Sushruta Samhita

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अथातो मूढगर्भनिदानं व्याख्यास्यामः ||१||

sanskrit

Now we shall discourse on the Nidana of Mudhagarbha (false presentations and difficult labour).

english translation

hindi translation

athAto mUDhagarbhanidAnaM vyAkhyAsyAmaH ||1||

hk transliteration

यथोवाच भगवान् धन्वन्तरिः ||२||

sanskrit

As said by Lord Dhanvantari.

english translation

hindi translation

yathovAca bhagavAn dhanvantariH ||2||

hk transliteration

ग्राम्यधर्मयानवाहनाध्वगमनप्रस्खलनप्रपतनप्रपीडनधावनाभिघातविषमशयनासनोपवासवेगाभिघातातिरूक्ष- कटुतिक्तभोजनशोकातिक्षारसेवनातिसारवमनविरेचनप्रेङ्खोलनाजीर्णगर्भशातनप्रभृतिभिर्विशेषैर्बन्धनान्मुच्यते गर्भः, फलमिव वृन्तबन्धनादभिघातविशेषैः; स विमुक्तबन्धनो गर्भाशयमतिक्रम्य यकृत्प्लीहान्त्रविवरैरवस्रंसमानः कोष्ठसङ्क्षोभमापादयति, तस्या जठरसङ्क्षोभाद्वायुरपानो मूढः पार्श्वबस्तिशीर्षोदरयोनिशूलानाहमूत्रसङ्गानामन्यतममापद्य गर्भं च्यावयति [१] तरुणं शोणितस्रावेण; तमेव कदाचिद्विवृद्धमसम्यगागतमपत्यपथमनुप्राप्तमनिरस्यमानं विगुणापानसम्मोहितं गर्भं मूढगर्भमित्याचक्षते ||३||

sanskrit

Causes of Mudha-garbha:— The fetus is expelled due to various factors such as disturbances caused by traditional vehicles, stumbling, falling, pressure on the womb, excessive walking, fasting, and repression of natural bodily urges. Additionally, partaking of extremely bitter, pungent, or dry foods, excessive intake of greens and alkaline substances, dysentery, use of emetics or purgatives, swinging, indigestion, and certain medications can lead to the expulsion of the fetus. Such causes cause a dislodgement of the fetus from its attachment to the uterine wall due to a kind of contraction, similar to how a blow can detach a fruit from its stem. The dislodged fetus excites peristalsis in the uterus and induces constant spasmodic contractions in the intestinal cavities, causing pain in the liver, spleen, etc. The obstructed Apana Vayu produces various symptoms, including spasmodic pain in the sides or pelvic cavity, leading to fetal destruction, especially if immature and accompanied by bleeding. If the fetus develops in an inverted posture at the vaginal canal, it becomes impacted and cannot be expelled, hence termed Mudha-garbhah.

english translation

hindi translation

grAmyadharmayAnavAhanAdhvagamanapraskhalanaprapatanaprapIDanadhAvanAbhighAtaviSamazayanAsanopavAsavegAbhighAtAtirUkSa- kaTutiktabhojanazokAtikSArasevanAtisAravamanavirecanapreGkholanAjIrNagarbhazAtanaprabhRtibhirvizeSairbandhanAnmucyate garbhaH, phalamiva vRntabandhanAdabhighAtavizeSaiH; sa vimuktabandhano garbhAzayamatikramya yakRtplIhAntravivarairavasraMsamAnaH koSThasaGkSobhamApAdayati, tasyA jaTharasaGkSobhAdvAyurapAno mUDhaH pArzvabastizIrSodarayonizUlAnAhamUtrasaGgAnAmanyatamamApadya garbhaM cyAvayati [1] taruNaM zoNitasrAveNa; tameva kadAcidvivRddhamasamyagAgatamapatyapathamanuprAptamanirasyamAnaM viguNApAnasammohitaM garbhaM mUDhagarbhamityAcakSate ||3||

