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== Etymology ==

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“Stanodbhavam stanyam”- the entity produced or secreted from breast (stana) is termed as ‘stanyam’. (Dalhana on Su. Sa. Nidana Sthana 10/18) Monniere Williams dictionary mentions it as that which is drawn from the breast i.e. breast milk or mothers milk.<ref name="ref1"></ref>

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“Stanodbhavam stanyam”- the entity produced or secreted from breast (stana) is termed as ‘stanyam’. (Dalhana on Su. Sa. Nidana Sthana 10/18) Monniere Williams dictionary mentions it as that which is drawn from the breast i.e. breast milk or mothers milk.<ref name="ref1">MONIER-WILLIAMS, M. (1872). A Sanskṛit-English dictionary, Page No. 1142</ref>

== Synonyms ==

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== Physiology of stanya according to ayurveda ==

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Stanya is regarded as upadhatu (the minor structural components that stabilize and sustain the body) and prasada bhaga (essence or formed from nutrient part) of rasa dhatu metabolism, produced in the breast/mammary glands in females. [Cha. Sa. Chikitsa Samhita 15/17, Bhoja Samhita] Bhoja mentions stanya as not having any movement or physiological functions in body (gativivarjita) as it does not participate in further metabolic activities in the body. Sushruta mentions stanya as a product of digested food (pakwahara). [Su. Sa. Nidana Sthana 10/18] Like shukra, its presence is felt across the body. [Su. Sa. Nidana Sthana 10/19] Kashyapa opines that stanya is produced from the rakta dhatu. [Kashyapa Samhita Rakta Gulma Adhyaya] This can be justified as the stanya is produced and expressed from the stana which consists of sira which are the upadhatu of rakta dhatu. The metabolism of rasa- rakta dhatu form the major canvas for the understanding the stanya physiology. Like menstruation (artava), stanya is observed for limited time during the course of life of a female i.e. post delivery period or lactation period. Sushruta states that it is expressed within 3 of 4 days of child birth and its secretion continues till the stanyapanayana or weaning occurs. [Su. Sa. Shareera Sthana 10/14] [A.H. Uttar Tantra 1/14] The development of breasts occurs after the menarche by physiologically accelerated growth of mammary glands during the pregnancy. [Su. Sa. Nidana Sthana 10/17] In the state of pregnancy, the rasa dhatu metabolism is directed towards stanya formation. [Cha. Sa. Shareer Sthana 6/23 ,Kashyap Samhita Sutrasthana 1] As per Vagbhat, the gross amount of breast milk (stanya) present in an individual is 2 anjali<ref name="ref2"></ref> (approximately 200ml with 1 anjali corresponding to 135ml according to a previous study). [A.H. Shareera Sthana 3/81] According to contemporary approach average breast milk production is about 500-700ml per day.<ref name="ref3"></ref> It is defined to have pure white colour and becomes homologous with water when mixed. It possesses a characteristic sweet/ madhura smell when unvitiated. [Su. Sa. Shareera Sthana 8/14, Su. Sa. Nidana Sthana 10/25] Any deviation from the normal colour and consistency of stanya reflects underlying pathological condition. Sushruta has also explained the physiology of stanya. Following factors are responsible for the appearance of breast milk in the post-natal period which also facilitates the process of labour. [Su. Sa. Nidana Sthana 10/22]-

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Stanya is regarded as upadhatu (the minor structural components that stabilize and sustain the body) and prasada bhaga (essence or formed from nutrient part) of rasa dhatu metabolism, produced in the breast/mammary glands in females. [Cha. Sa. Chikitsa Samhita 15/17, Bhoja Samhita] Bhoja mentions stanya as not having any movement or physiological functions in body (gativivarjita) as it does not participate in further metabolic activities in the body. Sushruta mentions stanya as a product of digested food (pakwahara). [Su. Sa. Nidana Sthana 10/18] Like shukra, its presence is felt across the body. [Su. Sa. Nidana Sthana 10/19] Kashyapa opines that stanya is produced from the rakta dhatu. [Kashyapa Samhita Rakta Gulma Adhyaya] This can be justified as the stanya is produced and expressed from the stana which consists of sira which are the upadhatu of rakta dhatu. The metabolism of rasa- rakta dhatu form the major canvas for the understanding the stanya physiology. Like menstruation (artava), stanya is observed for limited time during the course of life of a female i.e. post delivery period or lactation period. Sushruta states that it is expressed within 3 of 4 days of child birth and its secretion continues till the stanyapanayana or weaning occurs. [Su. Sa. Shareera Sthana 10/14] [A.H. Uttar Tantra 1/14] The development of breasts occurs after the menarche by physiologically accelerated growth of mammary glands during the pregnancy. [Su. Sa. Nidana Sthana 10/17] In the state of pregnancy, the rasa dhatu metabolism is directed towards stanya formation. [Cha. Sa. Shareer Sthana 6/23 ,Kashyap Samhita Sutrasthana 1] As per Vagbhat, the gross amount of breast milk (stanya) present in an individual is 2 anjali<ref name="ref2">Gadgil N, Kulkarni A. An observational study to quantify the measure of Anjali Pramana -A pilot study. 1 Neha Dattatraya Gadgil, and. 2019 Jul 27;</ref> (approximately 200ml with 1 anjali corresponding to 135ml according to a previous study). [A.H. Shareera Sthana 3/81] According to contemporary approach average breast milk production is about 500-700ml per day.<ref name="ref3">Kent, J. C., Gardner, H., & Geddes, D. T. (2016). Breastmilk Production in the First 4 Weeks after Birth of Term Infants. Nutrients, 8(12), 756. https://doi.org/10.3390/nu8120756</ref> It is defined to have pure white colour and becomes homologous with water when mixed. It possesses a characteristic sweet/ madhura smell when unvitiated. [Su. Sa. Shareera Sthana 8/14, Su. Sa. Nidana Sthana 10/25] Any deviation from the normal colour and consistency of stanya reflects underlying pathological condition. Sushruta has also explained the physiology of stanya. Following factors are responsible for the appearance of breast milk in the post-natal period which also facilitates the process of labour. [Su. Sa. Nidana Sthana 10/22]-

* Apatya sparsha- Touching the child.

