Introduction

As pes Ayurveda, Female is a foundation of reproduction; responsible for Garbhadharan, Garbhaposhan, Apatya-janma and Sangopan (nourishment and bringing up of baby). Stanya & updhatu (byproduct) of Rasa dhatu, termed as Jeevan (responsible for life) as it is chief source of nutrition to the infants. Matrustanya is a precious gift to a baby.[1] Breast milk is the unique ideal species-specific composition for nourishment of infants up to 4-6 months of life.[1] Adequate lactation has been defined as secretion of 10 ounces (300ml) by the 5th day & 16 ounces (480ml) by the 10th day. If the baby is satisfied and sleeping for 2-3 hrs. after breastfeeding, passing urine 6-8 times in 24 hrs. and gaining weight, the mother is producing enough milk. If these amounts are not achieved, a baby of normal weight won't be adequately fed, such situation is lactational deficiency. [2-3]

Lifestyle of human beings got modified improperly. Negligence of personal health in the race of carrier seems lost somewhere; causes of Stanyakshaya are explained by various acharyas like charaka, susrutha, Vaghbata, Kashyap and Bhavprakash. According to them stanyakshaya occurs due to psychosomatic factors of mother like krodha, shoka, bhaya etc., diet regimen of mother & physiological condition. [4-8] In Stankshaya there is decreased quantity of stanya due to Rasadhatukshaya & dhatudushti due to dhatwagnimandyata. It seems to be very simple but causes major problem in child health. Estimated Incidence is 23 to 63% during the 1st 4 month after delivery and noted to 40%. in common clinical practice in India.[9]

Hypo galactorrhea is a major problem and public concern world -wide. In our classics a large number of drugs, diet and behavior regimens are described as stanyavardhana & are useful in the management of stanyakshaya. Acharya Govinddassen had indicated Daruharidradigana Kashaya in stanyavriddi in chapter stanarogachikitsa adhyay of Bhaishajya Ratnavali (70/3rd shloka), it is also advised for stanyashodhana. In this study a patient suffering from stanyakshaya was treated with Daruharidradigana kashaya,[10]50ml twice a day after food for 30 days was given orally; followed up every 10th day for 40 days after intervention. These aspects help in clearing the srotosanga, followed by jataragni and Rasadatwagni vardhak which in turn helps in Rasa dhatu & its Upadhatu Nirmana & Poshana; Mandagni serving as nidana must be corrected with Deepana and Pachana karma in the erstwhile stages. Daruharidradiganakashaya works well in this scenario within defined parameters. We hope for further extended research on this problem.

REVIEW OF LITERTURE

DISEASE REVIEW [11]

STANYAKSHAYA –

• Stana mlanata - Flaccidity of breast
• Stanya sambhavalpata - Quantity of Breast Milk
• Sle?mavardhana dravya upyogah -To use slesmavardhaka dravya as treatment given by susrutha Acharya

CASE STUDY

Patient Information-

Age of patient- 25 years

Gender- Female

 Occupation- Housewife

 Socioeconomical status- Lower-middle class

Religion- Hindu

Chief complaints –

Stanya pravrutti abhav (Inadequate Breast Milk)

Stana mlanata, (Breast Flaccidity ++)

Other Histories

Patient was not having any history of past or present illness. No significant family history was observed. Less nutritious diet during ANC and post-delivery was observed.

Family History: Pitrukulam - N/H/O HTN/DM/Any major illness

                            Matrukulam - N/H/O HTN/DM/Any major illness

                            Swakulam - N/H/O HTN/DM/Any major illness

                                                 N/H/O Drug history/addiction

Obstetrics History

LMP: 11 months ago

Previous M/H: 3-4 days/25-30days- regular (no clots)

                           2-3pad/day------dysmennorrhea

Obstetrics History: G1 P1 L1 A0 D0

                        G1-MCH- 15 days- 2.4kg- FTND

Mode of Delivery: FTND with episiotomy.

Physical & Laboratory Examinations

Mother was examined carefully. Samanya Parikshana by Ayurveda perspective revealed

Agnimandya, Sama jivha, Asamyaka mala, madhyam koshtha and Vata-pradhan kaphanubandhi sharir prakruti. Temperature, Pulse, Respiration rate, Blood pressure were within normal limits. P/A- soft, P/V- lochia alba

Breast Examination- b/l breast laxity present +, alpa stanya pradhurbava, skin- dry and shrunken noted,

Measures

To the effect of treatment few outcome measures were defined in Mother.

Gradations of measures were as follows.

