Class Notes 1-10

Course TItle Women’s Health
Course Instructor Terra Rafael

CAP (NAMA) , Registered Midwife (in retirement), Maya Abdominal Therapist,
Energy Work Therapist, Shamanism Practitioner, founder WiseWomanhood
Practice & School www.wisewomanhood.com
Class Time Wednesdays, 12:00 - 2:00 pm EST (excluding school holidays)
Contact Info. terra@wisewomanhood.com
Class One - July 7, 2021
Women’s Health Intro Review of Reproductive Anatomy & Physiology - Western and Ayurvedic and hormonal
regulation; Summarized Common health concerns of females, such as hormonal changes throughout life, breast
health, yoni health, sexual health, birth control
Class Two - July 14, 2021
Menstrual Health - Basis of Fertility Menstrual cycle - understanding the cycle; Symptoms and Causes of
displaced uterus; Apana vayu & Rasa - roles in reproductive health; Determining healthy Artava; factors in
healthy Artava; yoni; and practices that maintain health; Herbs for Artava Vaha Srotas
Class Three - July 21, 2021
Menstrual Disorders Various roots of disorders & treatments (in Charak Samhita; displaced uterus; amenorrhea;
PCOS; Dysmenorrhea; Heavy Periods; Endometriosis; PMS)
Class Four - July 28, 2021
Female Fertility System Necessities for healthy conception/Kasheppa; Supporting healthy fertility in women -
diet, herbs, lifestyle, marmas; Fertility Awareness Method and use in diagnosing and treating menstrual/fertility
Class Five - August 4, 2021
Male Fertility Normal male fertility - determining healthy male shukra; and treating concerns : defective semen,
defective sperm, impotency, obstructive problems, testicular injury and disease, varicocele, problems with
erection and ejactulation, hormonal problems, general medical disorders that reduce fertility, other factors,
medications that reduce fertility ; Sperm enhancement treatments
Q & A before Midterm Exam
Terra Rafael, Wise Womanhood Practice & School terra@wisewomanhood.com www.wisewomanhood.com

Class Six - July 11, 2021
Female Fertility Concerns Treating problems of female fertility - displaced uterus; “trying” for pregnancy at wrong
time (FAM); systemic hormonal imbalances; infertility due to stress; aging and conception; coming off birth
control pills; mechanical issue of female fertility; ovulatory issues; fertile fluid problems; implantation problems
Class Seven - July 18, 2021
Normal Pregnancy Process of Development in Pregnancy - mother and baby; Healthy pregnancy practices,
nutrition, exercise, sleep, sex, yoga - Ayurveda and midwifery; practices contraindicated in pregnancy; signs of
VPK excesses in pregnancy; VPK soothing in pregnancy; importance of apana in pregnancy
Class Eight - July 25, 2021
Pregnancy Concerns Treating common problems in pregnancy and when to refer (miscarriage; hyperacidity;
digestive disturbances; constipation; hemorrhoids; gas, heartburn & indigestion; abdominal skin itch; muscle
cramps; swollen feet; insomnia; mood swings; excess salivation; dysentery; hiccup and dyspnea
Class Nine - September 1, 2021
Childbirth, The process of Labor and Birth; what is pain in labor about & Ayurveda treatment ; Supporting Labor
and Birth with Ayurveda - preparation and on the spot - Helping labor to start or strengthen; features of a high
vata, high pitta, and high kapha types of labor and soothing measures; Immediate Postpartum and newborn care
Class Ten - September 15, 2021
Menopause Menopause and Ayurveda - normal process = dance of the hormones; common concerns and
addressing with Ayurveda and natural remedies - hot flashes, vaginal dryness, uterine bleeding problems, sleep
disturbances; mood symptoms; short term memory and difficulty concentrating
Q & A before Final Exam
Terra Rafael, Wise Womanhood Practice & School terra@wisewomanhood.com www.wisewomanhood.com

WiseWomanhood Terra Rafael, AP
Class One - Women’s Health and Ayurveda Intro
Yoga Veda Institute – Instructor Terra Rafael, A.P.
Class Overview , (5 min)
Review of Reproductive Anatomy and Physiology - Western and

Ayurvedic 20 min
© WiseWomanhood, LLC wisewomanhood@gmail.com www.wisewomanhood.com





Doshas In Menstrual Cycle - Varying interpretations
~~~~~~/CRONE/~~~~MAIDEN~~~~~~/~~~~~~~~~MOTHER~~~~~~~~~~~~~~~~/~CRONE/~~
~~~~~~~~/Vata~~~~ /----Kapha hormones~~~~/Pitta~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~/ Vata~~~ PER Maya Tiwari

Monthly Egg Cycle


The Ayurvedic View on Oogenesis and the Ovum
The ayurvedic sense of the process in this case is very difficult to put forth since the entire development is in
two stages separated by years; viz. pre-natal developments and puberty.
At puberty the ovum once finally formed becomes a pitta and kapha dominated entity; or further to say that it is
Prithvi/earth, vayu/air, and agni/fire complex which is covered by jal/water element.
Fertilization
At fertilization this complex breaks and the akash/space component accommodates the sperm and in turn
releases energy, part of which is retained as ojas and part of it may be released as heat with water. After
fertilization, as the newly formed egg moves down towards the uterine wall for attachment, the Kapha complex
which is changed as a result of fertilization reactions, finds space and interacts with the uterine surface to
adhere with it to attach and form a place for development of the embryo and fetus.
Varying Lengths of Cycles: time from ovulation to menses is stable in stable reproductive years
(less so with menarche and menopausal years)
Cervical Fluid
Here's some background on cervical fluid. By remembering the origins you will have a good place to work from
rather than just following symptomatic treatments.
In the cervical canal there are crypts that produce cervical mucus of different types according to levels of

estrogen and progesterone in the woman's system.
Estrogenic or E-type mucus is created when estrogen predominates, usually coinciding with the
increasing levels of the follicular phase of the ovaries, when developing follicles are producing rising levels of
estrogen and the proliferative stage of the endometrial uterine lining. This climaxes at the time when peak
estrogen triggers the surge of Lutenizing Hormone, which triggers ovulation of the predominant follicle. At this
time, the highest levels of estrogen results in the most E-type mucus, which is the type that nurtures and
facilitates sperm survival and fertilizing capacity, with high water content and a more alkaline nature. It is the
egg-white, stretchy, type we want to see for natural fertility. Sperm can live for 3-5 days in this environment.
Gestagenic or G-type mucus is created when progesterone levels are high &/OR estrogen levels are low.
This happens after ovulation, when the spent husk of the predominant follicle left behind develops into the
corpus luteum, which secrete progesterone to make the lining of the uterus suitable for implantation of a
possibly fertilized egg. Progesterone inhibits the response of the cervical crypts to estrogen and reduces the E-
type mucus.
This creates a sticky plug that can block the cervical canal, inhibiting sperm from entering. More sperm aren't
needed at this time. This thick, viscous mucus will not usually be visible at the vulva and is thus named the
dry days when observing the mucus for fertility awareness methods. It is also more acidic and does not feed
the sperm. Sperm will only live for minutes in this environment.

Position Of Uterus At Different Times Of The Menstrual Cycle - Functional Changes
If you check your cervix regularly and in the same position you will see that it moves up
and down during the cycle. (All illustrations from Justisse Guide Images, training )

Dysfunctional Displacement of the Uterus



The Uterus changes in Size and Weight at different times in the

Menstrual Cycle:
3-4 oz pre ovulation
6-8 oz just before menses, when full of blood and fluid
This is what adds to vulnerability of uterus in premenstrual days.
Review of Female Anatomy per Ayurveda regarding Female

Reproduction: related to doshas, to tissues, to channels:
Doshas:
Vata: Movement in the body; lactation, menstruation, sexual function; sexual reproductive & growth
hormonal functions
• Prana vayu - relates to hormonal balance
• Apana vayu - relates to hormonal balance, menstruation, sexual functioning, downward movement
• Samana vayu - helps balance prana and apana, as well as digestion
• Udana vayu- exhalation, upward movement, speech, inspiration
• Vyana vayu- pervades the whole body via nervous system, also supports heart & circulation function;
impt for lactation problems, nervousness
Apana vayu balance is crucial for reproductive health:
Maintaining normal apana vayu:
• Avoid: holding urine/BM/ flatus; excess sex & masturbation; excessive jarring- ex. Jumping, snowboarding,
mountain biking, jogging; coldness; dryness; irregular lifestyle; excess travel and moving home; excess
multitasking
• Signs that apana is disturbed: a woman accumulates fat in the thighs; constipation or diarrhea, retention of urine
or polyuria; no menses or profuse menses; painful periods; pain during sex; lower backache and pain during
ovulation; sexual impairment; premature orgasm; weak sex drive; osteoporosis; any disorders below the belly
button.
• Ayurvedic treatments: according to disturbance or excess of Vata. Basti is often a useful treatment. Common
herbs: Triphala, Dashmula. Yogic support : Ashwini mudra .Marmani: All below waist help apana
Causes of vitiation of Vata (and so apana):
• suppression of natural urges ( urination, defecation, intercourse, farting, vomiting, sneezing, belching, yawning,
hunger, thirst, tears, sleep, breathing heavily from over exertion)
• taking food before previous meal is digested
• remaining awake for long time at night
• speaking with a loud voice
• physical exercise in excess of capacity
• exposure to jerkiness due to traveling on vehicle ( or due to snowboarding, gymnastics, or other activities where
a lot of jerking occurs)
• intake of pungent, bitter and astringent tastes
• intake of dry fruit
• excessive worry
• sexual over-indulgence
• fear
• fasting
• cold
• grief
During menses, the apana is predominant. One reason women are excluded from rituals, from cooking, and many
other activities in traditional society was that those activities will bring the energy more upward, disrupting the
apana.
Pitta: Metabolic and chemical functions of body; transformation of food and mental input; Menstruation
generally pitta
• Alochaka pitta: vision & comprehension of what is seen

• Sadaka pitta: heart, circulation and metabolic homones, and digestion of thoughts & emotions
(neurochemicals)
• Pachaka pitta: digestion in stomach
• Ranjaka pitta: liver/gall bladder, digestion and blood - thereby related to menstrual problem,
endometriosis, PID
• Bhrajaka pitta: metabolism of the skin
Kapha - stability of body and mind; cohesion, lubrication; excess restricts vata and subdues pitta leads to
congestion
• Tarpaka kapha: fluids in head, sinuses, cerebral fluids
• Bodhaka kapha: taste and cravings, digestion & saliva
• Avalambaka kapha: lubrication & fluids around heart, lungs, an dupper back
• Kledaka kapha: lubrication of digestive process
• Sleshaka kapha: lubrication of the joints
Dhatu Sub - dhatu (created at same Waste Materials

level)
Plasma & lymph fluids Breasts & breast fluids; menses Mucus (Kapha in general)
Red blood cells (blood in general) Blood vessels; muscle tendons Digestive bile (Pitta in general)
Muscles Skin; ligaments Any accumulation in body cavity ie.
earwax, belly button stuff
Fat & connective tissue Fatty tissue under skin Sweat
Bones Teeth Nails, body hair
Marrow & nerves Sclerotic fluid in eye; head hair Tears
Reproductive fluids Ojas (primary energy- immune Smegma (accumulation of fluid
vitality & important for successful under male foreskin or in female
conception & healthy child) labia)
• Plasma level (Rasa) is related to any menstrual problem
• Almost all hormonal & fertility imbalances relate to problems in the Reproductive tissue level - to
nourish this level general health and nourishment is needed.
• Artava tissue is involved in gynecological problems.
Shukravaha srotas and Artavavaha srotas- Which is What? : Different lineages of Ayurveda
speak of them differently - confusion? Not just you. Some say both male and female have shukravaha srotas
for reproductive- ovaries, uterus while artavavaha srotas is related to menses, vagina. Others say artavavaha
srotas is for all female sexual and reproductive functions.

COMMON HEALTH CONCERNS OF FEMALES

BREAST HEALTH BrH notes ,20 min
“O, thou with the beautiful face, may the child
Reared on your milk, attain a long life, like
The gods made immortal with drinks of nectar.”
- Susruta Samhita
Evolution of Lactation & Breasts

Evolution of Lactation
Lactation evolved from sweat glands in the Mesozoic era, as mammals gained ascendancy over dinosaurs. The world
became a different place. Before that animals popped out of eggs and then immediately had to find food.
Long before mammals were mammal like reptiles called synapsids - around 310 million years ago. They looked like giant
terrestrial lizards. After thriving for 10s of millions of years their descendants were nearly wiped out-along with 70% of
all creatures- by the Permian-Triassic mass extinction 250 million years ago. A few survived and evolved into small,
mammal-like creatures called cyndonts.
Proto-mammals had kangaroo-like pouches that transported eggs, then hatchlings, Because the eggs were porous, they
lost moisture easily and were susceptible to harmful microbes. Maternal skin glands in the pouch began to secrete fluids
to fight germs. From there nutrients found their way into the mix. Thus mammary glands likely first evolved for immune
support.