* Apatya darshana- Sight of the new-born.

* Apatya smarana- Thinking about the child.

* Grahanat shareerasya¬- Holding the new-born close to the mother.

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Contemporary view also suggests that the hormonal and emotional factors play a key role in the breast milk physiology.<ref name="ref4"></ref> Thus in the conditions like decreased lactation (stanya-kshaya), counselling can prove to be more beneficial. The main function of stanya is providing the nourishment to child as explained through the jeevana karma (promoting vitality). [Su. Sa. Sutra Sthana 15/14] The entire sustainance of the child for the first six months to one year is dependent on the stanya, which also determines the health profile of the infant. Another karma of stanya is peenatvajanana i.e. providing proper structure and nourishment to the stana or breast tissue. [Su. Sa. Sutra Sthana 15/5] Kashyapa has also emphasized the same stating the breast milk as jeevana (vitalizer), pushtikara (nourishing), vriddhikara (growth promoting), balavardhana (strengthening), ojaskara (promotinig essence part of life) [Kashyap Samhita Ksheera Vigyana Adhyaya] Ayurveda mentions that the, expression of breast milk from the right breast at first is indicative of male progeny, while that from left breast is indicative of female progeny. [Su. Sa. Shareera Sthana 3/34, Cha. Sa. Shareera Sthana 2/24]

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Contemporary view also suggests that the hormonal and emotional factors play a key role in the breast milk physiology.<ref name="ref4">Shah R, Sabir S, Alhawaj AF. Physiology, Breast Milk. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 May 12]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK539790/</ref> Thus in the conditions like decreased lactation (stanya-kshaya), counselling can prove to be more beneficial. The main function of stanya is providing the nourishment to child as explained through the jeevana karma (promoting vitality). [Su. Sa. Sutra Sthana 15/14] The entire sustainance of the child for the first six months to one year is dependent on the stanya, which also determines the health profile of the infant. Another karma of stanya is peenatvajanana i.e. providing proper structure and nourishment to the stana or breast tissue. [Su. Sa. Sutra Sthana 15/5] Kashyapa has also emphasized the same stating the breast milk as jeevana (vitalizer), pushtikara (nourishing), vriddhikara (growth promoting), balavardhana (strengthening), ojaskara (promotinig essence part of life) [Kashyap Samhita Ksheera Vigyana Adhyaya] Ayurveda mentions that the, expression of breast milk from the right breast at first is indicative of male progeny, while that from left breast is indicative of female progeny. [Su. Sa. Shareera Sthana 3/34, Cha. Sa. Shareera Sthana 2/24]

== Anatomical aspects related to stanya ==

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* Stanya asambhava: Lack of production of breast milk

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* This can be correlated with low milk supply or decrease in the quantity of milk.<ref name="ref5"></ref>

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* This can be correlated with low milk supply or decrease in the quantity of milk.<ref name="ref5">Riddle SW, Nommsen-Rivers LA. Low milk supply and the pediatrician. Curr Opin Pediatr. 2017;29(2):249-256. doi:10.1097/MOP.0000000000000468</ref>

* In some cases, complete failure of milk production can occur as well.

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* Toda: pricking pain at stana region

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* This is correlated to galactorrhea<ref name="ref6"></ref>

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* This is correlated to galactorrhea<ref name="ref6">Haney AF. Galactorrhea. Curr Ther Endocrinol Metab. 1997;6:393-396.</ref>

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* Breast hypertrophy or gigantomachia can be related with this condition.<ref name="ref7"></ref>

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* Breast hypertrophy or gigantomachia can be related with this condition.<ref name="ref7">Reisenbichler E, Hanley KZ. Developmental disorders and malformations of the breast. Semin Diagn Pathol. 2019;36(1):11-15. doi:10.1053/j.semdp.2018.11.007</ref>

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* Symptoms of breast abscess or carcinoma.<ref name="ref8"></ref>

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* Symptoms of breast abscess or carcinoma.<ref name="ref8">Ajao OG, Ajao AO. Breast abscess. J Natl Med Assoc. 1979;71(12):1197-1198.</ref>

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These conditions are often faced by the practitioners and primi mothers during day to day practice. The stanya kshaya or stanya nasha (reduction in amount of stanya- breast milk) is an important condition as it directly affects the growth and development of new born. Acharya Sushruta has provided the detailed explanation regarding the etio-pathology, clinical features and management of this condition.

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<li style="font-weight:bold">Diet (aharaja) protocol: One suffering from depletion (stanya kshaya) should consume the dietary items like, yava (barley), godhuma (wheat), shali (rice), mansa rasa (meat soup), sura (wine). Alcoholic preparations like seedhu [Su. Sa. Sutra Sthana 45/175-176, Cha. Sa. Sutra Sthana 27/179, A.H. Sutra Sthana 5/67], sauveeraka (alcoholic preparation), peenyaka (sesame extract), lashuna (garlic, allium sativum), matsya (fish), ksheera prayoga (milk and dairy products), drava-amla- lavana pradhana ahaara (liquid diet predominantly salty and sour in taste), nishpava (flat beans) (A.H. Sutra Sthana 6/20). Sushruta also mentions masha (black gram), rajamasha (cow peas). (Su. Sa. Sutra Sthana 46/34-35) </li>

