor and for easy expulsion of foetus without affect the health of mother and foetus.

Keywords: Prasava, Normal labor, Parushaka Twak Lepa

Corresponding Author How to Cite this Article To Browse
MN Meghana, Post Graduate Scholar, Department of Prasuti Tantra and Stree Roga, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India.
Email: 		MN Meghana, HV Rachana, The effect of Parushaka Moola Twak Lepa in Sukha Prasava - A Case Study. J Ayu Int Med Sci. 2022;7(8):176-180.
Available From
https://www.jaims.in/jaims/article/view/2042

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-07-30 2022-08-01 2022-08-08 2022-08-15 2022-08-22
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2022by MN Meghana, HV Rachanaand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Meghana M et al: The effect of Parushaka Moola Twak Lepa in Sukha Prasava

Introduction

Pregnancy is a joyful and precious event in every woman’s life; most of them will be having the fear of unbearable pain and discomfort and complications of delivery. Happy and safe motherhood can be achieved by safe pregnancy and easy delivery, for the same in Ayurveda our Acharya’s had given the prime importance for antenatal care from the day of conception till delivery. As the incidence of cesarean delivery is steadily rising and it is associate with short and long term risks which can extend beyond the current delivery, the risks like wound infection, anesthetic hazards, hemorrhage, increase the risk in future pregnancies [1] etc. so the rate of cesarean delivery to be decreased.

Labor is a physiological process and it should be complete with in normal duration for Primi gravida and multi gravida respectively, as prolonged labor also lead to maternal and fetal complications. Even the use of oxytocin during the process of labor may lead to fetal distress and harmful effects on mother.[2]

So, need of the hour is to adopt some safer and holistic ways to ease and augment the process of labor. The present study is an effort to evaluate effective of Parushaka Moola Lepa [3] in Prasava also it is having tonic effect[4], which may help for the augmentation of labor, in turn it may also help for the easy expulsion of foetus.

Aims and Objectives

1. To achieve normal vaginal delivery with in normal duration and without any complications.

2. To evaluate the efficacy of Parushaka Moola Twak Lepa in Prasava.

Case Report

A 21-year-old female pregnant patient with Amenorrhea of 38 weeks 2 day came to OPD of Prasuti Tantra and Stree Roga, SSCASR&H, Bangalore with the C/O intermittent abdominal pain along with show associated with back pain since 2 hours.

Obstetric History: G1 P1 A0 L0 D0

On Examination

Per Abdomen

Uterus~38-39 weeks

Cephalic presentation

Head engaged

Contraction - 1/10/20

Per Vaginal

Cervical dilatation 2-3 cm

Cervical effacement- 30%

Cervical position- posterior

Cervical consistency- soft

Head station- -2

Investigation

Blood group and Rh- “O” positive

Hb% - 13.6gm%

Platelet count - 3 lakh/cumm

BT - 5 min 10 sec

CT - 3 min 20 sec

RBS - 98mg/dl

VDRL, HIV, HBsAg - Negative

USG (III Trimester) - A single live intra uterine gestation of 36 weeks 2 days.

Adequate internal growth, BPP - 8/8

Urine - Routine and Microscopy - Normal study

Prasava Paricharya: Parushaka Moola Twak Lepa was applied over the Nabhi, Basti and Bhaga Pradesha in active phase of labor (Bhishop score - 6-7) and was repeated throughout the labor process, 4 applications of Lepa[5] was applied in this case.

Preparation of Lepa: Parushaka Moola Twak Churna[6] was taken around 15-20 grams by adding a luke warm water the drug was made into paste and was applied over Nabhi, Basti and Bhaga Pradesha.

Assessment Criteria

1. Duration of stages of labour

Duration of 1st stage.

Duration of 2nd stage.

Duration of 3rd stage.


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2. Partograph

Patient identification.

Time - recorded at hourly interval.

Fetal heart rate - recorded at every 30 minutes.

State of membrane and colour of liquor.

Cervical dilatation and descent of the head.