As mammals evolved, so did the complex hormonal conversation necessary to regulate their changing bodies. Hormonal
receptors receive messages about what is needed when.
Only a few small, straggler mammals survived the Cretaceous period. They adjusted skeletons and airways for better
running and became nocturnal. Also- invested more time and energy in their young, for better body-temp regulation in
the tiny offspring- high-fat milk and intensive snuggling parental care overcame the cold. Mammals delayed maturation
with lactation and could become more specialized.
Breasts have helped advance our own species evolution in ways both self-evident and
unexpected. - newborns are born smaller and brains grow bigger postpartum. Smaller
babies allows human hips smaller than other primates, assisting bipedalism. Nipples
and sucking helped develop and prepare the human palate for speech and gave a
reason to have lips. Needing to stay by mother all day for breastfeeding led to learning
from mom- socio-cultural transmission. The fat being available in the breast milk leads
to more flexibility in where mammals could live. Lactation allowed to a huge difference
in brain volume between reptiles and mammals.
Evolution of Fatty Breasts

Most mammals, even primates, only have big fatty breasts when breastfeeding, then
fat goes away. To function for nursing, it need only fill half an eggshell-big breasts aren’t required. Women won’t even
ovulate unless a body-fat threshold has been crossed. On average, reproductive-age women store twice the fat that men
do. Our fat helps make estrogen and estrogen made our breasts grow because the tissues there are so attuned to it.
For centuries male scientists often thought of the fatty breasts as Dave Barry wrote, “The primary biological function of
breasts is to make males stupid” which is verified by science- the males stupid around breasts part. Women with larger
breasts get more tips, are picked up more when hitchhiking by MEN ( not women). Breast images trigger the reward
centers in men’s brains. When eye-tracking machines are used, the same number of men preferred medium breasts to
large breasts and some men were most enthusiastic about small breasts. Men in Azande and Gande tribes prefer long
and pendulous breasts, whereas the Manus and Maasai prefer more rounded ones. Men have varying preferences for
areolar size also.
With more women scientists at end of twentieth century, other theories emerged, besides the sexual reasons for
breasts. These theories emphasized the maternal properties of women in the evolution of breasts with fat tissue - since
it gave more support to gestate and nurture human babies.
When our ancestors lost their fur, babies faced some new challenges. Other tiny primates cling to their mother’s fur
from a very early age. Mom is free to move around even while baby breast-feeds. Human mothers had to hold the baby
in the crook of the arm. And the nipple needed to come down a bit. The nipple is no longer anchored tightly to the ribs,
as in monkeys. The skin around the nipple is looser to make it more maneuverable.
The rounder breast was also determined by human skull shape. Since unlike most mammals, we don’t have a snout.
Flatter faces allowed for birth with bigger brains. Flat faces and flat chests don’t work well - to get the nipple the baby
would need to smoosh their face against the chest, making breathing difficult. Rounder breasts allow for breathing while
nursing.
Also we are the only mammal with unusually big heads and can’t hold them up at birth. The longer neck that flexes
differently than any other animal allows for growing a laryngeal cavity so we can speak.
-Evolution section from various passages in : Breasts - A Natural And Unnatural History by Florence Williams
The Varieties Of Breasts

The size of breasts depends on the state of rasa dhatu -
- Vata in rasa due to grief, sadness, other vata => small breast tx = Shatavari ghee applied for 6 mos to year
- Kapha in rasa => large pendulous breasts
- From pp 240-243, Textbook of Ayurveda, Vol 2, Vasant Lad
Breast Development & Changes Over A Woman’s Life
When Does Breast Development Begin?
Breasts begin to form during fetal development with a thickening in the chest area called the mammary ridge
or milk line. By the time a female infant is born, nipples and the beginnings of the milk-duct system have
formed.

Both men and women have the same breast potential early in fetal life, when the embryo is in its bipotential state. The
first six weeks the embryo can go either way in development- male or female - and all have the two parallel milk ridges.
for XX fetus estrogen will create the female organs, including breasts. In XY fetus, testosterone will inhibit that .
Theoretically fathers could lactate with a later does of estrogen and some prolactin to cause lactation. In one human in
a hundred an extra nipple or two can show up---useful in mammals with large litter.
Breast changes continue to happen over the lifespan, with lobes, or small subdivisions of breast tissue,
developing first. Mammary glands develop next and consist of 15 to 24 lobes. Mammary glands are influenced
by hormones activated in puberty. Involution or shrinkage of the milk ducts is the final major change that
happens within the breast tissue. A gradual shrinking of the mammary glands (involution) typically begins
around the age of 35.
What Breast Changes Happen At Puberty?

As a girl approaches adolescence, the first outward signs of breast development begin to appear. When the ovaries start
to secrete estrogen, fat in the connective tissue begins to accumulate causing the breasts to enlarge. The duct system
also begins to grow. Usually the onset of these breast changes is also accompanied by the appearance of pubic hair and
hair under the arms.
Once ovulation and menstruation begin, the maturing of the breasts begins with the formation of secretory glands at
the end of the milk ducts. The breasts and duct system continue to grow and mature, with the development of many
glands and lobules. The rate at which breasts grow varies greatly and is different for each young woman.
Beginning Puberty Happens Early in the USA

The age of sexual maturity in girls has dropped slowly but steadily about three months per decade, since 1850, due to
better nutrition and less infectious disease. The longer we hold off puberty, the taller (the sex hormones of puberty seal
the bones from growing more) and stronger women are and greater the likelihood their offspring will be healthy.
o By 2011 33% of black girls between the ages of 6 and 8 were budding breasts or growing pubic hair
o 15% of Hispanic girls, 10% of white girls and 4% of Asian girls are as well
o HALF of all girls in US start developing breasts by their 10th birthday
Causes of Early Puberty
o Obesity - increases aromatase which converts cholesterol into estrogen; more fat = more estrogen; also increases
leptin- which tells hunger and fires up puberty. Some correlated with obesity- BUT NOT ALL.
o Fiber - more fiber and vegetables, the later they enter puberty.
o Girls who had earlier puberty ate more meat
o Artificial light - melatonin made in darkness : blind women make less and have lower risk of breast cancer;
women working under lights on the night shift have a higher risk. Girls with precocious unusually low levels of
melatonin
o Divorce - girls not living with a biological father tend to mature earlier
o Highly sexualized media - but not showing increasing hormone levels, though growing breasts ealier.
o Toxins - in testing girls across the country for 51 toxic chemicals - Nearly all girls had these , sometimes in much
larger concentrations than in adults. CA girls - highest flame-retardants. NC girls - from cigarettes & second-hand
smoke; NYC girls - 2,5-dicholorphenol - mothballs and room deodorizers; Cincinnati girls- more PFOA, used in
making Teflon and other products
Because breast cells are dividing like mad during puberty makes it a very vulnerable time for these cells to be exposed to
possible carcinogens.
Beginning puberty early is related to increased risk of breast cancer; increased vulnerability to sexual harassment and
sexual exploitation ; also a greater risk of substance abuse, depression and suicide.
What Cyclical Changes Happen To The Breasts During The Menstrual Cycle?
Each month, women experience fluctuations in hormones that make up the normal menstrual cycle. Estrogen, which is
produced by the ovaries in the first half of the menstrual cycle, stimulates the growth of milk ducts in the breasts. The
increasing level of estrogen leads to ovulation halfway through the cycle. Next, the hormone progesterone takes over in
the second half of the cycle, stimulating the formation of the milk glands. These hormones are believed to be
responsible for the cyclical changes, like the swelling, pain, and tenderness that many women experience in their breasts
just before menstruation.
During menstruation, many women also experience changes in breast texture. Breasts feel particularly lumpy. These are
the glands in the breast enlarging to prepare for a possible pregnancy. If pregnancy does not happen, the breasts return
to normal size. Once menstruation begins, the cycle begins again.

Phase 1: They’re lumpy
The first few days of your cycle (when your period starts), the texture of your boobs may suddenly feel uneven and
nodular. Why the sudden rough patch? “During menstruation, breasts may feel lumpier as milk glands enlarge in
preparation for a possible pregnancy,” says Sara Gottfried, MD, a gynecologist in Berkeley, CA. The bumpy feel isn’t
permanent. As soon as your body realizes you’re not pregnant, your breasts will smooth out, she adds.
Phase 2: They’re softer and smaller
Suddenly your cup doesn’t runneth over. Toward the end of menstruation (depending on the length of your cycle, it’s
typically around day 3 or 7), your boobs are suddenly pulling a disappearing act. “Breasts are at their lowest volume at
this time because estrogen and progesterone are at their lowest,” Dr. Gottfried says. This is actually the most accurate
depiction of your true size because you’re not being pumped up with hormones. A perk of the smaller state: “They also
tend to soften up towards the end of bleeding,” Dr. Gottfried says.
Phase 3: They’re perky
As you get closer to ovulation (this is known as the follicular phase, until ovulation), estrogen starts to rise. And according
to the Journal of Ultrasound Medicine this causes your breasts to look extra buoyant. Oh hey—hormones. That’s because
estrogen improves skin elasticity. Consider it a natural lift.
Phase 4: They’re full and firm
In what’s considered the luteal phase (this occurs after ovulation, which is generally around day 15 and up through the
end of your cycle), expect to be at your largest cup size. “Progesterone is really peaking, so this is a time associated with
the largest breast size and density,” Dr. Booth says. They may even look swollen or slightly veiny, and feel tender.
Phase 5: They’re lopsided
Research published in the journal Ethology and Sociobiology found that when estrogen is low during your premenstrual
week, breasts become less symmetrical. That could be why your left boob looks crooked all of a sudden. But don’t sweat
it! Once your period arrives, your boobs will even out.
When It’s Not Hormones - Other Changes During the Childbearing Years
Aside from the surge and crash of hormones that are happening on a monthly rhythm, there are other things that can
cause changes to your chest.
Sex can make them (slightly, temporarily) bigger
As your heart rate and blood pressure increase, so does the size of your breasts, Dr. Gottfried says.
Carbs can make them enlarged
Eating carbohydrate-rich foods can hit you right in the chest. Carbs stimulate the production of insulin, which can lead to
fluid retention in your boobs, Dr. Booth says.
Caffeine can make them knotty
Your morning cup of coffee may cause you to experience something fibrocycstic breasts, Dr. Gottfried says. This is due to
sensitivity in breast tissue. It’s benign, but the rope-like feel can be painful. Some scientists and Ayurvedic practitioners
believe this imbalance may encourage cancer in the long run.
What Happens To The Breasts During Pregnancy And Lactation?

Many healthcare providers believe the breasts are not fully mature until a woman has given birth and made milk. Breast
changes are one of the earliest signs of pregnancy. This is a result of the hormone progesterone. In addition, the areolas
(the dark areas of skin that surround the nipples of the breasts) begin to swell followed by the rapid swelling of the
breasts themselves. Most pregnant women experience tenderness down the sides of the breasts and tingling or
soreness of the nipples. This is because of the growth of the milk duct system and the formation of many more lobules.
By the fifth or sixth month of pregnancy, the breasts are fully capable of producing milk. As in puberty, estrogen controls
the growth of the ducts, and progesterone controls the growth of the glandular buds. Many other hormones, like
follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, oxytocin, and human placental lactogen (HPL)
also play vital roles in milk production.
Other physical changes, like the prominence of the blood vessels in the breast and the enlargement and darkening of the
areola happen. All of these changes are in preparation for breastfeeding the baby after birth.
Breast Changes with Pregnancy

• Breast changes are often first sign of pregnancy - they hurt and tingle and grow - doubling weight and size and
nipples enlarge and grow darker
• Breasts become fully grown only during pregnancy
• These changes protect the breasts from cancer. If every young woman could have a blast of pregnancy hormones
early in reproductive years - if she has a child before age twenty about half the lifetime risk of breast cancer as a
non-mother or if wait until thirties to have children. A full term pregnancy is required.
• One theory of how it works is that it comes cancer resistant due to having the stem cells fully mature into their
lactating form.
• Before 1960 nearly 1/3 of American women had their first child before age twenty. The Pill changed that. Since
1970 the percentage of first child at age thirty-five or later has risen eight-fold.

What Happens To The Breasts At Menopause?
By the time a woman reaches her late 40s and early 50s, menopause is beginning or is well underway. At this time, the levels of
estrogen and progesterone begin to fluctuate. The levels of estrogen dramatically decrease. This leads to many of the symptoms
commonly associated with menopause. With this reduction in the stimulation by estrogen to all tissues of the body, including the
breast tissue, there is a reduction in the glandular tissue of the breasts. Without estrogen, the connective tissue of the breast
becomes dehydrated and inelastic. The breast tissue, which was prepared to make milk, shrinks and loses shape. This leads to the
"sagging" of the breasts often associated with women of this age. . As a result of these changes, your breasts begin to lose their
firmness and fullness. Also with age comes an increased risk of developing growths in the breast such as fibroids, cysts, and cancer.
Keep in mind that women of any age can develop these conditions, however.
Women who are taking hormone therapy may experience some of the premenstrual breast symptoms that they experienced while
they were still menstruating, like tenderness and swelling. However, if there was sagging of the breasts before menopause, this is
not reversed with hormone therapy.
Women who have had their ovaries surgically removed can have changes in their breasts at any time due to the loss of hormones.
Common Breast Changes with Aging
Common changes that occur in the breast due to age include:
• stretch marks
• downward pointing nipples
• an elongated, stretched, or flattened appearance
• wider space between the breasts
• lumpiness, which may be due to benign fibrocystic changes in the breast or serious conditions such as breast cancer
Aging changes in the breasts are visible upon physical examination. Puckering, redness, or thickening of breast skin, a
pulled in nipple, nipple discharge, breast pain, or hard lumps are not considered normal aging changes. See your doctor if
you notice any of these conditions, or if one breast looks significantly different than the other.
-information about breast changes includes information adapted from: -

• https://www.hopkinsmedicine.org/healthlibrary/conditions/breast_health/normal_breast_development_and_cha-
nges_85,P00151
• from various passages in : Breasts - A Natural And Unnatural History by Florence Williams
Anatomy and Physiology of Breasts - fact summary

• The pendulous breast is unique. The basic glandular architecture is shared by all other mammals.
• 6000 or so genes governing lactation are among the most strongly conserved ones through evolution to humans
today. At its core, lactation is a fat-delivery system, very little changed over millions of years, except for some
dietary tweaking.
• The average breast weighs just over a pound, but this can double in late pregnancy.
• Mean volume is about 2/3 cup or 561 mililiters.
• Over the course of a menstrual cycle breast volume varies by 13.6% owing to water retention and cell growth.
• Some studies say the left breast tends to be bigger than the right breast. One of the breasts is usually, on average
nearly a fifth of a cup, bigger than the other.

