MA 5.4 NUMA SI GA RBHAVIKA S KRAM Completed Fetus in prsava- vastha rASANUfJ*^SIK GARBHAVRUDHI

I N Ayurvedic classics, the embryonit*««,^jie.uaJf6f'ment has been narrated monthwise while the modern Medical literature has considered the development of embryo in months as well as in weeks.

"KALALAV/ASTHA

(first month)

^ T ^.?1T. 3/14

Susruta and both Vagbhattas us.ed the word

'K a la la ' forthe shape of the embryo in the first month of intrauterine life. I Caraka hasdescribed the first month embryo as a mass ofcells like mucoid character in which all body parts though present are not conspicuous.

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Incorporated within it all the five basic elements, ' Panchmah'abhuta' i.e. Pruthvi, Ap , Teja, Vayu and Akas . During the first month the organs of Embryo are both

manifested and latent. It is from this stage of Embryo that

various organs of the fetus develop, thus they are menifested.

But these organs are not well menifested for differentiation and

recongnisiation hence they are simultenously described as latent

as well as manifested.

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Astang - hrudayakar has described the embryo of

first month as 'Kalala' but in 'avyakta' form. The organs of an

embryo is in indistingushed form.

Modern embryologist has described this first

month development in week divisions.

First Week - No fertile ova of the first week has been

examined. Our knowledge of the first week of I embryo is of other mammals as amphibian. The

egg is fertilised in the upper end of the uterine

tube, and segments into about cells, before it I passes in to the uterus, it continues to segment and develop into a blastocyst (Budbuda) with a

trophoblastic cells and inner cell mass.

I Second Week - The blastocyst enlarges loses it's Zona pellucida I and becomes implanted in the uterine mucosa. The enlarges and develop an activity

invading outer and inner

and forms primitive

into which first mesoderm then blood vessels

grow. The inner cell mass becomes the embryonic

disc and . The primitive streak

differentiates and then mesoderm and notochord

are formed.

Third Week - During the early part of third week the

neurofolds appear. The allantoic duct begins to

develop. The yolksac enlarges, and blood |

vessels begin to form. Before the end of the i i week, the neuro folds begin to unite. The |

Neurenteric canal opens. The primitive segments ^

begin to form. The changes during this week

occur with great rapidity. | I Fourth Week- During the fourth week, the nural folds close, | s' the primitive segments increase number. The 5

brachial arches appear and the connection of

yolk sac with the embryo becomes considerbly |

narrowed so that the embryo assumes a more |

definite form . I

I Major events in Ilnd week -

Implantation of blastocyst is completed by the 12 th

day of development. The uterine is named as

deciduabesalis at the embryomic pole, decidua capsularis around

the rest of the blastocyst and decidua paritalis which lines the

rest of the uterine cavity. Decidua besalis forms the site of the

future .

The Trophoblast differentiates into th syncytiotrophoblast and cytotrophoblast on 8 day. The

successive development of trophoblastic lacunae, trabeculae, |

utero-placental circulation, primary villi, and intervilous space |

take place between 9 to 13 day. The are |

now filled with maternal blood. )f)

The embryoblast defferentiates into bilaminar

germdisc, ectodermal and endodermal layers. The germ disk is |

sandwiched between the two vesicles. Both vesicles are enveloped

by splanchnopleuric layer of extra-embryonic mesoderm. In the I |

I later part of Ilnd week the primary yolk sae converts into

secondary yolk sac. I i I I S Major events in Ilird week -

The flattened germ disc changes in shape from

circular to oval, and then pear shaped area with a broad

cephalicand a narrow caudal end.

The primitive streak appears in the caudal part

of the germ disc. The cephalic end of the streak is enlarged to |

form primitive node or Hensen's node.

The notochord is visible on 17^^ or 18*^*^ day. I

The successive processes in the development of notochord are |

canalised notochordal process, formation of the . |

But convertion of bilaminar germ disc to trilaminar one is the I I achievement of Ilir d week. {

Caudal to the cloacal membrane at the k I allanto-enteric diverticulum arises from the dorsi-caudal area of I the yolk sae extends into connecting stalk. I

Primary choriaonic villi are changed to secondary I v illi with the appearance of a central core of primary mesoderm | and tertiary v illi with the advent of the fetal blood vessels in | the mesoderml core. "GHANAVASTHA"

(Embryonic period)

According to modern science this period extend th th, from the begining of the 4 week to the end of the 8 week.