Blood pressure at every 2 hours and pulse at every 30 minutes

Uterine contractions and intensity - per 10 minutes

jaims_2042_02.JPGPartograph

3. Bhishop Score

    Score    
Parameters 0 1 2 3
Cervix        
Dilation (cms) Closed 1-2 3-4 5+
Effacement(%) 0-30 40-50 60-70 ≥80
Consistency Firm Medium Soft -
Position Posterior Midline Anterior -
Head station -3 -2 -1,0 +1,+2

4. Observe for PPH - Present or Absent.

5. Observation for fetal wellbeing (Apgar Score)

  0 1 2 3
A Activity (muscle tone) Absent Flexed arms and legs Active
P Pulse Absent Below 100bpm Above 100bpm
G Grimace (reflex irritology) Floppy Minimal response to stimuli Prompt response to stimuli
A Appearance (Skin colour) Blue, Pale Pink body, blue extremities Pink
R Respiration Absent Slow and irregular vigorous cry

Observation and Results

Duration of stages of labor

Duration of stages of 1st stage of labor: 5 hour 30 minutes

Duration of stages of 2nd stage of labor: 1 hour 20 minutes

Duration of stages of 3rd stage of labor: 5 -6 minutes.

Fourth stage of labor - Uneventful.

Uterine Contraction: It has been observed that the uterine contractions, intensity frequency increased gradually.

Per Vaginal Examination

Time 5:30 pm 7:30 pm 9:00pm 10:30 pm
Cervical dilatation 2-3 cm 4-5 cm 7-8 cm 10 cm
Cervical effacement 30-40% 60-70% 80-90% 100%
Cervical consistency Soft Soft Soft Soft
Cervical position Posterior Midline Anterior Anterior
Head station -1 0 +1 +1 ,+2

Discussion

Duration of stages of labor: The chemical constituents like tonic effect, phenolic acid, tannin, glycosides present in Parushaka Moola Twak which may increase the muscle contractions and also when applied in the form of Lepa over abdomen was absorbed through its Veerya, stimulates the Apana Vata, there by reducing the duration of labor.

Uterine Contrations
Duration of Uterine Contraction Mild
Tonic effect of Parushaka Moola Twak, when applied in the form of Lepa undergoes


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Paka by the Brajaka Pitta in skin, it helps in effect of Vata like Akunchana, Prasarana and Anulomana which leads to uterine contraction.

Uterine Contraction Moderate

Once the drug applied and the duration of contractions and frequency

Uterine Contraction Severe

As the labor progress duration and intensity of contractions will increase, due to action of drug on uterine contractions.

1. Cervical Dilation: The drug helps for smooth muscle contraction in turn helps for cervical dilatation.

2. Cervical Effacement: Action of the drug was on Apana Vayu it does Akunchana and Prasarana Karma due to which the descent of fetus and there by downward thrush of present part of fetus and upward pull of the cervix over the lower segment take place, thus helping in effacement of cervix.

3. Cervical Consistency: cervical consistency between medium to soft as the labor progresses, the drug in turn does favorable cervix for easy delivery.

4. Cervical Position: the drugs help for the initiation and for mechanism of labor by acting on Apana Vayu.

5. Head Station: As the drugs acts on Apana Vayu, stimulates the Avi thus helps for further progress of labor. Due to uterine contractions and further effect on cervical position and fetal head station was observed.

6. Fetal Heart Rate: 120-148 b/min throughout the delivery.

7. Postpartum Haemorrhage: Absent

8. Rupture of Membrane: Spontaneous rupture membrane was observed.

9. Liquor Colour: Clear

10. Apgar Score: 0th min – 8/10, 1st min 10/10, 5th minute 10/10.

Result

Patient Delivered normally with Birth weight of 2950g.


Discussion on Intervention

Lepa Kalpana which was explained under Bahir Parimarjana Chikitsa, which has applied over skin and was prepared with wet or dry drugs the importance of Lepa is highlighted like how the fire ceases after pouring water in the same way Dosha get subsided after applying Lepa.