• The milk flows out of several rivulets that emerge from the nipple through tiny holes like those at the tip of an
old-fashioned watering can.
• Blood-to-milk transformation happens in the alveoli cells, deep in the gland, in tiny grapelike structures that form
lobules. Lobules merge into separate ductal networks called lobes. The number of lobes vary among women,
with the average being two dozen.
• Each lobe empties out into an orifice on the nipple and sometimes different lobes share one orifice.
• The average nipple has about 12 orifices.
• During development, breast tissue growth starts at the nipple and branches backward towards the chest wall.
During pregnancy the lobules with their alveoli finally form.
• Cooper discovered the ability of the nipple to secrete substances other than milk including protective oils.
• The areola has little bumps to help form a seal with infant lips.
• The glands are densely wired with veins and nerves, for responding to infants sucking and stimulating more milk
production - and also leading to potential for erotic response.
• The different cells of the breast are constantly communicating -the extracellular matrix must allow the gland to
grow through it, possibly because the glandular cells command it to.
• Nipples change from small and light in youth to larger and darker in adulthood.
• Hormones tell the glands when to mature and when to regress. When there is a pregnancy, when to have a
glandular growth spurt, when to shut down milk production, what the sex of the fetus is to fine-tune the milk
composition.
Human breast tissue falls into three large categories:
1. Fat ( dark parts on a mammogram)

2. Stroma mostly made up of connective tissue
3. Glandular tissue called parenchyma made up of ductal epithelial cells. (light parts on a mammogram)
Unlike any other organ we have, breasts do most of their developing well after birth. The breast has to fully build itself
out of nothing during puberty. Then the gland grows new milk-making structures under the influence of pregnancy
hormones. Once the infant has weaned, a switch flips somewhere and the gland shuts down and shrinks. The breast
must construct and then deconstruct itself over and over again with each pregnancy. Even if a woman never gets
pregnant, her breasts construct and deconstruct a little bit each month just in case of pregnancy.
This glandular tissue growth happens literally molecule by molecule and is called mammapoiesis. Ductal cells grow into
surrounding tissue by massively proliferating- essentially the same process that occurs in cancer, except here is
supposed to happen and is controlled in its growth.


Human milk, contains one-sixth the protein found in the quokka (a small marsupial) and one-fiftieth the fat in seal
milk (a baby seal quadruples its weight in the first six weeks).
FOUR BASIC FUNCTIONS of Lactation

1. Breastfeeding provides specialized, highly adapted food for each newborn mammal
2. Breastfeeding provides immune support for the baby
3. Lactation produces hormones that work as natural contraception, ensuring that a mother’s births are spaced
adequately apart.
4. Breastfeeding provides a “window of learning” in which young mammals can focus on acquiring sills rather than
desperately seeking food.
Ayurvedic Anatomy/Physiology of the Breasts… from Rasa pp 240-243, Textbook of
Ayurveda, Vol 2, Vasant Lad
Brief Review of Rasa - Rasa is one of the Tissues or Dhatus of the body, most closely associated with the Plasma in
western medical terms. It is the first tissue to arise from the products of digestion or chyle and so is very tied to how and
what is digested, as well as the amount of liquid in the body. From Rasa arises Rakta, Mamsa, Medha, Asthi, Majja and
Shukra/Artava and eventually, Ojas- a vital fluid for immunity and stamina.
Both breast milk and menstrual fluid come as secondary products of the rasa, therefore is a strong key for these fluids.
Whatever affects the rasa will affect breast milk and menstrual fluid. Good digestion of food helps ensure healthy rasa.
Signs and Symptoms of Rasa Imbalance, by Dosha

Vata Pitta Kapha
Fever with chills High fever Low fever
Dry skin Hives Pallor
Dark skin coloration rash Cold, cough, catarrh, sinus congestion
Malaise Urticaria Lymphatic congestion
Fatigue Eczema, psoriasis Swollen lymph glands
Dizziness acne Lymphoma
Generalized pain Chemical sensitivities Edema
Palptations and tachycardia Dermatitis Excess salivation or mucus
Hypersensitivity to loud noises Tonsillitis Hay fever
Dehydration Appendicitis Cold, clammy skin
Excess thirst Red or yellow skin Fungal infections
Goosebumps Sensitive skin: bruises and burns easily Hyperglycemia
Melanoma
Moles
Hypoglycemia
pp60, 61, American Institute of Vedic Studies Ayurvedic Healing Course, Part IV

Reducing VATA in Rasa Reducing PITTA in Rasa Reducing KAPHA in Rasa
-Use the plasma increasing Use cooling expectorants, alteratives The plasma reducing therapy is mainly
demulcents with a small amount of and lymphatic cleansers specifically indicated. Use pungent plasma
spices like ginger, cinnamon, echinacea. It may be good to add cleansing herbs with some bitter
cardamom, or cloves to help digest some plasma increasing demulcents /astringent ones when fever and
them. Sour juices with salt are also when there is more thirst and dryness infection are more pronounced.
useful (llike shatavari or marshmallow). Milk Mustard is particularly good, as is
-A mild sweating, just enough sweat is a good drink for this condition. horseradish.
to moisten the skin. Ginger or Useful herbs are burdock, yarrow,
cinnamon are usually strong enough horsetail, elder flowers, yellow dock,
for this. Avoid strong sweating. mint.
-Emphasis on oleation therapy- The area of inflammation can be
external sesame and other medicated washed with aloe gel, bitter
oil like Mahanarayan can be applied- decoctions (like golden seal or Oregon
best on the back, heart and soles of grape root or tumeric) or cooling oils
the feet. like coconut and ghee. Heavier oils
-Anti-vata diet should be followed by like sesame should not be applied .
avoid too many hot spices or food Exposure of the skin to sun, heat and
that is too heavy. Fluid intake fire should be avoided, as well as
increased. aerobic exercise.
-Avoid soap, which is drying.
Causes of Increased Rasa/Low Rasa Agni
Excessive water intake Alcoholic drinks

Hydrophilic substances, such as salt and watermelon Sleeping during the daytime
Dairy products, such as milk, cheese and yogurt Insufficient exercise
Repression of emotions
Signs and Symptoms of Increased Rasa/Low Rasa Agni

Clogged channels Lymphatic or venous congestion
Excessive salivation Nausea
Edema (water retention) and swelling Pallor
Feeling of heaviness in the heart Poor appetite
Hypertension (high blood pressure) Repeated colds, cough or sinus congestion
Kapha accumulation Repeated bronchitis
Low agni Slow metabolism, leading to increased weight
To Reduce Excess Rasa

Warming, usually pungent expectorants and diaphoretics Generally the amount of water and fluid intake should
Bitter /astringent usually cooling expectorants, alteratives be reduced along with salt. Sweet oil, greasy and
and lymphatic cleansers sticky food should not be taken.
Some diuretics can be helpful but their role should be Sweating therapy, sometimes strong, can be usedful
secondary.
with dry saunas being best. Any strong exercise that
promotes sweating.

Causes of Decreased Rasa / High Rasa Agni
Insufficient water intake Profuse perspiration
Eating dry fruits Post-influenza dehydration
Leftover food Nausea
Hot, dry, spicy food Vomiting
Excessive amount of pungent, bitter and astringent foods Diarrhea
Beans Fluid loss
Excessive exercise Polyuria (excess urination)
Over-exposure to hot sun Emotional reactions, such as anger and fear
Signs and Symptoms of Decreased Rasa / High Rasa Agni

Anemia Inability to move
Cardiac Pain Insufficient salivation
Dehydration Irregular heartbeat
Dizziness Lack of faith
Dry, rough and scaly skin Malaise
Dry, cracked lips Palpitations
Emaciation and weight loss Sense of emptiness in the heart
Excessive thirst Shock
Fatigue Sunken eyes
Hypersensitivity to loud noice Sunken anterior fontanel
Hypotension (low blood pressure) Tremors
For Increasing the Rasa

Demulcents are specific, like milk, shatavari, licorice, The amount of water has to be increased. Sweet fruit
marshmallow, slippery elm, comfrey root, rehmannia. juices like grape, watermelon, pineapple and coc0+nut do
They are particularly useful in convalescence from febrile well. Raw sugars are helpful- not honey. Dry and heavy
diseases which have depleted or burnt up the plasma. It is food should be avoided, like beans and corn. Creamy
the main tissue damaged by fevers. soups are good or rice gruel, or seaweed soups.
Sour herbs like lemon, lime, amalaki, passion fruit are External applications of oils, esp. sesame is useful. Strong
helpful esp with a small amount of salt. exercise, exposure to sun and wind should be avoided.
Swimming or frequent baths can be helpful. Wearing of
pearl can be helpful.
Rasa Vaha Srotas (Plasma Channel) Plasma and lymphatic system, pp306-307, Textbook of Ayurveda
Vol 2, by Vasant Lad
Brief Review of Srotamsi - The srotamsi are channels of the physical body, similar to the organ systems of
western medicine. Rasa Vaha Srotas is strongly related to the rasa tissue, therefore related strongly to the
breasts and breast milk, as well as menstrual fluid. Stanya vaha srotas is specific tissues related to the stanya
or breasts in women.

Rasa Vaha Srotas -
Supplies nutrients to all the tissues, transports respiratory gases, helps to remove excess fluids and wastes, helps
absorption of minerals and fat through the lymphatic system and several important immune functions : production of
lymphocytes (K molecules) defending the body against infection; filtration of toxins and production of gamma-globulin
(related to ojas) Maintains the water-electrolyte balance, acid-base equilibrium and regulates body temperature.
Regulates blood pressure by maintaining blood volume, viscosity and velocity.
Assessment of Rasa Vaha Srotas

Skin, lymphatic system, blood plasma, veins, heart, conjunctiva, emotional state, menstruation (if applicable) and
Lactation (if applicable)
Causes of Rasa Vaha Sroto Doshic Imbalance

Heavy food and overeating Emotional stress, such as worries or anxiety
Cold food and drinks Lack of faith
Oily or fied food Bactieria and parasites
Leftover food Bodily toxins (ama)
Excess sugar, salt, pickles Foods that affect anna vaha srotas, because ras is
Excessive hydrophilic substances , such as yogurt, chees, nourished by anna vha srotas.
cucumber, watermelon and sea salt Caffeine, alcohol, tobacco, marijuana, steroids, and other
Incompatible food combining drugs
Too much thinking
Signs and Symptoms of Rasa Vaha Sroto Doshic Imbalance

Low agni Palpitations
Poor appetite Tachycardia
Perverted taste in the mouth, maybe bitter or sweet Lymphatic congestion or obstruction
Nausea Generalized Lymphadenopathy
Fever Venous engorgement
Darkness around the eyes Anxiety
Blackouts Lack of faith
Clogged channels Sexual debility
Lymphatic congestion Hair loss
Edema (swelling) Goosebumps
Dehydration Signs of ama (toxicity) in rasa:
Pallor • Generalized body ache
Emaciation • Heaviness
Ringing in the ears • Tongue coating
Hypersensitivity to sound • Lack of enthusiasm
Anemia • Roots of hairs aching
High or low blood pressure • Poor sense of taste and smell

Stanya Vaha Srotas
Stanya vaha srotas includes the lactiferous glands, lactiferous ducts and nipple ducts. It is governed by prana, udana,
samana, apana and vyana vayu, ranjaka, pachaka and bhrajaka pitta, kledaka kapha, avalambaka, bodhak and tarpaka
kapha.
Causes of Stanya Vaha Sroto Dushti Signs and Symptoms of Stanya Vaha Sroto Dushti
• Heavy food and overeating • Poorly developed breasts

• Cold food and drinks • Profuse lactation
• Fatty or fried food • Insufficient lactation
• High protein diet • Mastitis
• Meat or dairy products from animals treated with • Breast abscess
hormones or steroids • Breast tumors
• Leftover food • Fibrocystic changes in the breasts
• Excess sugar, salt, pickles • Breast cancer
• Incompatible food combining
• Emotional stress
• Bacteria and parasites (krumi)
• Caffeine, alcohol, tobacco, marijuana, steroids and
other drugs
• Anything that disturbs rasa vaha srotas
Causes of Stanya Vruddhi (increased Stanya) Signs and Symptoms of Stanya Vruddhi
• Kapha-provoking diet • Excessive secretion of breast milk

• Dairy products, especially milk • Stagnation of breast tissue
• Meat and high protein foods • Enlarged, plump, heavy breasts (usual in early
• Fatty fried food stage of lactation)
• Surgery and post surgical adhesions • Tender, swollen, painful breasts
• Repressed emotions, such as grief or sadness • Breast abscess
• Prolonged steroidal and hormonal therapy • Fibrocystic changes in the breasts
• Prominent blood vessels in the breasts
• Swollen, painful axillary lymph nodes
Causes of Stanya Kshaya (Decreased Stanya) Signs and Symptoms of Stanya Kshaya
• Vata provoking diet • Insufficient secretion of breast milk

• Lack of milk in the diet • Small breasts
• Insufficient protein • Dehydration
• Prolonged fasting • Emaciation
• Dehydration • Irritability in baby and mother (baby bites

• Anemia nipples)
• Chronic illness • Insecurity
• Rasa or mamsa kshaya • Grief and sadness
• Consumptive diseases
• Fear, anxiety, grief or sadness
General Healthy Breast Care
Remember - Good nutrition & digestion makes good Rasa, which greatly
effects the breasts! Organic is best.
Breast Fashions - and Augmentation

Throughout the ages, women have flattened them, buttressed them, veiled them, decorated them, and bared them,
sometimes all in the course of the day.
Today - plastic surgery - 289,000 women enlarged their breasts in 2009. In addition 113,000 had breast reductions,
17,000 breast reductions in men, 87000 “breast lifts”, and 20,000 implant removals.
Worldwide mraket for breast implants is roughly $820 million a year and growing at 8 percent a year. Between 5 and 10
million women are walking around with implants
Implants
come in different sizes - 100- 800 cc. : filling sandwich bags with rice to get an idea 275 cc -1 1/ 5 cups of rice; 800 cc
is almost 3 ½ cups of rice.
Computer programs can simulate different sized breasts on a woman’s body to try them out
Silicone implants, even today last only ten to twenty years.
Many patients - 41% according to a 1979 study experienced loss of nipple sensation.
An enormous percentage of patients - around 25-70 percent by ten years suffered “capsular contracture” - the body
walled off the implant by creating fibrous scar tissue around it.
Product insert data sheet for MemoryGel implants - after 3 years of study they found a complication rate of 36 to 50
percent for implant patients (including trickier cancer reconstruction patients), “Compared to before having the
implants, significant increase were found for fatigue, exhaustion, joint swelling, joint pain, numbness of hands, frequent
muscle cramps, and combined categories of fatigue, pain and fibromyalgia-like symptoms… these increases were not
found to be related to simply getting older over time.”