Mother (Sutika) [14]

Stana mlanata (Flaccidity of breast)

1. Grade 0: Prakrut                
2. Grade 1: Alpa
3. Grade 2: Madhyam              
4. Grade 3: Adhik

Stanya praman (Lactation)

1. Grade 0: Prakrut
2.  Grade 1: Alpa
3. Grade 2: Apravartan

Breast feeding frequency

1. Grade 0: Feeding >9 times/day
2. Grade 1: Feeding 6 to 8 times/day
3. Grade 2: Feeding 3 to 5 times/day
4. Grade 3: Feeding 0 to 2 times/day

Breast Engorgement                                     

1. Grade 0: Normal
2. Grade 1: Mild
3. Grade 2: Moderate
4. Grade 3: Severe
5. Grade 4: Very Severe                              

Breast Milk Ejection

1. Grade 0: Forceful
2. Grade 1: Stream like
3. Grade 2: Drop by Drop
4. Grade 3: No milk

TREATMENT:  Plan of Treatment

Drug - Daruharidradigana Kashaya

Dose - 50ml x BD

Kala - Bhojanantha (Adhobhakta)

Duration - 40 day

Materials and Methods-

Place of the study is Prasutitantra and striroga OPD, Sangamner.

The total duration of treatment was 40 days.

ASSESMENT CRITERIA

Discussion

The treatment as planned started from the first visit with daruharidradi kashayam 50 ml twice a day post meal for a period of 1 month (30 days) was advised in prasutitantra and striroga OPD. At the end of first week, Stanamlanata in mother was reduced slightly. Improvement in stanyapraman noted in mother. With same treatment patient was assessed further on subsequent visit on every 10th day for forty days. All parameters in mother showing improvement along with breast engorgement, milk ejection and feeding patterns shows significant improvement. Same treatment was continued till forty days. Follow up wise effect of treatment is shown in Table No. 01. (As Explained in Treatment Regimen)

For the present study Daruharidradigana Kashaya has been used. There are five ingredients namely Daruharidra, Haridra, Indrayava, Prishniparni and Yashtimadhu. Kashaya was prepared as per the instructions from Kashaya Kalpana adhyay of sharangadhara samhita. So, the potency of the medication was delivered in its purest form.[12]

Stanya & Artava are updhatus of Rasa. By definition Upadhatus are those which get nourished by corresponding dhatu and they do not nourish other entities. Aushada sevana kala was also decided as per Bhaishajya Vyakhyana Adyaya of sharangdhara Samhita [13]. Hence Bhojanantha Aushada sevan was decided as Vyaankopa has to be corrected. In stanyakshaya due to praman alpatha and srotorodha the disease manifests. Hence by correcting & strengthening vyaanvata proper separation of nutrients and waste products occurs, resulting in supply of nutrients to all body parts or utharothara dhatu poshana & upadhatu nirman.

Daruharidradiganakashaya is a perfect combination of drugs which can clear Agnimandyata and do srotoshodan. as the majority of the drugs are laghu in paka & ushna virya; the next step in samprapti vighatana is providing preenan & poshan as Rasa dhatwagnimandya and Rasa dhatukshaya are most common factors in samprapti of Stanykshaya and same should be corrected to increase Stanya praman as Stanya is upadhatu of Rasa dhatu. Yashtimadhu and Prishniparni which are madhur vipak do the latter function. Ushna Veerya and Katu Vipaka drugs are known as Ama pachana, Agni Vardhan. Srotoshodhana, Vatanulomana. This helps in clearing srotosanga followed by jataragni & Rasa dhatwagni Vardhan which in turn helps in Rasa dhatu & its upadhatu nirmana & poshan. Yashtimadhu relieves deep rooted stress. It acts on manasika bhava and is a medhya rasayan. It is having sheeta virya, madhura rasa and madhura vipaka. Ushna virya katu vipaka may have hormone stimulating action. These attributes are similar to stanya. Hence it can help in Rasa and Stanya vruddhi.

Fat deposits act as an energy reservoir to be used during breastfeeding. Another main concern after delivery is to reduce overweight gained during pregnancy. As most of the Herbal galactogogues available in market are madhur rasa pradhan and Brihmana in nature it is essential to find a better substitute. But lactational insufficiency or Hypo galactorrhea left as such. Therefore, the choice of drugs must be of Deepana- Pachana karma in the erstwhile stages. Kashaya was asked to consume in Adhobhakt aushadh sevan kala that is after meal as past study reveals Brihmana, Rasayan and Balya aushadi act effectively in this kala.

In the present study, the case of stanyakshaya was treated with Daruharidradigana Kashaya successfully. Effect of therapy on different parameters shows improvement in results. For stronger evidence clinical trials are expected on this topic as a single case study only opens dimensions for research and does not provide evidence. Previous studies have shown that if a patient is treated as per samprapti & ghataka involved in it as ayurved is a treasure of medicine; physicians will definitely get success in treatment. As per present study Breast appearance, Breast milk praman, Breast feeding frequency, Milk ejection and engorgement had shown positive changes within forty days

Conclusion

Treatment done with help of Daruharidradigana Kashaya is effective to increase stanyapraman and other chief complaints are also improved such as Stanya Mlanantha, Stanya pramana, Breastfeeding frequency, milk ejection and engorgement. Overall study includes that Stanyakshaya can be managed effectively and safely by stanya vardhak dravyas. In addition to these dravyas can be used in healthy lactating mothers also to enhance breast milk production in a safer way and regain body strength especially in sutika avastha. Same treatment plan might not work for each and every patient as in case of different samprapti different aushadhi will require to break the samprapti process. No adverse effects were noted during the course of this study.