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The postnatal period or puerperium (sutika kala) begins immediately after childbirth. This period generally lasts for six weeks. The pelvic organs revert to the pre-pregnancy state, and the female body restores anatomical and physiological normalcy.  

The postnatal period or puerperium (sutika kala) begins immediately after childbirth. This period generally lasts for six weeks. The pelvic organs revert to the pre-pregnancy state, and the female body restores anatomical and physiological normalcy.  

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|data5 = carakasamhita@gmail.com

|data5 = carakasamhita@gmail.com

|label6 = Date of first publication:

|label6 = Publisher

|data6 = June 30, 2021

|label7 = DOI

 

|data7 = in process

 

|label7 = Date of first publication:

|data7 = June 30, 2021

|label8 = DOI

|data8 = 10.47468/CSNE.2021.e01.s09.063

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Oral administration of fatty substance (sneha) with powder of panchakola (mixture of Piper longum (pippali and pippalimula), Piper chaba Hunte (chavya), Plumbago zeylanica (chitraka), and Zingiber officinale (nagara)) is prescribed. The quantity of fat is determined as per the digestive capacity. The scum of boiled rice (manda) is used as an after drink (anupana).   

Oral administration of fatty substance (sneha) with powder of panchakola (mixture of Piper longum (pippali and pippalimula), Piper chaba Hunte (chavya), Plumbago zeylanica (chitraka), and Zingiber officinale (nagara)) is prescribed. The quantity of fat is determined as per the digestive capacity. The scum of boiled rice (manda) is used as an after drink (anupana).   

In contemporary practices, ghee is the most widely used form of fat in post natal care. Studies show that ghee prepared by traditional methods contain a higher amount of docosahexaenoic acid (DHA) and omega-3 long-chain polyunsaturated fatty acids.  Maternal n-3 fatty acids levels, particularly DHA, are decreased during pregnancy. A low n-3 fatty acids level is found to be associated with postpartum depression (PPD).  Oral administration of ghee may be useful to prevent the incidence of PPD.   

In contemporary practices, ghee is the most widely used form of fat in post natal care. Studies show that ghee prepared by traditional methods contain a higher amount of docosahexaenoic acid (DHA) and omega-3 long-chain polyunsaturated fatty acids.<ref>Joshi KS. Docosahexaenoic acid content is significantly higher in ghrita prepared by traditional Ayurvedic method. J Ayurveda Integr Med. 2014 Apr;5(2):85-8. doi: 10.4103/0975-9476.131730. PMID: 24948858; PMCID: PMC4061595.</ref> Maternal n-3 fatty acids levels, particularly DHA, are decreased during pregnancy. A low n-3 fatty acids level is found to be associated with postpartum depression (PPD).  Oral administration of ghee may be useful to prevent the incidence of PPD.<ref>Teo C, Chia AR, Colega MT, et al. Prospective Associations of Maternal Dietary Patterns and Postpartum Mental Health in a Multi-Ethnic Asian Cohort: The Growing up in Singapore towards Healthy Outcomes (GUSTO) Study. Nutrients. 2018;10(3):299. Published 2018 Mar 2. doi:10.3390/nu10030299</ref>  

Judicious administration of fats is recommended in the postpartum protocol. Ghee in greater quantity may lead to weight gain. Post-partum obesity is an associated risk factor for cardiovascular diseases.  Therefore, the ghee administration is indicated in [[vata]] and [[pitta]] dominant constitution individuals. It shall be used with precautions in conditions associated with increased [[kapha dosha]] and [[meda dhatu]].   

Judicious administration of fats is recommended in the postpartum protocol. Ghee in greater quantity may lead to weight gain. Post-partum obesity is an associated risk factor for cardiovascular diseases.<ref>Ena Huseinovic, Fredrik Bertz, Monica Leu Agelii, Else Hellebö Johansson, Anna Winkvist, Hilde Kristin Brekke, Effectiveness of a weight loss intervention in postpartum women: results from a randomized controlled trial in primary health care, The American Journal of Clinical Nutrition, Volume 104, Issue 2, August 2016, Pages 362–370, https://doi.org/10.3945/ajcn.116.135673</ref> Therefore, the ghee administration is indicated in [[vata]] and [[pitta]] dominant constitution individuals. It shall be used with precautions in conditions associated with increased [[kapha dosha]] and [[meda dhatu]].   

Panchakola powder is observed to increase the serum levels of nutritional substances such as coenzyme Q10 & beta carotene and lengthen their serum half-lives. In addition, it can act as a thermal nutrient and increase the absorption of certain nutritional substances from the gastrointestinal tract by producing a local thermogenic action. Furthermore, these herbs have marked central stimulant activity, immune-stimulatory effect, and anti-inflammatory action. It also has bioavailability enhancer property and central dopaminergic activity. Thus, panchakola can help in relieving pain, promote uterine involution by contraction, autolysis and regeneration.  