Recurrent surgeries, costly, regular MRI screening to detect silent ruptures and and a reduced ability to detect early
breast cancer - implants can block effective mammography
Lactation insufficiency rates are 28-64%. There is the possibility silicone gets into breast milk and the effects are
unknown.
Breasts and Sexuality
In Ayurveda the artava/shukra are the sexual/reproductive tissues and channels of our bodies. The nipples are
the root of the artava and shukra vaha srotas and thus, are part of the sexual life
The breasts are part of sexuality, which is part of reproduction - or is it that reproduction is part of the sexuality?
Sexual Wiring of Women's Breasts Neuroscientists establish breasts as sexual organs Posted May 07, 2013
By Nigel Barber, Ph.D., is an evolutionary psychologist as well as the author of Why Parents Matter and The
Science of Romance, among other books.
If men have sex on the brain, they are not alone. Recent research found that women’s sensory cortex has three distinct
areas corresponding to stimulation of the clitoris, vagina, and cervix (1). To their surprise, researchers found that self
stimulation of the nipples lights up the same areas. This sheds further light on the sexual importance of breasts.
In an earlier post, I discussed some evolutionary reasons that men are fascinated by women’s breasts and pointed out
that stimulation of the breast plays a key role in women’s sexual arousal and satisfaction.
The Background
The permanently enlarged human breast is a peculiarity of our species (2). It may have some signal value in
communicating fertility and plays a role in physical attractiveness.
Breasts are less eroticized in subsistence societies where women go topless than in our own where they are exploited in
advertising, and in pornography. Even in subsistence societies, breasts are not entirely lacking in sexual significance and
are generally stimulated in foreplay according to ethnographic accounts (3).
Moreover, the breasts play a key role in female sexual arousal and we are beginning to understand why in terms of
hormones and neuroscience. In their classic report on the female sexual response, Masters and Johnson (4) pointed out
that breast volume increases during sexual arousal in addition to changes in the areola and erection of the nipples.
The breast and bonding
The function of the breast in sexual behavior is sometimes attributed to face-to-face copulation that is unusual amongst
mammals. If the breast is already used for mother- infant bonding, the argument goes, then it is a small step for it to be
used in facilitating bonding between lovers. After all, it is in easy reach!
Stimulation of the nipple during breast feeding increases the amount of the hormone oxytocin that circulates. Oxytocin
is often referred to as the “cuddling hormone” because it is released by male and female mammals during close social
encounters of various kinds (5).
In addition to its general social effects, whereby a mother feels closeness for the baby she is feeding (and vice versa),
there are other more specialized functions of oxytocin. One is that milk flows, a reflex known as the “milk let-down
response” familiar to mothers and dairy farmers alike.
Another is sexual arousal, and orgasm. Some women experiencing intense pleasure - even orgasm - from breast feeding.
This phenomenon was long written off as a mere oddity but neuroscientists are beginning to understand why it
happens.
Sexual wiring of women’s brains
The great complexity of the female sexual response may be attributable to the fact that there is not one, but three
sensory maps in the parietal cortex that light up in functional MRI images when the genitals are (self) stimulated. One
represents the clitoris, another the vagina and the third represents the cervix.
All three of these maps also receive input when the nipple is stimulated. From a functional perspective, this means that
the breast doubles as a truly sexual organ. It is not just an exciting visual stimulus for (most) men but also a key source of
sexual pleasure for most women.
As to the wiring of men’s nipples the jury is out. Some men’s nipples are also responsive to sexual stimulation but the
brain response has yet to be mapped.
Sources
1. Komisaruk, B. R., et al. (2011). Women’s clitoris, vagina, and cervix mapped on the sensory cortex: fMRI evidence. The
Journal of Sexual Medicine, 8, 2822-2830.
2. Barber, N. (1995). The evolutionary psychology of physical attractiveness: Sexual selection and human morphology.
Ethology and Sociobiology, 16, 395-424.
3. Ford, C. S., & Beach, F. A. (1951). Patterns of sexual behavior. New York: Harper.
4. Masters, W. H., & Johnson, V. E. (1966). Human sexual response. Boston: Little Brown.
5. Uvnas-Moberg, K. (1998). Oxytocin may mediate the benefits of positive social interaction and emotions.
Psychoneuroendocrinology 23: 819-835.
https://www.psychologytoday.com/blog/the-human-beast/201305/sexual-wiring-womens-breasts
Practice: Breast Self Massage
Breast self massage is a way to stimulate circulation of blood and lymph, cleansing and
nurturing the breasts.

Lymphatic breast massage - https://www.youtube.com/watch?v=ypR6inQpN3o
“When applying oil to the breast do so in circular movements,

going from the center of the chest towards the underarm
area, using light pressure (about as much pressure as you
would to massage your eyelid).”
Step #1: Finger Stroke
Starting at the nipple, use your fingers to make slow,
smooth strokes away from the nipple in all directions.
This is the first step, and should never be skipped.
Step #2: Hand Massage

Once the breast is covered with oil, gently knead it by lifting with both hands from the chest and pressing very
delicately.
“In addition, with both hands (thumbs above the nipple and forefingers below), carefully twist the breast in both
clockwise and counterclockwise directions.”
Note: If you are planning to do at home breast massage, get a book on the subject, or research online for
visual instructions.
Step #3: Compression

The last step is a cooling down massage: smooth and stroke the breast with fingertips starting at nipples and
going out.
“This will cause compression and encourage the lymph and other fluids to move out of the breast.”
Follow these same exact steps for both breasts, then drink lots of water afterwards, to help flush the fluids
from your system.
The Simple Squeeze Method – This method was taught to me by Dr. Claudia Welsh, DOM and Ayurveda
Practitioner in a Women’s Health Class – just grab sections of your breast and underarm area and squeeze
repeatedly. Be sure to cover the whole area. This stimulates the circulation in the breasts to allow for detox
and nourishment.
Anointing, massaging the breasts, making breast massage oil - mix oils and EO for breasts according to
condition and with prayers/chants, anoint/bless your breasts with the oil, try the breast massage technique

BREAST CANCER
Some Facts
• 78,000 women undergo mastectomies Each year in USA . Over 10 years, that’s enough women to fill the entire
city of San Francisco.
• Approx 200,000 cases of breast cancer per year and 40,000 deaths in USA
• Globally - leading cancer caused death in women. 1 million diagnosed each year and expected to increase by
20% by 2020. Largely due to longer lifespans, obesity, and better screening - modernity.
• Humans are about the only free-ranging animal other than minks to get breast cancer. Domestic pets, if not
spayed, get it. However, in some human populations, breast ca is virtually unknown : ex. the Kaingang women in
Parana, Brazil.
Preventing Breast Cancer What you can do-
• Avoid scented products when possible

• Avoid plastic in every form
• Avoid canned beverages and foods
• Eat vegan or at least minimize toxins with organic meat sources (animal products amplify
environmental toxins up the food chain)
• Avoid shampoos, sunscreen with parabens or phthalates
• Avoid drycleaning and other solvents (like nail polish remover) - fluids are highly toxic
• Stand away from the gas tank when you fill your car to avoid benzene
• Stop fracking to avoid POPs and benzene, among other toxins, in soil ,air, and water
• Avoid living near hazardous waste sites and industrial facilities
BIRTH CONTROL; 20 min

Ayurvedic View of Birth Control
Ovulation method is ideal - built on self knowledge and respect; no chemicals medications or plastic involved (we’ll talk
more about that in the Fertility class)
Alternatives -
o Birth control pills, shots, implants : block the whole hormonal system of the woman. Must take extra care to
make up for the increased Pitta.
o Spermicide: toxic
o Diaphragm : may cause cervix problems or UTI; need spermicides

o IUD - irritation of the uterine lining may lead to increased Pitta; toxic build-up if chemicals involved; Increased
Pitta if copper is involved
o Condom: may block tantric experiences when physical fluids are not exchanged but otherwise healthier and also
help prevent Sexually Transmitted Diseases
o Herbal birth control: little research done, risks
o Herbal abortions: more dangerous for the body than surgical abortions
o Anal sex: never safe - diseases more easily spread
o Sex during menses - diseases also more easily spread (cervix more open)and goes against the flow of the
menses; may disturb the tender and lower uterus
Ayurveda & Fertility Inhibition for Wisewomen
Fertility may be inhibited at different levels by (I F Level):
1. interrupting the process which bring the egg & sperm together,
2. by inhibiting the implantation of a fertilized egg,
3. by inducing a miscarriage,
4. by mechanically scraping a zygote from the uterus within the first 12 weeks,
5. by killing a fetus & causing premature labor,
6. by infanticide.
In using birth control two other major considerations arise -- effectiveness & safety risks. These are listed in the
chart following the text. The major resource being Contraceptive Technology, as well as some books on natural forms
of birth control.(herbs from ayurvedic texts are not generally available.)
Abortion as fertility inhibition method - In vedic literature it is considered a sin to abort a child AND it is considered a
sin to have an unwanted child. Therefore, once one is pregnant and is sure the child is unwanted there is a dilemma
to be faced and it must be faced by each woman in her own situation.
Before starting a course of aborting a baby it is important to be as clear as possible about it - it is morally questionable
to try abort by natural means & then decide to keep the baby if that doesn't work. How would you be affected if you
were that baby? Natural abortive means are less effective if there are any doubts about whether abortion is the right
decision (in the mother or father). Of course, there are feelings about the decision to abort - these should be
acknowledged & released; but ambivalence about the actual decision to abort or not can be problematical. I
recommend trying natural means only if you are ready to or have already made an appointment for a medical
abortion, in case other means have not worked. Natural means are also not as effective as a medical abortion and
may have more systemic effects on the woman's internal organs (especially the liver & kidneys) due to the poisoning
action on many abortifacient herbs.
There are possiblities of physical side effects with most of the means to abort. Abortion is always interference with a
natural process, whether you use herbs you picked from your garden or a metal tool. For that reason it can have
strong effects on your body. Be fully informed & have support before ever using herbal abortion techniques.
Strengthen the Uterus after Abortion
o Be sure that no infection happening - if signs of fever, chills, uterine tenderness, malodorous discharge,
cramping - see health practitioner immediately. Uterine infection is rare but can be dangerous.

o Be sure that blood loss is not too much - check blood for red blood cell level - hematocrit or
hemoglobin. If any anemia, treat with iron foods, vit c, exercise, Herbaliron or Floradex w/Iron tonics
o Strengthen & tone the reproductive system with nourishing herbs - like Dr. Lad's Shakti Prana or other
herbs - shatavari, red raspberry, nettles - according to dosha balancing needs
o Vata soothing means may be needed - Dashmula tea, bastis, yoni basti, herbal sitz baths
Available Fertility Inhibition Methods, Pregnancy Risk, Safety, & Level at Which Fertility is Inhibited
Birth Control Method Pregnancy Risk Safety risk IF Level

Abstinence & non Low Near zero 1
penetration sex
Lactation Moderate Near zero 1
Condoms Moderate - about 12% minimal 1
Spermicides (foams, 3% perfect use Irritation; long term toxicity? 1
creams, gels 21% typical use
Diaphragm 5.5-21.2% ; UTI; spermicides risks 1
More risk if >4x week; 30
years old; not consistent;
had children already
Cervical cap 16.7/100 years use Cervical irritation 1
Contraceptive Sponge 17.4; higher if parous Chemical risk/irritation? 1
Oral contraceptives- 3% perfect; typically higher Increased blood pressure, 1
combined estrogen/progest if less than 24 yrs old strokes, breast cancer,
Reduced volume/protein in
breast milk; systemic
exogenous hormone exposure
Oral contraceptives - 1.1-9.6%
progestin only
Hormonal implants 0.04% through 5th year Systemic exogenous 1
(norplant) hormones
Hormonal injections (dep- 0.3% Systemic exogenous 1
provera) hormone
Fertility Awareness Method 1% perfect user; 2% Zero 1
symptom-thermal nl use
3% ovulation only method -
w/intercourse only after
ovulation
Rhythm Method - by 9% Zero 1
calendar
IUD Typical: 3%; progestin 2%; PID; increased cervical 2 or 3
Copper 0.8% neoplasia; puncture of the
Lower preg risk for older uterus
women
Morning-after pill (Ovral) 75% fewer pregnancies Strong short term systemic 2 or 3
than expected exogenous hormone exposure
Wild Carrot Seeds ? 1% ? 2
Herbal abortion ? Liver / kidney stress 3
Surgical abortion Practically 100% aborted Surgical complication; 4 or 5
scarring
RU 486 95% aborted Excess blood loss 1/1000 ; 3
stroke risk for smokers
Cervical irritation ? ? 3
Menstrual extraction ? Perforation; infection 4
Resources Used-