Out of the trilaminar area, the ectodermal layer provides I

protection, the endodermal layer is meant for nutrition, andI

mesodermal layer is primarily available for function of Skeletan, |

tissues, muscles, and blood vascular system. Thus during Ilnd |

month all major organs and tissues are laid down from the germ

layers and external appearance of the embryo is recognisable with

the development of the face and the limbbuds. Between 20 to 30

days most of the Somites appear. After the somite period the age

can be calculated in ' CR' ( Crown Rump ) or CH ( Crown Heel )

length. On average the embryo at the age of 32 days is 5 mm in

CR length, and it may increase 1 mm/day upto 55 days and there

after 1.5 mm/day upto the full term. i

I f Rudimentary upper limb develop first then lower k

limb. The somatopleuric layer of the lateral plate extends within I

the limbbuds as a mesodermal core and later differatiate to form ||

bones, and joints. The heart increases greatly in size, producing |

a prominent bulge in the brachial region. I | I I I I

i The recent concept about the development of

trophoblast in vitro, from the blastocyst containing varying

amounts of inner cell mass is available. It has been observed

when intact blastocysts are cultured in vitro in medium

supplimented the total calf serum, trophoblast cells proliferate and

undergoes that cell transformation such as occur in vivo. If the

amount of inner cell mass in the blastocysts is decreased by the

culture with - HI - Thymidine , then giant cell transformation

occur normally but proliferation is reduced. In the absence of

giant cell mass no proliferation occures and giant cells

transformation is more rapid than undamaged blastocyst.

^ T 3 / 1 4 .

In Ayurveda the real work of Panchmahabhuta |I

I start with the help of Dhatvagni and embryo now turns to some

GHANA (solid) state. Which may be Pinda (o\=al), Peshi fi (elonggated) or Arbudasama (rounded). The external appearance i of embryo now turns to Pind (ball type) or Peshi (elongated) or |

Arbuda (rounded). These shapes also give the hint of future |

embryonic sex. If this solid mass had oval (Pinda) shape the | i I i born child would be male, if elongated (Pesi) the female and with

L I Susruta and his followers corroborating the above views have elaborated that these accumulated Mahabhutas get processed by combined action of - Slesma, Pitta and Vayu and become solid.

Susruta also suggested some herbal medicine known as 'Punsanvan Karma' for the male - sex embryo.

According to modern anatomists, in the 5 week of intrauterine life the embryo becomes markedly curved, the head increases greatly in size and the limb buds show segments, the brachial arches undergo profound changes and partly disappear.

The superficial nose, eye and erudiments become prominent.

In the 6 week of intrauterine life, the curvature of embryo is further diminished. The brachial grooves eruept the first have p appeared and the rudiments of the fingers and toes can be | recognised. But in the 7 and 8^^ week the flexure of the head | is greatly reduced and the neck is somewhat lengthened. The | I upper lip is completed and nose is more prominent. The nostrils » I are directed forward and plate is not completely developed. The | eyelids are present in the shape of folds and below the eye and | the different parts of the aurical are distinguishable. By the end | of Ilnd month the fetus measures from 2.7 to 3 cm in length. |

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•/ "PANCH-PINDAKAWASTHA"

In Ayurvedic classics this period is known as

' Panchpindakawastha because the shape of fetus is similar to five

buds stage. A head (Sir) upper extrimities (Hastas) and lower

extrimities (Pada) appear in this month. Carka, Susruta and

Vagbhata described the same condition with little difference.

3/14.

4/1 I .

TTT% ft ^ T 3T.f.?IT.^. 1/54.

According to Susruta in the 3^'^ month, there is |

growth of fourlimbsbuds and onebud for head, other than this all |

the externaldetails of the body parts are visible in the fetus. I ^

V^hile Carak did not mention about the limbbuds r I I I I and head. He says that all the 'Indriyas' are visible. This |

version it self speaks that all the four sense organs excepting

skin which are present in the head region are visible along with

the limbbud, which are ' Karmendriya' . Carak agrees with the

view of Susruta that all the ’nody parts collectively develop in

this month. ^ 5¥Tr^F^f^ T 3T.g.5n. 2/13-

Similar description is in' the 'Astang Sangraha'

about the development of four limbbuds and one headbud is

available.