Panchakola powder is observed to increase the serum levels of nutritional substances such as coenzyme Q10 & beta carotene and lengthen their serum half-lives. In addition, it can act as a thermal nutrient and increase the absorption of certain nutritional substances from the gastrointestinal tract by producing a local thermogenic action. Furthermore, these herbs have marked central stimulant activity, immune-stimulatory effect, and anti-inflammatory action. It also has bioavailability enhancer property and central dopaminergic activity. Thus, panchakola can help in relieving pain, promote uterine involution by contraction, autolysis and regeneration.<ref>Dr. Yennawar S. M. et al, sutika paricharya - a scientific step, World Journal of Pharmaceutical Research, Vol 8, Issue 2, 2019, pg 1045-1052.</ref>

*If the patient is not suitable for administration of fats, then decoction of  drugs alleviating [[vata]], or laghu panchamoola (the roots of Solanum indicum, Solanum xanthocarpum, Desmodium gangeticum, Uraria picta, and Tribulus terrestris) is prescribed.   

*If the patient is not suitable for administration of fats, then decoction of  drugs alleviating [[vata]], or laghu panchamoola (the roots of Solanum indicum, Solanum xanthocarpum, Desmodium gangeticum, Uraria picta, and Tribulus terrestris) is prescribed.   

The reason might be [[dosha]] specific activity of oil and ghee. Ghee helps to pacify [[vata]] and [[pitta]] [[dosha]]. Oil helps to pacify [[vata]] and [[kapha]] [[dosha]]. These [[dosha]] variations might have been observed in the postpartum period as per the gender of the fetus.  

The reason might be [[dosha]] specific activity of oil and ghee. Ghee helps to pacify [[vata]] and [[pitta]] [[dosha]]. Oil helps to pacify [[vata]] and [[kapha]] [[dosha]]. These [[dosha]] variations might have been observed in the postpartum period as per the gender of the fetus.  

Current research shows that the maternal immune milieu undergoes many changes based on the sex of the fetus. An increase in the levels of proinflammatory cytokines and proangiogenic growth factors is observed in the mother in the case of the male fetus. An increase in the expression of regulatory cytokines is found in the case of a female fetus. However, there was no fetal sex-based difference in their concentrations at the postpartum measurement. The reasons for physiological changes in the mother according to the gender of the baby are still unknown. Specific use of oil and ghee depending upon the gender of the baby is an area of research to be explored for better understanding.

Current research shows that the maternal immune milieu undergoes many changes based on the sex of the fetus. An increase in the levels of proinflammatory cytokines and proangiogenic growth factors is observed in the mother in the case of the male fetus. An increase in the expression of regulatory cytokines is found in the case of a female fetus. However, there was no fetal sex-based difference in their concentrations at the postpartum measurement.<ref>Elizabeth Ann L Enninga et al, Fetal Sex-Based Differences in Maternal Hormones, Angiogenic Factors, and Immune Mediators During Pregnancy and the Postpartum Period, Am J Reprod Immunol. 2015 Mar; 73(3): 251–262.  doi: 10.1111/aji.12303</ref> The reasons for physiological changes in the mother according to the gender of the baby are still unknown. Specific use of oil and ghee depending upon the gender of the baby is an area of research to be explored for better understanding.

==Guidelines based on the place of living (desha) ==

==Guidelines based on the place of living (desha) ==

In marshy place, usually, diseases of [[vata]] and [[kapha]] dominance occur. Initially, fat should not be used in postpartum due to the dominance of moisture in the atmosphere of marshy area. A scum of boiled rice (manda) treated with appetizer drugs is given.  Sudation, sleeping in a closed space (to avoid direct air exposure), use of hot substances is advised.[Ka.Sa.Khila Sthana 11/28-30]

In marshy place, usually, diseases of [[vata]] and [[kapha]] dominance occur. Initially, fat should not be used in postpartum due to the dominance of moisture in the atmosphere of marshy area. A scum of boiled rice (manda) treated with appetizer drugs is given.  Sudation, sleeping in a closed space (to avoid direct air exposure), use of hot substances is advised.[Ka.Sa.Khila Sthana 11/28-30]

=== Arid place (jangala desha) ===

=== Arid place (jangala desha) ===

In the arid area, diseases of [[vata]] and [[pitta]] dominance are usually prevalent. Since oleaginous substances are suitable (satmya) for people living in this area, they can be used in good quantity. [Ka.Sa. Khila Sthana 11/30, 31]  

In the arid area, diseases of [[vata]] and [[pitta]] dominance are usually prevalent. Since oleaginous substances are suitable ([[satmya]]) for people living in this area, they can be used in good quantity. [Ka.Sa. Khila Sthana 11/30, 31]  

So, the women are given ghee, oil, or other oily articles in large quantities and decoctions of drugs like Piper longum (pippali). If the woman is weak and not fit for intake of fat, she may be given the rice gruel. This regimen is followed for 3-5 days. Then the use of cereals mixed with unctuous substances in gradually increasing quantity is advised. [Su.Sa.Sharira Sthana10/17].