o Contraceptive Technology 16th Rev. Ed., by Hatcher et al
o A Woman's Book of Choices, by Rebecca Chalker & Carol Downer
o Dr. V. Ladd's notes on Ayurvedic Gynecology
o Notes, Fertility Control Study Group
o
Wisewoman Steps of Healing for Fertility Inhibition
(Steps of Healing by Susun Weed in Menstrual Years; elaborated here by Terra, homebirth midwife)
0. Do nothing; return to the creative void & do not interfere with the process as it unfolds.
• Be sexually abstinent
1. Collect information; retrieve from your inner wisdom, ask people, consult oracles, read books.
• Learn Fertility Awareness to be aware of your fertile time - avoid conception through abstention during possible fertile
time
• Check for astrologically fertile times in your lives - avoid conception by meticulous birth control or abstention
• Use Mental Birth Control - both partners being very clear about avoiding pregnancy; this may be illusory in some cases
2.Utilize energy or environment; engage elemental forces, walk, bathe, move, breathe.
• Flower essences for fertility control: Bleeding Heart - letting go of miscarried/aborted child; Borage - to soothe heart pain & grief after
miscarriage/abortion; Mullein - deciding whether to carry a child
• Barrier methods of contraception (diaphragm, condoms) - prevent meeting of egg & sperm; may involve using spermicidal products of
questionable healthiness & relatively low effectiveness
• ???Use extremes of heat (fire), fasting(air), physical hardship (air) , exercise (fire), spicy foods (fire) to throw doshas out of balance &
possibly cause a miscarriage; side effects of illness caused by imbalanced doshas
3. Nourish & tone; nourish yourself optimally, open to compassion
• Ask spirit of baby to leave
• Wild carrot/Queen Anne's Lace seeds ( Daucus carota) - inhibit implantation of possibly fertilized egg; taken daily 1 tsp; no anecdotal side
effects seen - 99% effective in study; no changes in usual hormone cycle & return of fertility when stop taking it; less likely to work when hormones
fluctuating- early menopausal, postpartum/breastfeeding, & soon after a miscarriage or abortion
(• Intrauterine devices - placed by provider into uterus to prevent pregnancy by inhibiting implantation of possibly fertilized
eggs by irritation of uterus; may include side effects of heavier menstrual bleeding or midcycle spotting, increased
risk of uterine infection, uterine perforation)
4. Stimulate & sedate; use herbs to facilitate desired effect, initiate and move forward, slow
down & reset the clock.
• Herbs or Vit C - stimulate miscarriage by stopping the normal course of pregnancy by toxic &/or uterine stimulating
effects; commonly involves imbalance and stress on kidneys & liver
5. Use drugs; vitamin & mineral supplements, immediate results.
• Morning after pill - this artificially changes the hormone balance to bring on a pseudo-menstrual period & flush out
the lining of the uterus & the possibly fertilized egg, preventing implantation; it involves artificial hormonal
manipulation for 1-2 days; systemic side effects of artificial hormone levels
• Birth control pills, shots, or implantations - this inhibits the egg from maturing, while inducing abnormal hormonal
states in the woman on an on-going basis; systemic side effects of long-term artificail hormone levels
6. Break & enter; use invasive technology that forcefully enters the physical, emotional or
energetic body
• Medical abortion - removes zygote by opening cervix of uterus & suctioning / scraping out the products of
conception; may lead to scarring of the uterus
• Tubal ligation or vasectomy - prevents egg or sperm from meeting by surgically blocking the tubes by which they
move towards fertilization; may have other less obvious side effects
• Menstrual extraction - removes zygote in home self-help group setting through suction

Women’s Health Course, Yoga Veda Institute
Terra Rafael, CAP, retired Midwife, Instructor
Class 2 Notes - Menstrual Health & Tools

Menstrual cycle - understanding the cycle; Symptoms and Causes of displaced uterus; Apana vayu & Rasa -roles in
reproductive health; Determining healthy Artava; factors in healthy Artava; and practices that maintain health; Herbs for
Artavavahasrotas; Menstrual Yoga; Menstrual song. TOOLS -
Healthy Menses with Ayurveda

Menstruation, the monthly bleeding which is part of the cycling of women who are fertile, can be more than
"the curse" or a "period". Ayurveda views menstruation as a cleansing time for a woman's body, which benefits
it greatly. It is a time for self healing when enough energy is devoted to taking care of oneself. However, in this
culture, women are expected to act "the same", no matter what, and their expected duties during the time of
bleeding are no different than at any other time. Partly due to such lack of rest, care and awareness during the
menses, many women in our culture experience menstrual problems and other related women's reproductive
diseases, such as fibroids, endometriosis, infertility, PID etc. By nurturing themselves, maintaining energetic
balance & avoiding build-up of toxins in the body throughout the cycle, women can find less discomfort and, in
the long term, less disease.
By bringing awareness and care into the menstrual cycle, women also gain in experience that will serve them if
they ever become pregnant. Excellent nutrition, maintaining energetic balance, nurturing herbs, adequate
exercise & rest, relaxation practice -- all serve in both cases. A woman who has been taught at menarche how to
care for herself at that special time is also practicing what she needs to know to take care of herself in
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Class 2 - Menstrual Health Page 1
pregnancy. They will also have a healthier & more balanced fertility because by resting during their periods
they will have honored the natural cleansing of menses which will have preserved their reproductive health,
both physically and energetically.
The Doshas & the Menstrual Cycle
During the menstrual cycle the energy of a woman may shift considerably. This is true more for some women
than for others. By considering the possibility that we really aren't the same the whole month and acting &
eating accordingly, imbalances may be avoided. Our women's bodies have their own seasons - just as Mother
Earth does.
The cycle itself has goes through the three different doshas: Ovulation time until bleeding begins is Vata-
predominant. Apan vayu stimulates ovulation & degeneration of endometrium. During the premenstrual phase,
apana vayu may push kapha, pitta or vata into uterus, creating different types of PMS - woman’s emotional
reactions colored by the out-of-balance dosha.
Bleeding time is Pitta-predominant.
Between bleeding & ovulation is Kapha- predominant. The new endometrium is built, ojas glows through her
eyes & lips, love & compassion come more easily, she become sexually active, constantly thinking of her mate.
Doshas In Menstrual Cycle - Varying interpretations
~~~~~~/CRONE/~~~~MAIDEN~~~~~~/~~~~~~~~~MOTHER~~~~~~~~~~~~~~~~/~CRONE/~~
~~~~~~~~/Vata~~~~ /----Kapha hormones~~~~/Pitta~~/ ????????????????????????????????? PER Maya Tiwari

Ama (toxins) and the Menstrual Cycle
Besides the effects of disordered doshas affecting the menstrual period, it may also be affected by excess ama or
toxins built up in the body. The most common cause of ama is improper digestion. In Ayurveda there are
cleansing processes available called Pancha Karma to rid the body of built up toxins from incomplete digestion
or other causes. By ridding the body of these excesses, the menstrual time, which concerns purification of the
woman's body, is not overloaded with its task and can work in the way Nature intended. Pancha Karma should
be undertaken with the help of a trained practitioner. Ayurvedic practitioners can also recommend herbs &
other means for re-kindling the digestive fire which is necessary to proper digestion.
The build up of ama can also be avoided by following these simple dietary practices:
• Sip plain hot water frequently throughout the day. This helps the body digest & eliminate ama and
metabolic wastes so that your internal balance can be restored & maintained.
• Eat a full, warm, cooked meal at lunch time, with all the six tastes described by Ayurveda.
• Take at least twenty minutes to eat, and sit for a few minutes at the end of the meal.
• Eat a light, early dinner & have only liquids after 8 pm.
• Leave time for food to digest from last meal before eating any more solid food - about 1hr for fruits,
2hrs for vegetables & grains, 3 hrs for dairy & heavy proteins
• Sip room temperature or warm water with meals, avoiding dumping a whole glass of liquid into your
stomach soon after eating. Avoid icy drinks and foods, especially with meals.
Recommendations for Between Periods

-Eat according to balancing your doshas, following the ama reducing recommendations
-Regulate amount & type of exercise according to your dosha
-Get enough rest on a regular basis
-Practice a daily form of turning inward - meditation, contemplation, chanting/singing/drumming, dancing,
divination, prayer
-Use nourishing herbs (red raspberry, nettles, oatstraw) & food supplements (sea weed, bee pollen, etc.) that suit
your dosha
Recommendations for During Periods
-Take time out for rest. Some women ask their bloods to come on the weekends - and that works. Some
women wear special jewelry or clothes to signify they are bleeding to their family & friends, which allows those
in their life to give them extra care & extra space. Some women seclude themselves while they bleed. Some
cut back on work those days. The investment of time off during bleeding will pay off in more energy to
accomplish things during the rest of the cycle. Women can honor each other when they are bleeding with food,
herb teas, massages, taking the kids.
-Keep exercise easy.Avoid strenuous, jarring exercise = ex. jogging, jumping, running, horseback
riding,inverted hatha yoga poses, snowboarding, mountain biking. In the days just before the period and at the
beginning of it, the uterus is twice as heavy as at ovulation, making it vulnerable to moving out of place during
such jarring activities.
-Turn inward as much as possible. The traditional Moon Hut where women secluded themselves during their
moon blood was a place where women could be free from daily work & distraction and allow their intuitions &
visions to emerge uninterrupted. Use your favorite help to turn inward - meditation, contemplation,
chanting/singing/drumming, dancing, divination, prayer
-Eat a diet to pacify your doshas, eating lightly and warmly (no cold drinks or foods). Handle cravings
comfortably. If you crave sweets, eat healthy sweets or just a little dark chocolate.
-Shower with warm, not hot or cold water. Hot Baths may the ovaries, deranging Vata. The ovum that will be
released in the next ovulation begins to develop during the menstrual cycle – especially important when trying
to conceive. Excess heat can derange it.
-Avoid vigorous massage, especially of head, to avoid distracting the downward energy from its work of
releasing the menses downward.
-Avoid sexual activity during bleeding time. Low resistance of genital organs during menses means viral
infections e.g. herpes may be more easily obtained. Intercourse during menses also will disturb the direction of
apan vayu ( the specific type of Vata energy regulating menstruation, ovulation, urination, & excretion) and may
create vata abnormality in women's reproductive system. Western medicine agrees that there may be a
connection between intercourse during menses and endometriosis.
-Use external absorbent pads if possible - tampons create anti peristaltic movements, disturbing the rhythm
of fallopian tubes & the apana vayu. There is also the medically acknowledged possibility of toxic shock
syndrome if tampons are left in too long. Feeling the flow coming out may be an experience keyed into our
inherited physical well-being, since women have been experiencing it that way since the beginning of
womanhood. And the acidic vagina is cleansed by the alkaline menstrual fluid, helping maintain a healthy pH.
Tampons also encourage the idea that women can just act "normal" during our periods without any possible sign
that we are bleeding. Some women use cloth pads, soaking them and then giving their blood directly back to
the earth & plants -- or at least their household plants (the plants love it!). Connecting to the cycle of giving
back to the earth is another way to heal menstrually & ecologically.
-Deal with discomforts that arise with an Ayurveda practitioner or other natural health practitioner,
resorting only when absolutely necessary to drugs or surgery.
Gentle Menstrual Yoga Routine

This apana and Vata soothing routine is designed for use during the menstrual bleeding time.
• Baddha Konasana (Butterfly pose) 5 min against the wall
• Upavista Konasana ( Forward bend w/legs wide open) 5 min against the wall
• Janu Shirsasana (Forward bend w/ one foot against inner thigh of other leg) 3 min on each side

• Pascimottanasana 5 min (Forward bend with both legs forward)
• Supta Baddha Konasana ( Lying butterfly pose) 5 –10 min, breathing evenly
• Shavasana (Dead woman’s pose) 5- 10 min
• Alternate nostril breathing 9 rounds
• Meditation (sitting w/ awareness of breathing)
Based on - Yoga the Iyengar Way by Silva, Miora & Shyam Mehta
yoni health, sexual health 20 min
THE YONI AND SEXUAL HEALTH

The Yoni naturally opens like a flower to allow the menses to flow out during the new moon phase, then closes slightly
after menses is over. Tiwari says that the yoni even closes very slightly at the end of each day. The yoni is the gateway
to sexual activity AND the gateway to spiritual growth. When Goddess energy was suppressed between the 10th and 16th
centuries, much of the sacred feminine traditions were destroyed. To reclaim - acknowledge female strength AND
vulnerability. Deep self care is needed, tuning in to the lunar cycles.
Ojas - is related to mucosa - which includes the yoni- safeguards against viral and pathogens. Over 80% of the body’s
immune cells are in the mucosal membranes. These areas are easily affected by stress hormones- the threats that
disturb in our current culture.
PRACTICE: Yoni Mudra: for 3 days directly before the new moon and full moon phases or anytime to revitalize
the Shakti prana or breath of the Goddess, in you. NOT for during
menses, pregnancy or bleeding from the lower pathways.
• Sit in a meditative posture and cup your hands together, palms

facing up.
• Intertwine the little fingers and fully extend the middle fingers,
which meet at the tips to form a pyramid shape.
• Cross the ring fingers behind the extended middle fingers and
hold them down with the index fingers.
• Tuck in your thumbs to touch the base of the middle fingers.
• Hold the hand gesture for five to ten minutes
• Allow your breath to flow freely
• Visualize your breath flowing freely throughout your body,
keeping your mind centered on the mudra.