According to modern embryologist the head is ,

extended and the neck is lengthened. The eyelids meet and fuse,

remain closed until the end of 6*"'^ month. The limbs are well

developed and nails appear on the digits. The external genital

organs are properly differentiated that is possible to distinguish the

sex. By the end of this month the length of the fetus is about

cm. But if the legs are included, it is from 9 to 10 cm.

It is difficuilt to explain the view of Ayurvedic

Physiology of formation of all organs in Ilird month at a time.

But when we examine the expelled product of Ilnd and Illrd month I

the differentiation is clearly noticed.

I According to modern embryology the period from the beginning of the Ilird month to the end of intrauterine life is I known as the fetal period. It is characterized by the maturation

of tissues and organs and rapid growth of the body. Growth in

31 length is particularly striking during the Ilird, IVth and Vth . I » H 5 months, while increase in weight is most striking during the last

2 months of gestation.

At the beginning of the Ilird month, the head

constitues approximately one-half of the CR length. The face

becomes more human-looking. The eyes initially directed laterally,

become located on the ventral aspect of the face and the ears

come to lie close to their definitive position at the side of the

head. The limb reach their relative length in comparison to

the rest of the body. But the lov/er limbs are less developed than

the upper limbs. At the end of the week the sex of the fetus

can be determined with the examination of external genital organ.

The limb muscle is formed in the 7^^ week of development. Before |

that the musculature of the body wall is divided in to a small | I dorsal portion 'the epimere' and larger ventral part 'the

I hypomere'. The epimere forms the extensor muscles and hypomere |

muscle forms the flexor muscles of the body. |

DAUHRUDAWASTHA/VYAKTANGAWASTHA |

(fourth month) I I I I I ^1^%^ I 3/14. I I

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According to Susruta the fetus comes in

'Cetanyavastha' in this period or 'life' is present in the growing

one and the all the body parts become more clear and visible in

this period. The heart of the fetus starts it's function in this

period thus the mother is called as 'dauhurdini' thus mother

posseses double heart. In this period mother expresses peculiar

desires to satisfy her will. The desires expressed by the mother

are the expression of fetal desires. if these desires are not

honoured, they may lead to malformations and developmental

defects in the growing fetus.

^ T ' ^ . ? T T . 4 / 2 0 .

Caraka says that in this period the fetus becomes

stabilised and grows longer in size and heavier in weight consequently, the pregnent woman shows a pronounced increase in body weight. | I ^ T 3f.^.w.2/22^ |

Vagbhat says in Asting Sangraha that all the I body organs can be clearly distinguished in the 4^^ month and i fetus is established. |( I According to modern concept, the loop of the gut,

which is projected in the is withdrawn the fetus.

Hair begins to make their appearance. There is general increase t" h in size, so that by the end of the 4 month the fetus is from 13

to 15 cm. in length. In this month face looks 'human'. Most

bones distinctly indicated throughout the body. Joint cavities

appear. General organs differentiate. The weight of the fetus

however, increases little during this period at the end of 4^^

month.

%?TT: j WI-'U-W. \/20-

During the 4*^^ month, hair appears in the fetus.

3T.^.

7 1 'MANA-PRABUDHAWASTHA"

(fifth month)

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W. 4/2 I

In this month the ’ M A N A ’ gets matured, t h According to Caraka in the 5 month, there is greater increase to

the fetus inthe accession of bod/ muscles (Mansa) and blood

(Rakta) as compared to other months. (Photograph ).

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According to Astang Sangraha along with the

development of Mana, Rakta (Blood) and Mansa (Muscles) are also

developed fast.

WT.^.W. 1/21

Harita opines that fetus becomes more 'Sujiva'.

I In modern view, in this month the first movement

^ of the fetus are usually observed. The erruption of hair on the I L I head commences and the vernix caseosa begins to develop

By the end of this month the total length of the fetus is from 25

to 27 cm. Lanugo (fetal hairs) appear.

Enamal and dentine are depositing, ligual

tonsils are formed. Lymph nodules and muscularies mucosae of

gut are present. Nose begins ossifying. Messenterial attachment

are completed. Female urogenital sinus are becoming a shalow

vestibule. Vegina regains lumen. Blood formation is increasing

in bonemarrow and decreasing in liver. Mylination of cord

begins.