<li style="font-weight:bold">Medication/aushadha protocol: Use of herbs like kasheruka (Actinoscirpus grossus (L.f.) Goetgh.), shrungataka (Trapa bispinosa Roxb.), bisa (Nelumbo nucifera Gaertn), vidarikanda (Pueraria tuberosa), madhuka (Madhuca longifolia), shatavari (Asparagus racemosus), nalika (Pergularia daemia (Forssk.)), alabu (Chenopodium album), kaalashaaka (Corchorus capsularis). veerana (Vetiveria Zizanioides), ikshu (Saccharum officinarum), darbha (Desmostachya bipinnata Stapf.), kasha (Saccharum spontaneum) , gundra (Typha angustata) , moolaka (Raphanus sativus L.). [Cha. Sa. Shareera Sthana 8/56]</li></ol></ul>

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As mentioned earlier, extensive knowledge and research is available on the lactogenic, galactagogic potential of herbs mentioned in Ayurveda. The dravya like shatavari (Asparagus racemosus), ashwagandha (Withania somnifera), vidari (Pueraria tuberosa), musali (Chlorophytum borivilianum), durva (Cynodon dactylon), haridra (Curcuma longa Linn), musta (Cyperus rotundus), padmaka (Prunus Cerasoides D), guduchi (Tinospora cordifolia). Similarly, other drugs constituting jeevaniya (A.H. Sutra Sthana 15/5), vidarigandhadi (A.H. Sutra Sthana 15/7), padmakadi gana (A.H. Sutra Sthana 15/41), mustadi gana (A. H. Sutra Sthana 15/42, Su. Sa. Sutra Sthana 54-55), vacha-haridradi gana (A. H. Sutra Sthana 15/35-36), vacha-haridradi (Su. Sa. Sutra Sthana 38/26-28), kakolyadi gana (Su. Sa. Sutra Sthana 38/35-36) have proven potent effect in enhancing the breast milk production.<ref name="ref9"></ref><ref name="ref10"></ref><ref name="ref11"></ref><ref name="ref12"></ref><ref name="ref13"></ref> Dalhana has also mentioned few treatment modalities like sura (fermented or alcoholic preparations), shali (rice), mansa (meat), goksheer (milk), sharkara (sugar), dadhi (curd), hridya diet in the treatment of stanya kshaya [Dalhana on Su. Sa. Sutra Sthana 15/29-31] The aparistruta stanya (improper or inadequate expression of breast milk, improper technique of breast feeding), the child can suffer from conditions like kasa (cough), shwasa (breathing difficulties), vami (vomitus) hence breast feeding should be avoided in such conditions. [Su. Sa. Shareera Sthana 10/29]

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As mentioned earlier, extensive knowledge and research is available on the lactogenic, galactagogic potential of herbs mentioned in Ayurveda. The dravya like shatavari (Asparagus racemosus), ashwagandha (Withania somnifera), vidari (Pueraria tuberosa), musali (Chlorophytum borivilianum), durva (Cynodon dactylon), haridra (Curcuma longa Linn), musta (Cyperus rotundus), padmaka (Prunus Cerasoides D), guduchi (Tinospora cordifolia). Similarly, other drugs constituting jeevaniya (A.H. Sutra Sthana 15/5), vidarigandhadi (A.H. Sutra Sthana 15/7), padmakadi gana (A.H. Sutra Sthana 15/41), mustadi gana (A. H. Sutra Sthana 15/42, Su. Sa. Sutra Sthana 54-55), vacha-haridradi gana (A. H. Sutra Sthana 15/35-36), vacha-haridradi (Su. Sa. Sutra Sthana 38/26-28), kakolyadi gana (Su. Sa. Sutra Sthana 38/35-36) have proven potent effect in enhancing the breast milk production.<ref name="ref9">Patil DPD, Bhalgat DMS. WJPR - Abstract. 1 [Internet]. [cited 2023 Jul 10]; Available from: https://wjpr.net/abstract_show/12611</ref><ref name="ref10">Gulshan. Padmakadi Gana - Group of Ayurvedic Herbs [Internet]. 2017 [cited 2023 Jul 10]. Available from: https://www.ayurmedinfo.com/2012/04/23/padmakadi-gana-group-of-ayurvedic-herbs/</ref><ref name="ref11">Apila Nath M.K, N.Sudhakar, Sarojini Byadagi, Binu.M.B. Haridradi Gana Kwatha in The Management of Stanya Kshaya w.s.r to Hypogalactia - A Clinical Study. International Journal of Ayurveda and Pharma Research. 2020;8(Suppl 1):19-24.</ref><ref name="ref12">Dipti, et al. Vidarigandhadi Gana of Sushruta Samhita: A Review of its Clinical Indications. Nat Ayurvedic Med 2020, 4(3): 000262. Ayurvedic Medicine. 2020;</ref><ref name="ref13">Kumar B. A REVIEW ON KAKOLYADI GANA OF SUSHRUTA SAMHITA. Indian Journal of Agricultureand Allied Sciences,Vol 4, Issue No.: 2 , page No 80-82</ref> Dalhana has also mentioned few treatment modalities like sura (fermented or alcoholic preparations), shali (rice), mansa (meat), goksheer (milk), sharkara (sugar), dadhi (curd), hridya diet in the treatment of stanya kshaya [Dalhana on Su. Sa. Sutra Sthana 15/29-31] The aparistruta stanya (improper or inadequate expression of breast milk, improper technique of breast feeding), the child can suffer from conditions like kasa (cough), shwasa (breathing difficulties), vami (vomitus) hence breast feeding should be avoided in such conditions. [Su. Sa. Shareera Sthana 10/29]

=== 2) Treatment of stanya dushti as per Sushruta ===

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<ol style="text-align:justify;"><li style="font-weight:bold">Chhaga paya (goats milk): It is considered to be best when breast milk is not available. [Cha. Sa. Sutra Sthana 25/42]</li>