• This mudra will help to bring your mind into a deep state of calmness.
PRACTICE: Herbal sitz baths at new moon or any time for vaginal symptoms; best done in the evening; use
soothing herbs like chamomile, comfrey, marigold unless you need medicinal help for symptoms. Use a sitz bath tub
from the pharmacy or order from https://1cascade.com/sitz-bath-round-disposable . You can also use any small tub that
the bottom fits into.
Making a sitz bath
make a strong decoction with roots and barks/ an infusion with leaves and flowers
For a decoction– put a big handful of the root or bark in a quart of water that is at a boil, turn down to
simmer and cook until it is only about half as much water.
For an infusion - put a big handful of the leaves or flowers into a quart jar. Add boiling hot water and
cap it. Let it sit for at least 4 hours.
Strain. Put into sitz bath, adding cooler or hotter water for a comfortable temperature for your toosh.
Sit for a time in the bath, thinking of good thoughts, doing some relaxing, deep breathing– until water is cooling down or
you HAVE to get up.
Gently pat dry with a clean towel. If you’re doing this for a yeast infection, you may want to dry your bottom extra well
with a hair dryer (avoiding aiming it directly into your yoni).
SEXUAL HEALTH WITH AYURVEDA

Seven dhatus -each builds from the previous, becoming more concentrated, finally build up to the highly concentrated
& potent tissue of reproduction, which produce life in the form of human conception or ojas
If digestion or tissue imbalance at a lower level - will deplete the more concentrated tissue levels therefore -
must care for all levels, to have healthiest reproductive tissue
To feed sexual directly - cow’s milk, almonds, figs (for women), hummus, Ashwaganda
Close connection especially for men between sexual and ojas: with each ejaculation they can lose some ojas since so
much precious fluid is lost. Masturbation and gay sex are also more depleting because they have not the balance of
male-female energies to restore them. Women who lose a lot of fluids by female secretion during sex can also be
depleted in ojas - however it varies greatly how much fluid women lose-some little, some a large amount.
For healthy men ejaculation once a month or for young men once a week is about right. Varies with the constitution
and balance - Kapha has more reserves of fluid and can withstand more frequent sex and the simulation is even good for
them - although usually they seek it less often and may be slow to be interested. Pitta may be easily addicted to sex,

tending to have a passionate nature and may go for the pure sexual excitement of it. Vatas have the least reserves and
least fluid to lose so should not have sex more than once a month, even though they may tend to fantasize about it
more often, wishing for the contact of it.
Women’s imbalances are often more related to an unloved sex life, when being used.
Artava vaha srotas - channel carrying female repro tissues, fluids and production of ojas
o Root - ovaries and areola of nipples

o Passage - fallopian tubes, uterus cervix, vaginal passage
o Mouth- external genitalia - Yoni ( yo= creation ni= projection) =clitoris, labia minora & labia majora and
actual opening of vagina
o Yoni granthi -bartholin glands, which secrete rajas or fluids -
The Clitoris and Pelvic Floor - Anatomy

The clitoris is not just the little knob at the top of your labia. It has legs that extend into the labia, around the introitus.

PRACTICE: Marma Point Therapy : in inner lips, ½ way down: have client or her partner massage with
almond oil for problems of orgasm (illustration from Marma Points of Ayurveda by Lad, Durve Highly recommended
reference book)
The subdoshas of Vata includes the apana vayu or downward energy in the pelvis, which eliminates urine, feces,
menses, ejaculation (and female orgasm?) and expels the baby & placenta in childbirth.
During menses, the apana is predominant. One reason women are excluded from rituals, from cooking, and
many other activities in traditional society was that those activities will bring the energy more upward, disrupting the
apana.
Causes of vitiation of shukravaha srotas (male reproductive channel) and artava vaha
srotas (female reproductive channel:
o sexual intercourse at improper time
o improper place
o suppression of sexual urge
o excessive sexual indulgence - if feel tired day after sex then it’s too frequent for you - you should feel
better
o surgery
o application of alkalies and cauterization

Causes of vitiation of Vata (and so apana):
• suppression of natural urges ( urination, defecation, intercourse, farting, vomiting, sneezing, belching, yawning,
hunger, thirst, tears, sleep, breathing heavily from over exertion)
• taking food before previous meal is digested
• remaining awake for long time at night
• speaking with a loud voice
• physical exercise in excess of capacity
• exposure to jerkiness due to traveling on vehicle ( or due to snowboarding, gymnastics, or other sports where a
lot of jerking occurs)
• intake of pungent, bitter and astringent tastes
• intake of dry fruit
• excessive worry
• sexual over-indulgence
• fear
• fasting
• cold
• grief
Timing of sex
• Daytime weakens kidneys. Sex in day increases vata more than at night (to avoid increased Vata after sex must
sleep afterwards).
• Midnight weakens liver
• Dawn weakens colon.
• Ideal time : 9-10 pm at night
• Need a safe and secluded space to avoid increasing Vata.
Connection between individuals is very important -most vata increased in sexual relations with anger involved; loveless
sexual relations deplete ojas more, especially for women; love addiction. Instinctively women need to feel it would be
safe to get pregnant - if it’s not a proper contxt for pregnancy and would lead to abortion, then improper for sex.
(Abortions are not good for health and very best to avoid, though may be the best choice in a difficult situation
(“In love” lasts 18 months as a chemical hormone trick of nature to start families)
Before lovemaking
• Have a light but nourishing meal
• Treats & snacks in the bedroom are fine - like cut fruit, Indian sweets, chocolate
Hours of sex without male orgasm can happen with yogic or tantric or Taoist practices. To delay orgasm in the male
takes much practice - satisfying the woman is the way to do this. It’s easier for men on a spiritual path to achieve this
since their energy is more upward which counters the downward energy of orgasm.

The main purpose of male in Kama -sexual pleasure- is to satisfy the female - that takes work! (not so generally true in
our culture unfortunately)
Woman is good to urinate immediately after - to prevent UTI
Rest 20 minutes to absorb all fluids that are charged with prana before bathing
Post sex drink

o Almond Ojas drink - if very strong digestion
o Pomegranate juice - easier to digest before sleep
o Non-dairy ojas drink
Next day - re-nourish the body, especially the male must build back energy
ex. humus; milk with Ashwagandha powder; almonds, or almond drink
PRACTICE: Some Rejuvenative Foods for After Sexual Relations

Ojas drink Almond Restorative Drink, Serves 1 , Sattvic ; V-P-K+
o Soak together overnight:10 raw almonds & 1 cup pure water

o In the morning, drain off the water. Rub the skins off the almonds.
o Bring to a boil: 1 cup milk (unhomogenized if possible) (milk is highly rejuvenative when digested)
o Pour the milk in the blender w/ the drained & peeled almonds and :1 tablespoon organic rose petals
(optional- rejuvenative), 1 tsp ghee (rejuvenative),1/32 tsp. saffron (increases digestion & rejuvenative),
o 1/8 tsp ground cardamom (increases digestion),pinch of black pepper (helps control the K),
o ½ tsp of sweetener (increases lactose digestion).
o Blend until smooth.
o Drink 3-4 times/ week as directed. Best done after panchakarma as part of rejuvenation.
o Watch if any signs of excess mucous/kapha, consult if so.
Non-dairy version of almond drink Soak 20 raisins in 1 cup pure water overnight or several hours. Blend them
together & use them instead of cow’s milk for rejuvenative drink. Omit sweetener in this case since the raisins are
sweet enough.
Date Dream Balls from Amadea Morningstar’s The Ayurvedic Cookbook, Makes 24-30 balls; prep time 45 min
-VP+K : requires a strong digestion, so don’t OVER indulge!
o 1 cup whole dried pitted dates (about ½ lb)

o 2 Tablespoons water
o 2 Tablespoons brown rice syrup
o 1 tsp vanilla
o 1 Tablespoon organic tangerine peel (orange can substitute)
o ¼ cup blanched almonds, chopped
o ¼ date sugar (or less)

Chop dates finely. Mix dates, water, rice syrup, vanilla & tangerine peel in a small heavy skillet & cook over low
heat 10-15 min or until all water has evaporated off & the dates are a thick mass. The thicker it is, the easier it is to
work. Stir in almonds and let cool. When cool, form into 1” balls. (You can grease up your hands with a bit of ghee,
but basically, you’re going to get sticky with these.) Roll the balls in date sugar to get them dry enough to serve.
Sweet Potato Halvah – a fall rejuvenative recipe from Amadea Morningstar’s The Ayurvedic Cookbook Prep
time: 1 hour (most of it unattended); Serves 2-3; - V-P+K
o 2 ½ cups sweet potato, grated (about 2 large sweet potatoes)

o 2 cups whole milk or soy milk
o ½ cup raisins
o ½ cup blanched almonds or almonds & pecans
o 4 tablespoons ghee
o 1 teaspoon ground cardamom
o 15-20 threads of saffron
Preheat the oven to 400 degrees.
Grind the nuts in a blender into a fine powder. Wash & grate the sweet potato. Saute the sweet potato in 2
tablespoons of ghee, just enough to coat it. Stir in the milk and raisins.
Lightly grease and 8 by 8 inch baking pan or iron skillet & transfer the mixture into it. Cover & bake for 40-55
minutes or until all the milk is absorbed. If you need to, uncover the halva in the last 10 minutes of baking to allow
the milk to dry. When all the milk is absorbed, stir in the rest of the ghee, nutmeal, cardamom and saffron. Press
back into a flattened shape. Add sweetener (such as brown rice syrup) if desired. Cut in small pieces and serve.
(Can also be made with butternut or buttercup squash or pumpkin in place of sweet potato).
PRACTICE: Natural Helps for Improving Women's Sex Lives

Recent research suggests that a large number of US women are dissatisfied with some aspect of their sexual
function. The U.S. National Health and Social Life Survey of 1749 women aged 18-59 years reported a prevalence of
sexual dysfunction of 43% for women. This figure was substantially higher than that found in the same survey for
males (31%). A third of women lacked sexual interest, and nearly one fourth were unable to experience orgasm in
the menopause. Twenty percent of women reported lubrication difficulties and 20% said they find sex not
pleasurable. This high prevalence of sexual problems that can affect quality of life make these important areas of
concern. An AARP study of sex among elders found that the greatest determiner of whether a woman remained
interested in sex was whether she had a partner who was still able. Those that didn't, often moved on to other
ways of expression and affection, and were quite happy.
Increasing Libido
Ayurveda to help digestion and balance doshas - this will naturally bring you body to a place where
there is more life and energy in your body so you may experience more libido.
RELAXATION! Stress hormones decrease the amount of sex hormones in the body. To increase, reduce
stress hormones. A healthy, daily routine can bring calm, including abyanga and alternate nostril
breathing (10-15 min / day- really!) can help a lot. Meditation and other destressing activities, such as
gentle (not overly vigorous or long) exercise can also be useful.
Kegel exercises greatly increase circulation in the pelvic area, necessary for arousal, and also contribute
to larger orgasmic response. General health of the area is enhanced.
Maya Abdominal Therapy increases circulation, decreases tension which might inhibit sexual feelings.
Saltwater foot baths, hot water bottles to the lower abdomen &/or feet stimulate circulation in the
area.
What turns you on? If nothing does now—what used to turn you one? Pay more attention to this. Do it.
Fantasize about it. Talk about it with your partner.
Higher estrogen means more circulation to the pelvis-. If you reduce excess estrogen for health
reasons with drugs or DIM, this may be a side effect. Use other ways to increase the circulation, if needed.
Use phytoestrogens if your estrogen is low – Ayurvedic favorites are Shatavari (Asparagus racemosis) and
pomegranate juice.
Testosterone peaks at ovulation and just before and during menstruation. It seems to affect desire but it
isn't clearly shown for all women—it seems more important in men. Stress and lack of exercise diminish
testosterone levels, although very strenuous exercise can also diminish it. Make sure that you are getting
enough saturated fat & cholesterol to make hormones-- 1 tablespoon of butter, ghee or coconut oil
daily if you need to supplement. Stephen Buhner, herbalist, reports that pine pollen is exceedingly high
in testosterone. Ingestion of the pollen itself, or the tincture of the pollen in dropperful doses, seems to
gradually increase libido in those susceptible to its action.
Reduce tension and stress. They create fight or flight hormones, made for emergency. Relaxation
allows for the “feed and breed” hormones, supportive of digestion AND sexual pleasure. What conditions
do you need to get comfortable and relaxed enough to make love with your partner? How do you create
those conditions more frequently? Do deep belly breathing to turn off your adrenals! (see video at
www.youtube.com/wisewomanhood/videos )
Herbs for increasing desire-

• Jasmine V+excess, PK- emmenagogue, cleanse uterus, aphrodesiac
• Vitex berries (Agnus castus)--The berries are considered to be an aphrodisiac, though other
reports say that they are anaphrodisiac. The reason for this apparent disagreement is that the
berries have a regulating effect on the body and so are likely to increase sexual activity in those
who are not very active in this area while reducing it in those who are very active.
• Pomegranate juice – This juice increases nitric oxide in the blood stream, which relaxes blood vessels,
leading to lower blood pressure AND easier erections for men (which you may find exciting in your male
lover). Also a strong phytoestrogens, increasing circulation in the pelvis.
• Aphrodesiac formula for women – p 107 from Sex, Love and Health by Brigitte Mars
o 2 parts damiana herb
o 2 parts schizandra berry
o 11/2 parts rosemary leaves
o 11/2 parts organic rose flower
o 1 part clove bud
o 3 cups water
1. Combine all the herbs
2. Place 3 tablespoons of herbs in a Mason jar. Add 3 cups boiling water. Cover and let sit overnight.
3. Strain infused tea from spent herbs. Drink 1 cup of the tea before each meal during the day.
4. Continue this daily program for one-two months.
Increasing Lubrication
Avoid dehydration. If you don't have enough fluid in your blood, your vagina will be dryer.
Lack of estrogen leads to vaginal dryness. This is why it commonly happens postpartum, when
pregnancy hormones leave and ovarian cycles aren't yet active to produce it. It also commonly happens in
menopause, when ovaries are less active. Shatavari is a natural phytoestrogen that helps some
menopausal women with this. (see section in Class 10 about Phytoestrogens for more ideas.) You can use
a ghee infused with shatavari as an insert into the yoni, as well as using Shatavari orally. Another natural
source of estrogen is pomegranate seeds- which are part of pomegranate juice. WishGarden herbs has an
Estrogenic Herbal formula. And if none of this works-- using vaginally inserted estrogen cream, made for
this purpose can sometimes have effects that last for awhile.
RELAXATION!! As explained under Increasing Libido section, stress is a root cause of sex hormone
imbalance. Strengthen the “feed” and “breed” hormones by turning down the stress.
Evening primrose oil – or seminal fluid can be beneficial for aging vaginal tissues, due to
prostaglandins that soften and condition.
Yoni Luscious - herbal infused ghee formulated to help with aging yoni problems - or just for dry yoni
from info@rootsofwellnessayurveda.com
Use it or lose it. Have weekly sex and/or frequent self lovemaking sessions. One study showed that
weekly intercourse increased women's estrogens levels enough to overcome this discomfort. Orgasm
increases circulation and natural lubrication. Again- sometimes a self-loving “warm-up” session can help
prep for partnered encounter later that day. Just be sure to maintain your ojas levels for a healthy immune
system and spiritual energy. Eat renewing foods after a sexual session.
Herbs for increasing lubrication (for oral use):