hk transliteration

ततः कीलः प्रतिखुरो बीजकः परिघ इति | तत्र, ऊर्ध्वबाहुशिरःपादो यो योनिमुखं निरुणद्धि कील इव स कीलः; निःसृतहस्तपादशिराः कायसङ्गी प्रतिखुरः; यो निर्गच्छत्येकशिरोभुजः स बीजकः; यस्तु परिघ इव योनिमुखमावृत्य तिष्ठति स परिघः; इति चतुर्विधो भवतीत्येके भाषन्ते | तत्तु न सम्यक्; कस्मात्? स यदा विगुणानिलप्रपीडितोऽपत्यपथमनेकधा प्रपद्यते तदा सङ्ख्या हीयते ||४||

sanskrit

Classification and Symptoms:— Mudha-garbha may be classified into four types: Kilah, Pratikhurah, Vijakah, and Parighah. The Kilah is when the fetus presents with its arms, head, and feet turned upward, firmly obstructed at the vaginal entrance, resembling a stake. The Pratikhurah is when the fetus emerges with its hands and feet, while its body is impacted at the entrance. The Vijakah is when a single arm and the head of the fetus emerge, with the rest of its body still obstructed. The Parighah is when the fetus remains in a horizontal position, obstructing the passage like a bolt. However, this classification is not comprehensive. Why? Because when the Apana Vayu is deranged and the fetus presents in various abnormal positions at the vaginal canal, the variety of presentations increases.

english translation

hindi translation

tataH kIlaH pratikhuro bIjakaH parigha iti | tatra, UrdhvabAhuziraHpAdo yo yonimukhaM niruNaddhi kIla iva sa kIlaH; niHsRtahastapAdazirAH kAyasaGgI pratikhuraH; yo nirgacchatyekazirobhujaH sa bIjakaH; yastu parigha iva yonimukhamAvRtya tiSThati sa parighaH; iti caturvidho bhavatItyeke bhASante | tattu na samyak; kasmAt? sa yadA viguNAnilaprapIDito'patyapathamanekadhA prapadyate tadA saGkhyA hIyate ||4||

hk transliteration

तत्र, कश्चिद्द्वाभ्यां सक्थिभ्यां योनिमुखं प्रतिपद्यते; कश्चिदाभुग्नैकसक्थिरेकेन; कश्चिदाभुग्नसक्थिशरीरः स्फिग्देशेन तिर्यगागतः; कश्चिदुरःपार्श्वपृष्ठानामन्यतमेन योनिद्वारं पिधायावतिष्ठते; अन्तःपार्श्वापवृत्तशिराः कश्चिदेकेन बाहुना; कश्चिदाभुग्नशिरा बाहुद्वयेन; कश्चिदाभुग्नमध्यो हस्तपादशिरोभिः; कश्चिदेकेन सक्थ्ना योनिमुखं प्रतिपद्यतेऽपरेण पायुम्; इत्यष्टविधा मूढगर्भगतिरुद्दिष्टा समासेन ||५||

sanskrit

In the context of Mudha-garbha, there are eight types of presentations described. One type presents with two thighs at the vaginal entrance, another with a single thigh in an abnormal position. There can be cases where the fetus is impacted with its body oriented horizontally, obstructing the vaginal opening. Some may present with the arm covering the vaginal entrance, while others may have both arms obstructing it. There are also instances where one arm and the head emerge while the rest of the body remains impacted. The variety in presentations demonstrates the complexity of Mudha-garbha.

english translation

hindi translation

tatra, kazciddvAbhyAM sakthibhyAM yonimukhaM pratipadyate; kazcidAbhugnaikasakthirekena; kazcidAbhugnasakthizarIraH sphigdezena tiryagAgataH; kazciduraHpArzvapRSThAnAmanyatamena yonidvAraM pidhAyAvatiSThate; antaHpArzvApavRttazirAH kazcidekena bAhunA; kazcidAbhugnazirA bAhudvayena; kazcidAbhugnamadhyo hastapAdazirobhiH; kazcidekena sakthnA yonimukhaM pratipadyate'pareNa pAyum; ityaSTavidhA mUDhagarbhagatiruddiSTA samAsena ||5||

hk transliteration