<li style="font-weight:bold">Gavya paya (cow milk) : It is also mentioned to be one of the best substitute for breast milk [A.H. Sutra Sthana 5/22]</li>

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Contemporary science states that raw and unpasteurised cows milk is difficult to digest and contain more protein content like casein as compared to human milk. The infant formula milk is however treated bovine milk making it a appropriate substitute for breast milk.<ref name="ref14"></ref> The goats milk based infant formula can also be administered as a substitute in case of cow milk allergy but can result in nutrient deficiency.<ref name="ref15"></ref>

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Contemporary science states that raw and unpasteurised cows milk is difficult to digest and contain more protein content like casein as compared to human milk. The infant formula milk is however treated bovine milk making it a appropriate substitute for breast milk.<ref name="ref14">Martin, C. R., Ling, P. R., & Blackburn, G. L. (2016). Review of Infant Feeding: Key Features of Breast Milk and Infant Formula. Nutrients, 8(5), 279. https://doi.org/10.3390/nu8050279</ref> The goats milk based infant formula can also be administered as a substitute in case of cow milk allergy but can result in nutrient deficiency.<ref name="ref15">British Journal Of Midwifery [Internet]. [cited 2023 Jul 10]. British Journal Of Midwifery - Alternatives to breastfeeding: The use of goats’ milk in infant formula. Available from: https://www.britishjournalofmidwifery.com/content/clinical-practice/alternatives-to-breastfeeding-the-use-of-goats-milk-in-infant-formula/</ref>

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<li style="font-weight:bold">Laghu- panchamula siddha ksheera with sitopala or sthiradi varga siddha kshira with sitopala - Laghu Panchamula consists of roots of 5 herbs namely , Shalaparni (Desmodium gangeticum), Prishniparni (Uraria picta) , Brihati (Solanum indicum), Kantakari (Solanum virginianum) and Gokshura (Tribulus Terrestris). Research proves that these herbs have proven galactogogue activity<ref name="ref16"></ref> These can be used as substitutes for formula milk or breast feeding in the circumstances where breast feeding is not possible. The evidence based scientific preclinical study and clinical trials should be carried out to prove the effectiveness of the mentioned options. </li></ol>

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<li style="font-weight:bold">Laghu- panchamula siddha ksheera with sitopala or sthiradi varga siddha kshira with sitopala - Laghu Panchamula consists of roots of 5 herbs namely , Shalaparni (Desmodium gangeticum), Prishniparni (Uraria picta) , Brihati (Solanum indicum), Kantakari (Solanum virginianum) and Gokshura (Tribulus Terrestris). Research proves that these herbs have proven galactogogue activity<ref name="ref16">Ghildiyal, S., & Joshi, V. K. (2012). A critical review on two types of Laghupanchamula. Ayu, 33(3), 343–347. https://doi.org/10.4103/0974-8520.108820</ref> These can be used as substitutes for formula milk or breast feeding in the circumstances where breast feeding is not possible. The evidence based scientific preclinical study and clinical trials should be carried out to prove the effectiveness of the mentioned options. </li></ol>

== Contra-indications to breast feeding ==

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Researches on experimental studies exploring the galactagogic activities of various ayurveda herbs are observed. Few clinical trials measuring the galactogogue activity were also obtained. Findings of some of these articles can be summarized as below –

=== Studies focusing on the physiological and pathological aspects considering the stanya ===

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<ol style="text-align:justify;"><li>In the article , “Noxious Alterations in Human Milk: An Ayurveda Perspective<ref name="ref17"></ref>” is related with the understanding of causes of vitiation of human milk, its effect on composition of human and to critically analyse the effect of consumption of vitiated milk on the infant.</li>

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<ol style="text-align:justify;"><li>In the article , “Noxious Alterations in Human Milk: An Ayurveda Perspective<ref name="ref17">Londhe D, Chinchalkar S, Chiluveri AC, Kumar S, Chiluveri SK. Noxious Alterations in Human Milk: An Ayurveda Perspective. J Hum Lact. 2022;38(2):332-338. doi:10.1177/08903344211032130</ref>” is related with the understanding of causes of vitiation of human milk, its effect on composition of human and to critically analyse the effect of consumption of vitiated milk on the infant.</li>

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<li>Breast milk as an etiological factor in infantile disorders – An observational study<ref name="ref18"></ref> The breastmilk from 100 mothers with infants in age group of 1-6 months was collected and subjected to organoleptic and laboratory tests to identify the type of stanya sushti.</li>

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<li>Breast milk as an etiological factor in infantile disorders – An observational study<ref name="ref18">Meti R, Ankad G. Breast milk as an etiological factor in infantile disorders - An observational study. J Ayurveda Integr Med. 2021;12(4):700-704. doi:10.1016/j.jaim.2021.06.011</ref> The breastmilk from 100 mothers with infants in age group of 1-6 months was collected and subjected to organoleptic and laboratory tests to identify the type of stanya sushti.</li>

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<li>In the article, ‘Understanding the Concept of Stanya and its Need in Context to Breastfeeding’<ref name="ref19"></ref>, the authors have underlined the importance of breast feeding in context to concept of Stanya in Ayurveda.</li>

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<li>In the article, ‘Understanding the Concept of Stanya and its Need in Context to Breastfeeding’<ref name="ref19">Tanwar K, Tanwar A.K “Understanding The Concept of Stanya And Its Need In Context To Breastfeeding IRJAY.[online]2022;5(2);179-183.Available from: https://irjay.comDOI: https://doi.org/10.47223/IRJAY.2022.523</ref>, the authors have underlined the importance of breast feeding in context to concept of Stanya in Ayurveda.</li>

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<li>The article, The Concept Of Stanya Apanayana (Weaning)<ref name="ref20"></ref> focuses on the concept of Stanya apanayana i.e. weaning according to the classical texts in detail. </li>