• American Ginseng ( Panax quinquefolius) Relieves vaginal dryness .
• Asparagus (Asparagus officinalis)- root- helps vaginal dryness. Can improve libido.
• Chickweed (Stellaria media) Helps relieve vaginal dryness. Cooling.
• Motherwort (Leonurus cardiac) Nourishes mucus membrane of vaginal walls, reduces
menopausal emotional upheaval, hot flashes and night sweats
• Oatstraw (Avena sativa) Spikelets and herb reduce night sweats and improve vaginal moisture.
• Shatavari (Asparagus racemosa) Ayurvedic root that is a female rejuvenative, phytoestrogen.
Helps avoid dehydration, which helps circulation and vaginal juiciness.
Enhancing Orgasms
Practice, practice, practice! Masturbation is a way to learn about your sexual self, what turns you on. It helps
prep before a time when you think you'll have a sexual encounter. And if you can orgasm with masturbation it
helps your body practice for partnered sex-- and you'll know what to guide your partner to do to help you come to
orgasm.
RELAXATION!! As explained above! Do it!
If you get over-stimulated clitorally before you can orgasm – clove anesthetic balm- suggested by Brigitte
Mars. “Combine 1 or 2 drops of clove essential oil with 1 or 2 oz of sesame oil. When massaged onto the genitals,
this aromatic oil brings a warm glow and has a pleasant numbing effect, which can allow for prolonged
lovemaking.”
Are you on antihistamines for allergies? (Tumeric is a natural antihistamine) Histamine deficiency can
cause a difficulty achieving orgasm. Histamines contribute to the intensity and frequency of orgasms,
by causing dilation of capillaries and contraction of smooth muscles. Supplementation with Niacin may
contribute to histamine production. It improves circulation and tactile sensations. It can also overcome
the effects of an overly rich, saturated fat diet. Daily: 25-300 mg. For a niacin rush – hot and intense
sexual encounter – take 100 mg about 15 min before encounter.
Elevating your hips on a pillow can increase pleasure for some women when “on the bottom”.
Love Potion Number 9 by WishGarden Herbs is an herbal tincture which potentiates orgasm through
potentiating oxytocin, the hormone of orgasm, childbirth, breastfeeding,& bonding.
Herbs for Artavavaha srotas (always check for pregnancy safety, including for fertility if not using
birth control- see Ayurveda for the Childbearing Years for list of herbs contraindicated in pregnancy)
Ones in capital letters are ones I use frequently in my practice.
• TRIFALA-tridosha –ama reducing

• ASHOKA VK+P- prevents miscarriage, uterine sedative, endometriosis, vaginal discharge or burning, PMS,
various gyne/ob problems - good esp for Pitta cramps: very cooling - Ashoka milk (cow or almond): 1-2 tsp
Ashoka/1 cup milk/ 1 cup water - cook down to 1 cup; imbibe 3-5x day
• BRAHMI VPK= eases ovulation pains
• Berberis V+PK- excess menses
• Chrysanthemum V+PK- menstrual cramps
• Fennel VP- menstrual cramps
• Guggulu -reduces all-Leucorrhea, dysmennorrhea, amenorrhea, 3rd stage of labor to remove placenta
• HIBISCUS V+PK- emmenagogue, dysmenorrheal, menorrhagia, venereal disease
• Jasmine V+(if excess dose) PK- emmenagogue, cleanses uterus, aphrodisiac
• Jatamansi V+PK- spasmodic cramps of uterus
• LICORICE V-P- (not if hypertensive)oogenesis, vaginal dryness, cervical dysplasia
• Lotus VP-K+ menorrhagia, leucorrhea, venereal disease
• Mace K- agni+ tones uterus
• Musta V+PK- menstrual cramps, PMS (w/shatavari)
• PIPPILI V-K-P=– to help placenta delivery, digestive focusing on artava
• Punanarva V-P+K--regulates menses, menorrhagia; for fibroids - inhibits blood supply for fibroids ;
endometriosis; tone of uterus; rejuvenative of female reproductive
• ROSE P- uterine hemorrhage, menstrual regulation with safflower or hibiscus
• SAFFRON – tridoshic but heating – menstrual pain, female revitalize
• SESAME V- amenorrhea
• SHATAVARI VP- K+ female tonic, fertility , phytoestrogen
• VIDARI VP-K+ increase fertility, cystic ovaries, endometriosis
• Chandra Prabha heating - ovarian cysts, menstrual irregularity, balance the heat w/shatavari
• DASHMULA VPK- postpartum recovery
• Sulphur and borax - PURIFIED PROPERLY - orally for female genital diseases - per Dr. Sarita Shreshtha
• Unexplained Infertility formula per Dr Sarita - Kapikacchu, Ashwaganda, Shatavari, and Guduchi: equal parts.
Give ½ tsp with milk , Twice a day to both partners for 3 month
Herbs are an important help in restoring and maintaining health, and they are a finite resource. What if everyone in the
world started using herbs??? They would soon be too rare, extinct, or expensive for many. One solution is to grow your
own herbs and using herbs nearby that you can wild craft. I highly recommend that you learn to use local herbs.
A good book for learning how “western” herbs work Ayurvedically is: Dispensing with Tradition - A Practitioner’s Guide
to using Indian and Western Herbs the Ayurvedic Way by Anne McIntyre and Michelle Boudin, published in Great
Britain. If this resource doesn’t cover your local herbs, consider working with other Ayurvedic practitioners to identify
your herbs within the Ayurvedic paradigm.

Therapies Beyond Herbs
Another way to balance use of herbs is to learn and apply other therapies with clients. Too often it is just so easy to
prescribe an herbal formula and leave it at that. But remember, as holistic practitioners we seek to wake up the healing
of clients, in not only the anna maya kosha but all the other subtle bodies. This leads to deep change that will last.
TURNING DOWN THE STRESS HORMONES TO ENHANCE THE SEX HORMONES

As mentioned, over and over – this is a prime strategy to help women balance their reproductive, digestive, mental, and
general health. Do not neglect to address this for deep rather than symptomatic healing.
REMEMBERING TO ADDRESS THE FIVE KOSHAS
Our Many Bodies -The Five Koshas or Sheaths

Name Functions How to Nurture It How to Connect to It
Annamayakosha Physical body for physical existence Proper eating and exercise; In meditation, we become aware
Food Body Ayurveda and Yoga; Marma of Annamaya kosha, explore it,
therapy and then go inward, to and
through the other koshas
Pranamayakosha Enlivens the physical body and connects Pranayama, singing/chanting; In meditation, yoga
Vital Energy Body with the subtle body; It pervades the Marma therapy
whole organism, its one physical
manifestation is the breath. Coupled with
the five organs of action it forms the vital
sheath.
Manomayakosha Processes thoughts and emotions. It is in Meditation, contemplation, Moment to moment
Mind Body direct control of the operation, through affirmation, cultivating sattva awareness
the prana, of the physical body and of the mind; Marma Therapy
senses. It gives instructions, but is not
supposed to be the manager . The mind
(manas) along with the five sensory
organs is said to constitute the manomaya
kosa.
Vinjanamayakosha Wisdom that is underneath the Cultivating sattvic mind which Practices to cultivate sattva,
Wisdom Body processing, thinking aspect of mind. It then allows wisdom to shine being in the present moment,
knows, decides, judges, wills, and through; letting go of the past loosening the identity with
discriminates between this and that,
and the fruits of our labors past experiences/memories
between useful and not useful. It is also
the level of ego consciousness, meaning
the powerful wave of I-am-ness. This I-am-
ness itself is a positive influence, but when
it gets co-mingled with the memories, and
is clouded over by the manas, it loses its
positive strength. the combination of
intellect and the five sense organs

Anandamayakosha Not bliss as a mere emotion experienced It is self- born Known through meditation ;
Bliss Body Also known at the level of the sheath of mind. Ananda sometimes experienced in
as the causal body. is a whole different order of reality from daily life
that of the mind. It is peace, joy, and love
that is underneath, beyond the mind,
independent of any reason or stimulus to
cause a happy mental reaction. It is simply
being, resting in bliss called ananda. In
deep sleep, when the mind and senses
cease functioning, it still stands between
the finite world and the self. The bliss
sheath normally has its fullest play during
deep sleep.
“Mano vaha srotas has its root in the heart, brain and chakra system. It encompasses the entire person through the five
koshas. The opening of manovaha srotas is where the energy flourishes and can be accessed. There are three principal
openings for the channel of the mind: the synaptic space between neurons, the sense organs and the marmani. Thus,
marmani provide direct access to the mind, bridging it with the physical body. ..
Majja dhatu, nervous tissue, is the medium through which the marmani express themselves. It acts as an intermediary
between prana vayu (sensory stimuli) and apana vayu (motor response). … Majja provides the structure, while mano
vaha srotas is the function. Together, they govern all the basic cognitive functions of the mind: comprehension,
recognition, memory storage and communication…
Marmani are the sites of vitality where consciousness flourishes and flowers. However, when the mind becomes stagnant
or clogged, the flow of prana is similarly obstructed, like a river that is stagnant or polluted, and the marmani mirror this.
Blockage at a marma is the obstructed flow of awareness. If the mind Is overactive, the marmani reflect this too, becoming
painful, sensitive or tender. Likewise, disturbance at the level of a marma is reflected in the mind - revealing the inherent
mind/body connection. This is why, for rapid spiritual evolution, a comprehensive mind-body program is so helpful, a
program that integrates meditation and breathing with purification procedures for the body and nervous system….
Marmani are also intimately connected to the chakra system. A marma is a doorway of consciousness, while each chakra
is a reservoir of consciousness. Stimulating a marma activates the energy of the corresponding chakra through its pranic
energy currents.
Chakras Related Koshas Vayus Marmani Function

Muladhara Anamaya Apana Trik Survival, groundedness
Svadishthana Pranamaya Apana Nabhi Procreation, self-identity, self-esteem
Manipura Manomaya Samana Surya Ambition,achievement, power, control
Anahata Jnanamaya Vyana Hridayam Love, immunity
Vishuddhi Vijnanamaya Udana Jatru Communication, wisdom
Ajna Anandamaya Prana Ajna Intuition
Sahasrara Beyond the koshas Prana Murdhni Self realization, bliss
- Quoted and summarized from Marma Points of Ayurveda by Lad and Durve pp.29-32
Marmani are stimulated by direct stimulation of various kinds. They are also stimulated by general massage, by Maya
Abdominal therapy, by yoga. Teaching clients to use marmani is a sustainable and deep way to support their healing.

MARMA - Vital Therapeutic Energy Points
Marma Basics
Marmas are vital energy points on the surface of the body, an integral part of majja dhatu, the nerve tissue. While there
are an uncountable number, Ayurveda focuses on 107 major points. These points are permeated by Prana the life force
and embody consciousness in a way that allows you to access a person’s consciousness through these energy points.
They are a bridge between body, mind, and spirit. Through the interaction of prana vayu, sadhaka pitta and tarpaka
kapha, communication between marmani is facilitated.
In fact the marmani are the primary seat of prana, tejas, and ojas as well as being sites of sattva, rajas, and tamas and
individual consciousness. The marma points possess the ability to balance the three doshas, three gunas, and prana,
tejas and ojas at the cellular level. Sattva give the intelligence that operates at these vital points. Rajas causes the
dynamic flow of prana from a marma to another area in the body and is responsible for the ability of marmani to be
affected by movement, pressure, and stimulation. Tamas is responsible for sustaining the healing action that can
continue even after physical pressure is removed. Thus, all three gunas are present at the site of a marma and function
harmoniously together.
Using Marmani
Diagnosis : hypersensitivity in a marma point indicates imbalance/blockage of energy in the corresponding body organ.
o Vata: initial touch brings tenderness which quickly goes away

o Pitta: tender with pressure
o Kapha: tender only with deep pressure
Preventing disease: Daily stimulation with gentle oil massage nourishes prana, tejas and ojas, balances the body mind
and consciousness.
Therapy: Treat diseases through the energetic pathways; balancing the doshas; balancing the dhatus; balancing the
channels; balancing body organs; balancing prana, tejas and ojas; balancing agni; pain relief; balancing the mind and
emotions; maintain optimal sensory perception; enhancing awareness.
Marma Stimulation Techniques:

Massaging with oil - use oils specific to the dosha on the tip of thumb or index finger and massage in a circular
movement around the point with gentle pressure. Clockwise movement pacifies kapha and vata; counterclockwise
movement pacifies pitta. ex. Vata oil: sesame; Pitta oil: sunflower; Kapha oil: mustard oil.
Applying heat - for soothing Vata and Kapha - generalized, like a steam bath or localized heat.
Deep tissue pressure - movement in opposite direction of hair follicles - no oil is used. May apply with knuckles or fists.
Breaks down crystals of unresolved emotions accumulated in the marma points, eliminating stress and emotions and
relieves pain.

Deep tissue pressure without movement - Can create pain but release underlying pain in the area - release of natural
pain relievers.
Herbal paste applied to marma point : ginger or cinnamon for vata; sandalwood for pitta; Punanarva for kapha; anti-
inflammatory: sandalwood, turmeric, or neem; Draw out toxins: ginger, mustard, cinnamon
Mantra Therapy- Silently chant a sacred sound while pressing a corresponding marma examples:
Aim to pacify: Sacred Sound Marma Point pressed

Awaken cellular intelligence Shrim (shreem) Adhipati
Unfold happiness, joy, bliss
Vata Aim (aeeem) Sthapani (3rd eye)
Increase clarity of perception
Pitta Hrim (hreem) Brahmarrandhra
Kapha Klim (kleem) Shivarandhra
Activiate cellular agni Rim (rim) Brahmarandhra
Color therapy - Can unfold the normal functioning of the chakras by using marmas associated with them. Red= 1st
chakra; Orange=2nd chakra;Yellow=3rd chakra; Green=heart; Blue= throat; Indigo = 3rd eye; Violet= crown
Aromatherapy - Use Essential OIls on points, selecting them according to their actions on the doshas.
Textbook of Ayurveda, Vol 3 by Vasant Lad, M.A.Sc.