According to Ayurvedic view the knowledge is the

result of interaction between Mana and Indriyas. Since by the 5 5 month auditary reflexes and peripheral sensory reflexes |

develop to certain extent, hence Mana enlightened. Fetus of 21 to |

28 weeks are termed as previable. The description of 'Sujiva' by |

Harita probably refers to this fact. I ||

SNAYU-SIRA-ROMADI-VKAKTAWASTHA I || (sixth month)

R x k I - h W T 3 T . 1 . 5 T T . I Jsi ■ i According to Vagbhatta Second tendons, vessels,

body hair, nails, skin energy and complexion appears in this

month. ^ t ^ . ^ . 4/ 2 2 .

^J^TSftrfr WT«p£T T 3T.g.W .2/24.

Caraka says that there is greater pigmentation and strength increases in fetus. VJhile mother looses her strength and discolouration of skin noticed. Astang Sangraha says that in this period, hair (kesa) Nails (Nakha) Bone (Asthi) Vein (Sira) and ligaments (Snayu) are clearly distinguishable. Bala

(strength) and Varna (complexi on) becomes prominent.

^ T ^.W.3/I6.

According to Susruta ' Buddhi ’ (Brain) is developed | in this month. |

According to modern embryologist the body is | covered with fine hairs or lanugo (Garbhaloma) and there is considerable deposite of vernix-caseosa. Body is lean but better | proportioned. Permanent teeth primodia are indicated. Ascending ^ colon becomes recognisable. Perinial muscles finish development. I |

Cerebral cortex developed in this period. So the description ofI

Budhi and complexion is given. Lanugo becomes more conspicuous I in 6^^ month. Deposition of calcium is more so Ayurvedic view of | I bone and hair formation is correct. (Photograph ). | I I

"SARVANG-PRATYANGA-VYAKTAWASTHA'

(seventh month)

51.^.5^11.2/25.

^iR) I ^•^■4/23*

According to Susruta all the body parts and

organs are developed. While Caraka says that there is all-round

development of fetus. Astang Sangraha also described the

development in the same manner.

According to modern embryologist the pupilary

membrane atrophies and eyelids are open. The testi descends |

v/ith vaginal sac of peritoneum. | I

Fetus looks lean, wrinkled and red, eyelids '*

reopen. Deep oesophageal glands are visible. Veginal sac pass

in to the scrotum. Uterine glands appear. Spleen acquires

typical structure. Fetal hair are prominent. Cerebral fissures I

and convlutions appear rapidly. I I;'

I A fetus born during the 6^*^ month or in the first | ^ t h ^ week of 7 month has great difficulty for surviving although several

I organs are able to function. The respiratory functions and central

nervous system is not differientiated sufficiently. And co-ordination

between these two system is not well establihed.

"OJA-SANCARAWASTHA"

(eighth month)

Susruta says that, in this month, there is

regular shifting of 'Oja' from maternal side to fetal side and from

fetal side to maternal side. If by chance child delivers just

v/hen the Oja has shifted to maternal side, it will not survive.

This means, there is no Oja at all (Oja-Rahitya) in the delivered

child. It is clear that Oja is a very-very vital substance for |

human survival. ^

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■1 ' I f W I : I ^.™.4/24. I

\ According to Caraka also in the months there is continuous shifting of Oja from the mother to fetus and vice-versa. Hence during this time the birth of the fetus is full of risk .

62,63.

In Astang Hrudaya similar concept of Oja shifting has been described.

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i t -Ci tn -C £ i l A C -- -3 U) n 1 Si. q £ I f 5P P PI 2 . Of 2 j 6i I z -s( ± I H Iaj > a G < R Ma < o sy 0> 2 A! n ua i j; • <1 r 1 t r > 2 2 A i <3- r1-0) w Q. JQ. -C M ri-QJ n 5P 3 (/> p . LO H > O m -d- EC C/l J1-. fli i t-t "I o ± a ' o 5 . > I I i . ?o 03 K > < 6 ^I ^ 00'. -C D3 ?o ' ^ •pr > X o z a < H 3 H- a w 3 " QJ "PRASAVAWASTHA"

(ninth month)

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According to Ayurvedic classics (Susruta Samhita,

Carak Samhita and Astang Sangraha) as well as modern

embryology, 9^^ month is the full term, when fetus attains

complete age of intrauterine life and is prepared to deliver in

outer world .

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