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<li>The article, The Concept Of Stanya Apanayana (Weaning)<ref name="ref20">Konapalli J, Krishnaiah N. The Concept Of Stanya Apanayana (Weaning). Int J Ayu Pharm Res [Internet]. 2018Dec.9 [cited 2023May12];6(10). Available from: http://ijaprs.com/index.php/ijapr/article/view/1075</ref> focuses on the concept of Stanya apanayana i.e. weaning according to the classical texts in detail. </li>

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<li>The observational study entitled, Biochemical Analysis Of Stanya & Its Correlation With Rasa-Sarata<ref name="ref21"></ref>, the lipid profile along with the Rasa Saarata of lactating mothers was assessed in the present study showing strong positive correlation between the Stanya and Rasa Saarata.</li>

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<li>The observational study entitled, Biochemical Analysis Of Stanya & Its Correlation With Rasa-Sarata<ref name="ref21">Rai S, Versha P, Sawhney S. Biochemical Analysis Of Stanya & Its Correlation With Rasa-Sarata, WJPR, Volume 10, Issue 7, Page No. 814-823</ref>, the lipid profile along with the Rasa Saarata of lactating mothers was assessed in the present study showing strong positive correlation between the Stanya and Rasa Saarata.</li>

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<li>The article An ayurvedic perspective of hypoprolactenemia: Stanyakshaya<ref name="ref22"></ref> explores the concept of Stanya Kshaya in Ayurveda in perspective of hypoprolactenemia. </li>

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<li>The article An ayurvedic perspective of hypoprolactenemia: Stanyakshaya<ref name="ref22">Meher S, Jayasingh BK. AN AYURVEDIC PERSPECTIVE OF HYPOPROLACTENEMIA: STANYAKSHAYA, WJPR, Volume 11, Issue 9, Page No. 492-500.</ref> explores the concept of Stanya Kshaya in Ayurveda in perspective of hypoprolactenemia. </li>

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<li>The study, Stanyajanan drugs in Bhavprakasha Nighantu - a review Article<ref name="ref23"></ref> the understanding of stanya physiology in light of contemporary medical science is explained in detail in the article.</li>

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<li>The study, Stanyajanan drugs in Bhavprakasha Nighantu - a review Article<ref name="ref23">Uike CS, Landge ST. Stanyajanan drugs in Bhavprakasha Nighantu-A Review., WJPR, VOLUME 8, ISSUE 10, 408-412</ref> the understanding of stanya physiology in light of contemporary medical science is explained in detail in the article.</li>

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<li>The author has compared the condition of ksheeralasaka with cow milk allergy and implications it can pose upon the health and wellbeing of child in the article entitled, Ksheeralasaka Vis-À-Vis Cow’s Milk Allergy: A Critical Review<ref name="ref24"></ref></li>

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<li>The author has compared the condition of ksheeralasaka with cow milk allergy and implications it can pose upon the health and wellbeing of child in the article entitled, Ksheeralasaka Vis-À-Vis Cow’s Milk Allergy: A Critical Review<ref name="ref24">Antony C. Ksheeralasaka Vis-À-Vis Cow’s Milk Allergy: A Critical Review. Int J Ayu Pharm Res [Internet]. 2018Jul.28 [cited 2023May12];6(6). Available from: http://www.ijaprs.com/index.php/ijapr/article/view/984</ref></li>

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<li>The article, A scientific understanding of mammary gland and physiology of lactation in Ayurveda<ref name="ref25"></ref> the physiology of lactation is widely explained. </li>

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<li>The article, A scientific understanding of mammary gland and physiology of lactation in Ayurveda<ref name="ref25">Verma V, Agrawal S, Gehlot S. A scientific understanding of Mammary gland and physiology of lactation in Ayurveda. 2020 Jun 24;10:1–4.</ref> the physiology of lactation is widely explained. </li>

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<li>In the article , Explication on tissue nutrition in prenatal and postnatal life: An Ayurveda perspective<ref name="ref26"></ref> the authors have beautifully elaborated the nutrition related metabolism mentioned during the intrauterine and postnatal life of infant. </li>

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<li>In the article , Explication on tissue nutrition in prenatal and postnatal life: An Ayurveda perspective<ref name="ref26">Agrawal S, Verma V, Gehlot S. Explication on tissue nutrition in prenatal and postnatal life: An Ayurveda perspective. Journal of Ayurveda and Integrative Medicine [Internet]. 2021 Jan 1 [cited 2023 May 12];12(1):198–205. Available from: https://www.sciencedirect.com/science/article/pii/S097594761830682X</ref> the authors have beautifully elaborated the nutrition related metabolism mentioned during the intrauterine and postnatal life of infant. </li>

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<li>In the article, Concept of Dhatri (wet nurse) in perspective of Ayurveda w.r.t. Babylonian Code of Hammurabi<ref name="ref27"></ref> the historical aspects regarding the tradition of wet nurse and ethical considerations are discussed. The study states that the concepts of wet nurse is as old as the proofs Babylon code.</li>

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<li>In the article, Concept of Dhatri (wet nurse) in perspective of Ayurveda w.r.t. Babylonian Code of Hammurabi<ref name="ref27">Kiran Tawalare, Sumedh Meshram, Pankaj Jogi, Maneesha Kothekar, Pooja Chandak. Concept of Dhatri (wet nurse) in perspective of Ayurveda w.r.t. Babylonian Code of Hammurabi. J Ayurveda Integr Med Sci 2021;1:125-129</ref> the historical aspects regarding the tradition of wet nurse and ethical considerations are discussed. The study states that the concepts of wet nurse is as old as the proofs Babylon code.</li>