So, the women are given ghee, oil, or other oily articles in large quantities and decoctions of drugs like Piper longum (pippali). If the woman is weak and not fit for intake of fat, she may be given the rice gruel. This regimen is followed for 3-5 days. Then the use of cereals mixed with unctuous substances in gradually increasing quantity is advised. [Su.Sa.Sharira Sthana10/17].

=== Ordinary place with average atmosphere (sadharana desha) ===

=== Ordinary place with average atmosphere (sadharana desha) ===

For those who reside in an ordinary place, general management with balanced use of oily and dry substances is recommended. [Ka.Sa. Khila Sthana 11/34]   

For those who reside in an ordinary place, general management with balanced use of oily and dry substances is recommended. [Ka.Sa. Khila Sthana 11/34]   

*Exercise, sexual intercourse, exposure to cold air, and excessive anger [B.P.Purva Khanda 4/2]

*Exercise, sexual intercourse, exposure to cold air, and excessive anger [B.P.Purva Khanda 4/2]

*Evacuative enema (asthapana [[basti]]) [Cha. Sa. [[Sidhi Sthana]] 2/14]

*Evacuative enema (asthapana [[basti]]) [Cha. Sa. [[Siddhi Sthana]] 2/14]

*Venesection(siravedha)[A.S.Sutra Sthana 36/8], [A.Hr.Sutra Sthana 27/7]

*Venesection(siravedha)[A.S.Sutra Sthana 36/8], [A.Hr.Sutra Sthana 27/7]

==Current Researches==

==Current Researches==

*A clinical study conducted in 1000 puerperal women found that panchakola churna regimen 2 gm bd for first 10 days after 24 hours of normal delivery significantly reduces the incidence of secondary post partum hemorrhage (PPH). The group of panchakola churna regimen showed better outcome compared to the control group with conventional treatment, i.e. Inj. Pitocin 10 IU IM immediately after delivery of baby.  

*A clinical study conducted in 1000 puerperal women found that panchakola churna regimen 2 gm bd for first 10 days after 24 hours of normal delivery significantly reduces the incidence of secondary post partum hemorrhage (PPH). The group of panchakola churna regimen showed better outcome compared to the control group with conventional treatment, i.e. Inj. Pitocin 10 IU IM immediately after delivery of baby.<ref>Sameer Gholap et al, Study of the efficacy of panchakola churna in sutika paricharya in de-creasing the incidence of secondary postpartum Haemorrhage (PPH), IAMJ: Volume 8, Issue 4, April - 2020 (www.iamj.in),pg 3218-3221</ref>

*A randomized placebo-control study conducted in 30 puerperal women was done for assessment of clinical efficacy of root of Piper longum (pippali moola) in reducing the postnatal abdominal bulkiness.  Two capsules of the trial drug  (1 capsule= 250mg) twice a day with buttermilk (takra) for 21 days were administered. Objective parameters like body fat percentage, body mass index, waist-hip ratio, abdominal skinfold thickness, supra-iliac skinfold thickness, triceps skinfold thickness etc. were applied. The therapy showed marked improvement in the study group than the placebo group.

*A randomized placebo-control study conducted in 30 puerperal women was done for assessment of clinical efficacy of root of Piper longum (pippali moola) in reducing the postnatal abdominal bulkiness.  Two capsules of the trial drug  (1 capsule= 250mg) twice a day with buttermilk (takra) for 21 days were administered. Objective parameters like body fat percentage, body mass index, waist-hip ratio, abdominal skinfold thickness, supra-iliac skinfold thickness, triceps skinfold thickness etc. were applied. The therapy showed marked improvement in the study group than the placebo group.<ref>D. S. N. V. Neeraja et al, Clinical study with kanajata (piper longum linn. Root) and its effect on postnatal abdominal bulkiness in women, World Journal of Pharmaceutical Research, Vol 5, Issue 9, 2016.Pg No: 1821-1840.</ref>

==List of theses done==

==List of theses done==

9. Rajkrinti (2019): Ayurvedic management of episiotomy wound : a  clinico-experimental study, Department of  Prasutitantra &Streeroga Department of Prasutitantra &Streeroga,IPGT &RA, Jamnagar.

9. Rajkrinti (2019): Ayurvedic management of episiotomy wound : a  clinico-experimental study, Department of  Prasutitantra &Streeroga Department of Prasutitantra &Streeroga,IPGT &RA, Jamnagar.

==References==

==References==