The Lepa which is applied in the direction opposite to hair follicle will enter into hair follicle by its Veerya and the action of drug is carried out.

Acharya Sushruta in Dhamani Prakarana Adhyaya explained Tiryagga Dhamani, each one of the four Dhamani spreading side wards / transversely divide into hundreds and thousands of branches and become innumerable by these the body is covered like a network, bound, pervaded, their openings (Sira Mukha) are attached to Roma Kupa which carry Sweda Vahini and replenishes Rasa inside and outside, through these only the Veerya of drug used for Lepa enter into the body by the action of Brajaka Pitta.[7]

The chemical constituents, Triterpenoid, phenolic effect Tannins which are present in Parushaka Moola Twak which is having tonic effect,[4] which may help for the Augmentation of labor, in turn helps to hasten the duration of labor for the easy expulsion of fetus.

Due to the above chemical constituents these drugs are useful for Sukha Prasava, the tonic effect of Parushaka helps for hastening the duration of labor, as this drugs are inducing uterine contractions inturn favouring the cervical dilatation, effacement, position and head stations provided the Bhishop Score is favourable and subjects are in active stage of labor it also maintain the normalcy of Apana Vata helping for Sukha Prasava.

Maintaining the Apana Vayu normalcy is important because any Vaigunya in Apana Vayu leads to Prasava Vyapad.

The drugs used here in the study have an action on Vayu especially Apana and Vyana Vayu to have their function normally without affecting the mother and fetus.

In the modern science absorption through the skin occurs by stratum corneum, secretary glands and hair follicles the tropical applications have advantages like it avoid the first pass metabolism,


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prolonged residence time, can be applied over the organ where we want action.[8]

Drug application in the form of Lepa Kalpana is advised, as it doesn’t involve the gastrointestinal track and easy to remove if any adverse reaction is noted.so, this mode of application is selected in this study.

Conclusion

Parushaka Moola Twak Lepa application in active labor shown effective result by reducing the duration of stages of labor and in cervical effacement, dilatation, consistency, position and head station. Over all it helps for the progress of labor in turn leading to Sukha Prasava with causing maternal and fetal mortality and morbidity.

Reference

1. Dutta DC. Text book of obstetrics.9th ed. New Delhi, London, Panama: Jaypee Brothers Medical Publishers;2019. Ch.37, Operative obstetrics; p.552-553.

2. Dutta DC. Text book of obstetrics.9th ed. New Delhi, London, Panama: Jaypee Brothers Medical Publishers;2019. Ch.34, Operative obstetrics; p.465.

3. Acharya Vangasena, Vangasena Samhita, Nirmalasaxena, Ch.73/229, Varanasi, Chaukhambha Sanskrit series, p.985.

4. Uday Singh Paviaya, Parveen Kumar, Manish Wanjari M, Thenmozhi, Bala Krishna B R. Analgesic and Anti-inflammatory activity of Root bark of Grewia Asciatica Linn. In rodents. Anc Sci Life.2013 Jan-Mar; 32(33):150-5.

5. Acharya Sarangdhara, Sarangdhara Samhita, Srikanta murthy, Madyama Khanda, Ch.6/ver1, Sixth edition, Varanasi: Chaukhambha Orientale; p.84.

6. Acharya Sarangdhara, Sarangdhara Samhita, Srikanta murthy, Uttara Khanda, Ch.11/ver1, Sixth edition, Varanasi: Chaukhambha Orientale; p.235.

7. Acharya Sushrutha, Sushrutha Samhita, Acharya Jadavji Trikamji Narayan Ram Acharya, Shaareera sthana.Ch.9, Varanasi: Chaukhambha Orientalia; p.383-4.


8. Tripathi KD. Essential of Medical Pharmacology.7th ed. New Delhi: Jaypee Brothers Medical Publishers;2015. Ch.14, Miscellaneous Drugs; p.895-96.


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