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<li>In the article, Breastfeeding assessment protocol: An integrated approach<ref name="ref28"></ref> the authors have extensively described the breast feeding protocol and assessment to ensure the health of newborn and lactating mothers. This can also be used as reference for further studies.</li>

+

<li>In the article, Breastfeeding assessment protocol: An integrated approach<ref name="ref28">Thomas P, Jayavarma MK. Breastfeeding assessment protocol: an integrated approach, J Res Educ Indian Med, July - Dec., 2014: XX (3-4):153-163</ref> the authors have extensively described the breast feeding protocol and assessment to ensure the health of newborn and lactating mothers. This can also be used as reference for further studies.</li>

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<li>In the study, An Ayurvedic Review on Phakka Roga w.s.r. To Rickets in children<ref name="ref29"></ref> the detail analysis of Phakka Roga as a consequence of Stanya Dushti leading to nutritional deficiency like rickets is done in the present article.</li></ol>

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<li>In the study, An Ayurvedic Review on Phakka Roga w.s.r. To Rickets in children<ref name="ref29">Shelke DSB, Chavan DDB. An Ayurvedic Review On Phakka Roga W.S.R. To Rickets In Children. World Journal of Pharmaceutical Research, Vol 11, Issue 7, 2022 , Page No. 994- 1000</ref> the detail analysis of Phakka Roga as a consequence of Stanya Dushti leading to nutritional deficiency like rickets is done in the present article.</li></ol>

== Herbal drugs for nourishment of stanya ==

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<ol style="text-align:justify;"><li>Many herbal galactogogues have like Shatavari (Wild Asparagus) and Ashwagandha (Withanina) are extensively studied in contemporary sciences as well. Various systematic reviews are done to generate bulk data regarding the same.<ref name="ref30"></ref><ref name="ref31"></ref></li>

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<ol style="text-align:justify;"><li>Many herbal galactogogues have like Shatavari (Wild Asparagus) and Ashwagandha (Withanina) are extensively studied in contemporary sciences as well. Various systematic reviews are done to generate bulk data regarding the same.<ref name="ref30">Mortel M, Mehta SD. Systematic Review of the Efficacy of Herbal Galactogogues. Journal of Human Lactation. 2013;29(2):154-162. doi:10.1177/0890334413477243</ref><ref name="ref31">Bazzano AN, Hofer R, Thibeau S, Gillispie V, Jacobs M, Theall KP. A Review of Herbal and Pharmaceutical Galactagogues for Breast-Feeding. Ochsner J. 2016;16(4):511-524.</ref></li>

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<li>Similarly extensive studies have been done on the evaluation of the galactogue potential of single herb like Musta (Cyperus rotundus)etc. Preclinical study entitled as “The Evaluation of a lactogenic activity of an aqueous extract of Cyperus rotundus Linn”<ref name="ref32"></ref> revealed that the the aqueous extract of Cyperus rotundus can stimulate milk production in the female rats. </li>

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<li>Similarly extensive studies have been done on the evaluation of the galactogue potential of single herb like Musta (Cyperus rotundus)etc. Preclinical study entitled as “The Evaluation of a lactogenic activity of an aqueous extract of Cyperus rotundus Linn”<ref name="ref32">Badgujar SB, Bandivdekar AH. Evaluation of a lactogenic activity of an aqueous extract of Cyperus rotundus Linn. J Ethnopharmacol. 2015;163:39-42. doi:10.1016/j.jep.2015.01.019</ref> revealed that the the aqueous extract of Cyperus rotundus can stimulate milk production in the female rats. </li>

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<li>The article, The Potential of Medicinal Plants as Galactagogue in Indonesia: A Review from Medical Perspective the ethnobotanical review galactagogue effect and breast milk promoting effect of different herbs native to Indonesia is elaborated.<ref name="ref33"></ref></li>

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<li>The article, The Potential of Medicinal Plants as Galactagogue in Indonesia: A Review from Medical Perspective the ethnobotanical review galactagogue effect and breast milk promoting effect of different herbs native to Indonesia is elaborated.<ref name="ref33">Khairani A. F, Adzdzikri T. M, Menggala S. T, Bashari M. H, Rohmawaty E, Achadiyani A, Kania N. The Potential of Medicinal Plants as Galactagogue in Indonesia: A Review from Medical Perspective. Biomed Pharmacol J 2021;14(3).</ref></li>

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<li>The study “ Botanical galactogogues: nutritional values and therapeutic potentials” focuses on the nutritional and therapeutic effect of selective herbal plants from the family like Verbenaceae, Bignoniaceae, Sapindaceae, Amaranthaceae, Asclepiadaceae, Bombacaceae, Sapindaceae, and Asteraceae.<ref name="ref34"></ref></li></ol>

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<li>The study “ Botanical galactogogues: nutritional values and therapeutic potentials” focuses on the nutritional and therapeutic effect of selective herbal plants from the family like Verbenaceae, Bignoniaceae, Sapindaceae, Amaranthaceae, Asclepiadaceae, Bombacaceae, Sapindaceae, and Asteraceae.<ref name="ref34">Gbadamosi I, Okolosi O. Botanical galactogogues: nutritional values and therapeutic potentials. Journal of Applied Biosciences [Internet]. 2013 Feb 19 [cited 2023 Jul 12];61:4460–9. Available from: https://www.ajol.info/index.php/jab/article/view/85594</ref></li></ol>

== Clinical Studies considering the aspects of stanya ==

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<ol style="text-align:justify;"><li>The article “Clinical Study on Plant Galactagogue Worldwide in Promoting Women’s Lactation: a Scoping Review<ref name="ref35"></ref>”, is a systematic review on the different herbs analysed for their clinical galactagogic activity.</li>

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<ol style="text-align:justify;"><li>The article “Clinical Study on Plant Galactagogue Worldwide in Promoting Women’s Lactation: a Scoping Review<ref name="ref35">Kwan SH, Abdul-Rahman PS. Clinical Study on Plant Galactagogue Worldwide in Promoting Women's Lactation: a Scoping Review. Plant Foods Hum Nutr. 2021;76(3):257-269. doi:10.1007/s11130-021-00901-y</ref>”, is a systematic review on the different herbs analysed for their clinical galactagogic activity.</li>

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<li>The article, A Double-Blind Randomized Clinical Trial for Evaluation of Galactogogue Activity of Asparagus racemosus Willd.<ref name="ref36"></ref> is a randomized double-blind clinical trial evaluates galactogogue effect of Shatavari in 60 lactating mothers by evaluating their prolactin hormone level during the study.</li>

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<li>The article, A Double-Blind Randomized Clinical Trial for Evaluation of Galactogogue Activity of Asparagus racemosus Willd.<ref name="ref36">Gupta M, Shaw B. A Double-Blind Randomized Clinical Trial for Evaluation of Galactogogue Activity of Asparagus racemosus Willd. Iran J Pharm Res. 2011;10(1):167-172.</ref> is a randomized double-blind clinical trial evaluates galactogogue effect of Shatavari in 60 lactating mothers by evaluating their prolactin hormone level during the study.</li>

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<li>The article, Stanyakshya (insufficient lactation) and its management by an Ayurveda formulation: A case report<ref name="ref37"></ref> mentions the positive effect Kwath prepared with Shatapushpa, Dhanyaka, Jeeraka, Methi used traditionally in Rajasthan which was administered in women with insufficient lactation. This intervention showed encouraging results. </li>

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<li>The article, Stanyakshya (insufficient lactation) and its management by an Ayurveda formulation: A case report<ref name="ref37">Sharma U, Sharma S. Stanyakshya (insufficient lactation) and its management by an Ayurveda formulation: A case report. J Indian Sys Medicine 2022;10:192-5</ref> mentions the positive effect Kwath prepared with Shatapushpa, Dhanyaka, Jeeraka, Methi used traditionally in Rajasthan which was administered in women with insufficient lactation. This intervention showed encouraging results. </li>

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<li>In the research study, To Evaluate the efficacy of Aahara –Vihara on Stanya Kshaya in Healthy Female Volunteers of different Deha Prakriti<ref name="ref38"></ref> the effect of dietary and lifestyle intervention on Stanya Kshaya is explored. The study included the dietary interventions in women of Stanya Kshaya. Most of the women were of Vata-Kapha Prakriti and dietary interventions showed benefit in their condition.</li>

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<li>In the research study, To Evaluate the efficacy of Aahara –Vihara on Stanya Kshaya in Healthy Female Volunteers of different Deha Prakriti<ref name="ref38">Kiran Tanwar, Uma Shankar Sharma, Ankur Kumar Tanwar. To Evaluate the efficacy of Aahara –Vihara on Stanya Kshaya in Healthy Female Volunteers of different Deha Prakriti. J Ayurveda Integr Med Sci [Internet]. 2016Jun.30 [cited 2023May12];1(01):1-. Available from: https://jaims.in/jaims/article/view/1</ref> the effect of dietary and lifestyle intervention on Stanya Kshaya is explored. The study included the dietary interventions in women of Stanya Kshaya. Most of the women were of Vata-Kapha Prakriti and dietary interventions showed benefit in their condition.</li>

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<li>The efficacy of different Gana mentioned in the management of Stanya Kshaya is also assessed clinically. For instance, the article, Haridradi Gana Kwatha in the Management of Stanya Kshaya w.s.r To Hypogalactia - A Clinical Study<ref name="ref39"></ref> depicted that the Haridradi Gana kwatha has promising results in the management of all the parameters of Stanya Kshaya. </li>

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<li>The efficacy of different Gana mentioned in the management of Stanya Kshaya is also assessed clinically. For instance, the article, Haridradi Gana Kwatha in the Management of Stanya Kshaya w.s.r To Hypogalactia - A Clinical Study<ref name="ref39">Apila Nath M.K, N. Sudhakar, Sarojini Byadagi, Binu.M.B. Haridradi Gana Kwatha in The Management of Stanya Kshaya w.s.r to Hypogalactia -A Clinical Study. International Journal of Ayurveda and Pharma Research. 2020;8(Suppl 1):19-24.</ref> depicted that the Haridradi Gana kwatha has promising results in the management of all the parameters of Stanya Kshaya. </li>

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<li>The study entitled. A Comparative study of Madhuk Churna with Vidarikanda Churna in the management of Stanyakshaya<ref name="ref40"></ref> showed encouraging results in management of Stanya Kshaya. The authors have compiled the different Stanyajanana herbs in Bhavaprakash Nighantu</li>

+

<li>The study entitled. A Comparative study of Madhuk Churna with Vidarikanda Churna in the management of Stanyakshaya<ref name="ref40">Dr. Pravin A. Patil, Dr. Anjali N. Lade, & Dr. Chetna J. Kulkarni. (2019). A Comparative study of Madhuk Churna with Vidarikanda Churna in the management of Stanyakshaya. Journal of Ayurveda and Integrated Medical Sciences, 4(02), 11-13. https://doi.org/10.21760/jaims.v4i02.587</ref> showed encouraging results in management of Stanya Kshaya. The authors have compiled the different Stanyajanana herbs in Bhavaprakash Nighantu</li>

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<li>The article, Role of Stanyashchotan (topical application of Breast milk) in Opthalmia Neonatorum - a case study<ref name="ref41"></ref> discusses the pharmacological effect of topical application of Stanya in condition of Opthalmia Neonatarum leading to significant relief in symptoms.</li></ol>

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<li>The article, Role of Stanyashchotan (topical application of Breast milk) in Opthalmia Neonatorum - a case study<ref name="ref41">Kale DY, Choure S. Role of stanyashchotan (topical application of breast milk) in Opthalmia Neonatorum - a case study. World Journal of Pharmaceutical Research, Volume 9, Issue 7, Page No. 2758-2763</ref> discusses the pharmacological effect of topical application of Stanya in condition of Opthalmia Neonatarum leading to significant relief in symptoms.</li></ol>

== Contemporary approach ==

=== Physiology of Lactation- ===

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The initial growth of mammary glands starts with thelarche at puberty while the duct system and glandular tissue develops for the production of milk just before gestation under the influence of hormones estrogen and progesterone. Prolactin is necessary for milk secretion and proliferarion of epithelial cells of mammary alveoli. Thus the physiological aspects related to initiation of milk secretion (lactogenesis) and maintenance of milk secretion (galactopoiesis) is dependant on hormones via hypothalamo-pituitary axis. Milk ejection is dependant on suckling by the infant and is a neuro-endocrine reflex initiated via the oxytocin.<ref name="ref42"></ref>

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The initial growth of mammary glands starts with thelarche at puberty while the duct system and glandular tissue develops for the production of milk just before gestation under the influence of hormones estrogen and progesterone. Prolactin is necessary for milk secretion and proliferarion of epithelial cells of mammary alveoli. Thus the physiological aspects related to initiation of milk secretion (lactogenesis) and maintenance of milk secretion (galactopoiesis) is dependant on hormones via hypothalamo-pituitary axis. Milk ejection is dependant on suckling by the infant and is a neuro-endocrine reflex initiated via the oxytocin.<ref name="ref42">Sembulingham K , Sembulingham P, Essentials of Medical Physiology,Mammary glands and Lactation, Seventh Edition , Jaypee Health Sciences Publisher, New Delhi , Page No. 530-533</ref>

=== Composition of Breast Milk ===

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Human milk forms the primary source of nutrition for infants. It contains about 88.5% of water and 11.5% of solids. The breast milk secreted before parturition and in initial post natal period is termed as colostrum at rate of 40ml a day. It also contains lactose, lactalabumin, iron, Vitamin A and D and minerals. It also contains several antibodies (Immunoglobulins- IgA), phagocytes, macrophages important for the protection of infants from microbial attack.<ref name="ref43"></ref> The colostrum contains low fat content but more protein. During the 2nd and 3rd weeks after birth there is change in composition of breast milk where it becomes rich in fats and sugars and its calorific value also increases. This is termed as transitional milk. By the time baby is 3 weeks old, the milk attains mature composition making it high in fats, sugars, essential amino acids, is iso-osmotic with plasma with high calorific value.<ref name="ref44"></ref> The composition of human breast milk can be expressed in table as given below (Table No. 4)-

+

Human milk forms the primary source of nutrition for infants. It contains about 88.5% of water and 11.5% of solids. The breast milk secreted before parturition and in initial post natal period is termed as colostrum at rate of 40ml a day. It also contains lactose, lactalabumin, iron, Vitamin A and D and minerals. It also contains several antibodies (Immunoglobulins- IgA), phagocytes, macrophages important for the protection of infants from microbial attack.<ref name="ref43">Hall J , Hall M , Guyton and Hall Textbook of Medical Physiology, 3rd South Asian Edition , published by Elsevier publishers , Page No. 726-727.</ref> The colostrum contains low fat content but more protein. During the 2nd and 3rd weeks after birth there is change in composition of breast milk where it becomes rich in fats and sugars and its calorific value also increases. This is termed as transitional milk. By the time baby is 3 weeks old, the milk attains mature composition making it high in fats, sugars, essential amino acids, is iso-osmotic with plasma with high calorific value.<ref name="ref44">Pocock G , Richards C , Richards D , Oxfords Human Physiology , Fifth edition , Oxford University Press, United Kingdom, Page No. 813.</ref> The composition of human breast milk can be expressed in table as given below (Table No. 4)-

{| class="wikitable"

|+'''Table No. 4 Composition of breast milk'''

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=== Contradictions to breast milk feeding<ref name="ref45"></ref>- ===

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=== Contradictions to breast milk feeding<ref name="ref45">Golwalla A, Golwalla S, Golwalla’s Medicine for Students, Twenty Fifth edition , reprinted 2018, Jaypee Brothers Medical Publishers , Page No. 795 to 797. </ref>- ===

<ol type="a" style="text-align:justify;"><li style="font-weight:bold">Temporary – Fissuring or crackling of nipples, mastitis, acute illness of mother</li>

<li style="font-weight:bold">Permanent- Galactosaemia, poor nutrition, debility, postpartum psychosis, breast abscess, HIV or Hepatitis B infected mothers (chance of infection transmission upto 25%)</li></ol>

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Milk banks have now emerged as important source for the storage and dispensing of the donor breast milk to the infants who may stay devoid of mothers milk due to variable reasons. These are being established across the globe to meet the long term demand.<ref name="ref46"></ref> Extensive research is being carried out to promote the breast feeding and establishment of milk banks also supported by the organisations like UNICEF and WHO.<ref name="ref47"></ref>

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Milk banks have now emerged as important source for the storage and dispensing of the donor breast milk to the infants who may stay devoid of mothers milk due to variable reasons. These are being established across the globe to meet the long term demand.<ref name="ref46">Kim, J., & Unger, S. (2010). Human milk banking. Paediatrics & child health, 15(9), 595–602.</ref> Extensive research is being carried out to promote the breast feeding and establishment of milk banks also supported by the organisations like UNICEF and WHO.<ref name="ref47">Research on supporting breastfeeding - Baby Friendly Initiative [Internet]. [cited 2023 Jul 12]. Available from: https://www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/research-supporting-breastfeeding/supporting-breastfeeding-research/</ref>

== Weaning ==

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