PRANAYAMA - Clearing the energy channels/ Increasing and balancing energy

Pranayama Basics
• Always be sure the pranayama is safe for pregnancy/ breastfeeding before using in those situations. When there
is a disease process, defer to a pranayama & Ayurveda expert.
• The first 3 months of pranayama practice= Start gradually (retention is 5 sec or less - I suggest not to hold your
breath unless you have an in-person teacher who can advise you)

• Practice on an empty stomach & bowels, early morning or evening, in an airy room.
• Always begin with a complete exhale- one cycle consists of one inhalation and one exhalation.
• Learning from a well-trained and experienced teacher is the best way to properly & safely learn pranayama.
Contraindications:
• Do not do it just before or after strenuous asanas. Asanas help move prana throughout the physical body.
• Do meditate after pranayama to use the prana positively.
• Do not practice during menses
• Do not do deep inhalations or retention if hypertensive or heart problems.
• Do not do deep exhalations if hypotensive or depression.
Correcting imbalances
• To balance nervous system if overloaded with energy by pranayama or meditation: viparita karuni mudra (see
photo below)
• Sleeping more lightly may be a side effect of P & M due to less tamas guna, increased sattwa guna
• Headaches : pressure due to opening of nadis is ok. If there’s actual pain or heat, look at imbalance of doshas; if
it’s after pranayama, did too much or wrong practice; use viparita karuni mudra to neutralize negative effects;
essential oils to cool: rose, sandalwood
• Nausea/faint with pranayama: due to digestive problem or emotions. Commonly can be transient: go on or do
vipartia karuni mudra for too much pranayama; if this happens every time you practice, look at what your fear is
and consult with a well-trained pranayama teacher for individual guidance
• Coughing : if not sick it’s due to loosening of mucus; try kapala bhati or agnisara dhati (see below for instruction)
• Nadis or energy channels are purified by pranayama and can carry more energy.
• Vatas need to support nerves with ghee, milk, more Kapha-increasing types of foods;
• Kaphas need lots of pranayama to get currents flowing - but won’t burn out.
• Asana pose to correct bad effects of incorrect or too much Pranayama:
o Viparita karuni mudra - half shoulder stand:

FOUR PURIFICATIONS - an overall balancing pranayama regime - be sure to see contraindications below before
starting a practice on your own.
Four purifications Video: http://www.youtube.com/watch?v=8jovZVjXOFM#t=43
Four Purifications Transcript
Prana, the life force or energy that is concentrated in the central channel of the nervous system of the body, tends to get
dilute and scattered. Pranayama aids in the concentration, organization and distribution of that energy. Pranayama can
be thought of as breathing exercises, but in reality prana is not breath. Instead, breath can helps move prana from the
central nervous system through energy channels called nadis to be absorbed in other parts of the body, like in the mind
and heart. In most people, the nadis are clogged due physical and emotional experiences that create fear, aversions,
and tension, which all block pranic flow.
In order to prepare the gross body for the work that a yoga practice offers the subtle body and mind, it is helpful to take
pranayama before your asana practice. The subtle body is made up primarily of the chakras (energy valves or centers),
the pranic currents called vayus, and the network that transfers prana – the nadis. When the subtle body is left
unattended, it can grow dormant, as does the pranic flow. That is why yoga and pranayama make us feel so energized!
Because they get the prana flowing again.
In this video, I will show you a practice called the four purifications, which are safe for all levels. This method includes
four separate techniques (type on screen): Nadishodhana, Kapala bhati, Agnisara dhauti and Ashvini mudra.
First, nadi shodana, which translates as purification of the nadis, but you might know it as alternate nostril breathing.
It’s possible to do this WITHOUT USING YOUR HANDS. Try doing it just with your attention, breathing in and out through
alternate nostrils. This will bring your awareness more to the prana then to the finger pressures. 10-15 Min EVERY DAY
can mitigate stress, supporting a balanced metabolism. An excellent guided prana yama for this is by Dr. Claudia Welch,
OMD at: https://drclaudiawelch.com/shop/audio/
As a beginner, you may want to use fingers. Tuck your pointer and middle finger into your palm of your right hand. Bend
your elbow and bring your hand to your face, with the elbow lifted away from the heart. Place your thumb of your right
hand over the right nostril and take an inhale in through the left. Always start with an inhale thru the left. Then close
the left nostril with the ring and pinky finger and exhale through the right nostril. Without changing the hand, inhale
through the right nostril, then close the right with the thumb again and exhale through the left. That is one round. A
round always ends with an exhale through the right side. Take 10-15 rounds of nadi shodana.

This practice harmonizes the solar and lunar sides of our subtle body, our masculine and feminine energies. Our
feminine side is the left nostril (which connects to the right brain), and it offers creativity, relaxation, compassion, and
cooling temperatures. The right, masculine side (connected to the left brain) builds our confidence, rational thought,
and motivation. It warms us internally. With careful attention, you can feel the heating and cooling temperature in the
wind that passes through the nostrils. It’s also interesting to notice if and when one or the other nostril is clogged. This
indicates imbalance between the masculine and feminine energies in your body. This pranayama truly creates a calm
and relaxed, focused energy and can be done at any time if we feel off center, anxious, or lethargic.
Kapalabhati or breath of fire is the second of the purifications. In this practice, the diaphragm acts as a bellows that
fans the internal fire that burns within all of us. Our diaphragm is located right under the front of the ribcage. It is a
pranayama used specifically to burn up the vrittis or vacillations of the mind, to calm our busy thoughts.
The practice is done by taking a full inhale breath, exhaling slightly to ¾ full and then taking short forceful exhales while
allowing the pump of the diaphragm to create involuntary, quickened inhales. This is all done through the nose, not the
mouth. It is difficult for most people to understand the non-active inhale, and so often the forceful exhales will cause
you to lose your breath entirely. You can try to put your hands on your diaphragm to get the feeling of the pumping. On
the forceful exhale the diaphragm puffs out and to get the inhale to come in, relax or bring the diaphragm back in. Start
slow with maybe only 10 forced exhales before letting the rest of the breath out, work up to 30, but more than 60 might
be overdoing it. Take 3-5 full rounds of kapalabhati.
The heat that this practice is similar to that created by ujayi pranayama, it is used for purification. In chemistry,
reactions and movement of molecules occur with heat. In the same sense, the chemicals in our body need heat to get
moving, either to be absorbed where needed or simply flushed out through elimination or sweat. Just like prana moving
through the nadis, it’s important that our glands and organs have the ability to complete their natural cleansing
processes and are not left cold and dormant.
Another way to get the organs into action for the purpose of digestion is with agni sara dhauti, the third of the
purifications. Agni is that internal fire. Sara is cascade or washing and dhauti is cleansing. In this practice, we learn to
let go of tension held in the abdomen, and to create movement and action in the belly. It is performed on the retention
of the exhale breath. Again, we use that heat created with the breath to purify.
Take in a full inhale, opening the mouth, stick the tongue out and exhale all the breath out forcefully. Round the spine
and lean forward. At the base of the exhale hold the breath out. Start to pump the belly gently at first and as slow as
you need. When you need to take your inhale do so, but work up to 20-30 belly pumps. Take 3-5 full rounds of agni
sara dhauti.
This practice can be done sitting down, but it might be easier to try standing up, bending the knees slightly and bringing
the hands to the knees on the exhale, leaving them there to pump the belly.
The last of the purifications is ashvini mudhra, translated as gesture of the horse. We won’t get into the details of why
a horse, but instead let’s get into the description of the practice, and maybe you’ll guess on your own! This practice is
performed on the retention at the top of an inhale. You will take in the breath and at the top, drop the head back
slightly, opening the throat. With the tip of your chin draw an arch down to the chest. Try to grab a tiny bit of flesh with
the chin and pull up to seal jalandara bhanda, the throat lock. Holding this, you will begin to contract and release the

anal sphincter. There should be no movement in the body and this might be hard to feel at first. Try to count the times
you contract and release and increase this with practice to around 30. Take 3-5 full rounds of this last purification
method.
By holding jalandara bandha, the Amrita (the nectar of immortality formed in Sahasrara chakra) is kept from dripping
down and being consumed by the fire in the navel region. By contracting the anal sphincter we are able to seal in the
area where prana likes to leak out – at the base of the spine near manipura chakra. This helps develop mula bandha
which is extremely beneficial in the ashtanga practice.
This practice can also be performed by taking three full rounds of all four (5 rounds of nadi shodana, 1 round each of the
others). I’ve seen it taught both ways. Remember, that when we commit to any spiritual practice such as a pranayama
practice like this, we will see the best results if we are consistent with it and do it for a long time. I suggest starting any
practice on a new moon, and trying to take it daily for the entire cycle of the moon. Feel free to email me with
questions, concerns, or success stories. Namaste.
http://deanacavan.blogspot.com/2012/09/the-four-purifications_8.html
SHITALI, KAKI, OR SHITKARA - Cooling breaths Inhale through the mouth (may have natural hissing sound),
hold 5 sec or less, exhale through nose (no sound); Belly breathing; Shitali: breathe through curled tongue;Kaki: (crow
beak) purse lips like a crow beak and breathe through the teeth; Shitkari : breathe through big smile with tongue spread
across the inside bottom of teeth (teeth closed)
UJJAYA BREATH - Chest breathing- often done in yoga classes to raise the energy- the abdomen moves very little;
the breath rubs in the throat “Darth Vader Breath” - if you need help doing this, pull back of tongue to change shape of
throat from an open oval shape to a flattened oval; pull in anal sphincter when inhale, release when exhale or hold
lightly the whole time; retain breath less than 4 seconds after inhale
Pranayama Indication Quality Doshas Main location Contraindications Beginning #

Technique Balanced
Nadi Shodhana To calm, Balancing - All - reduces Natural none 10 rounds
Alternate nostril balance stress/ done slowly tamas breathing
sex hormones;
yang/yin
Agni saur dhauti Increase Heating - breath Reduces Kapha Abdomen Stomach ulcer, 3 rounds of
- Fire wash digestion held out & Vata menses, pregnant 30
Ashwini Mudra - Balance Movement Regulates Lower pelvis Menses 3 rounds of
Horse reproductive apana; 30
movement and excretion:
apana
Cooling breaths To reduce Cooling Reduce Pitta Belly Breathing If too cool already
- Shitali, Kaki, excess heat
Shitkari
Ujjayi breath - To reduce Heating Reduce Kapha Chest Too much pitta;
Triumphant excess Strain or fatigue;
breathing coolness Menses

SPIRITUAL BATHS I learned about using spiritual baths through the Maya
teachings of Miss Beatrice Waight and Rosita Arvigo. See Rosita's beautiful book,
Spiritual Bathing—she reveals that they are used by most spiritual traditions in
one form or another. Spiritual baths are especially helpful in healing past pains,
sorrows, & traumas. You could do one bath or a series, intending to do whatever
is your special number of baths, on a daily or weekly schedule. The intention is
to bring the help of the plant spirits and your prayers into the water, then let it
splash through your aura or energy body, which surrounds your physical body, to
cleanse & revivify it. The tiny droplets of splashing water reflect rainbows into
the aura, bringing the promise of your prayers into your energies.
I often do a spiritual bath weekly. I also do it if I need special cleansing after a traumatic or difficult event
or just feeling some icky energy has settled in my energy field:
First I sit and form an intention to seek the plants in the yard and home that will be part of the spiritual
bath. When it's winter, pine needles are a possibility to add a living plant. --Be aware that roses from the
store are sprayed and probably have chemicals on them you may not want to use on your body.-- I
sometimes use dried herbs, usually ones that I have picked myself for the winter—they have been grown
& picked in a loving way, honoring the plant spirit. I gather any herbs with prayers to the spirit of those
plants, asking their help for my intention for healing & renewal and giving thanks for their help.
One herbal friend, Ann Drucker taught me to greet the plants with a song-- I really like singing to them.
Give a little offering to the living plant-- I often offer something of myself -- my saliva for moisture in the
dry Colorado climate and a tiny piece of my hair for compost. Native Americans usually offer tobacco.
You might collect a special number of leaves or blossoms or sprigs from a special number of plants,
according to what honors the amount of plant living there. For example- today I collected 13 cherry
blossoms, 9 comfrey leaves, 3 grape hyacinths, 9 springs of lemon balm, & 3 sprigs of oregon grape
blossoms. In Belize I did one bath with just orange blossoms-- it was heavenly! ( If I use dried herbs, use
a special number of sprigs or pinches or buds.)

Next put the collected plants into a large container. I have huge ceramic bowl-- in Belize we used big
plastic buckets, which work great when outside bathing and you can freely splash around. Somehow to
me using metal wouldn't be right. Put the herbs in, add some pure water and then sit and create sacred
space - sometimes I do it in front of my altar, with copal incense & candles burning and ask the blessings I
desire. Call upon your spiritual helpers to bring your intention to life.
While praying I tear and rub and schmoosh the leaves and blossoms up into tiny pieces and the water
starts to turn color from the plant material. I do this for about 10-15 minutes. I like to sing again--
"Sacred plant spirits hear my song, make my way sacred, fill me with beauty....Fill me with beauty , that I
may bring others beauty...." this is one of my favorites. Then let the mixture sit for several hours-- in the
sunlight if possible or in front of an altar. If time is short, use warm water to begin with and do the bath
as soon as you’re done with your prayers.
When it's time to bathe--first shower or bathe as usual. Then you might want to have incense & candle lit
nearby to create sacred space. Have the strained liquid (so I don't clog the drain!) nearby to which splash
over yourself, standing in the tub or shower. (It can be a little messy!) You might add some hot water to
the strained liquid so its not too cool. If you live where you have a private outdoor space and it's warm
enough out doors-- you can do it outside and really go to town with the splashing. (a bathing suit is
acceptable if necessary for modesty’s sake out of doors) Afterwards, leave the wetness and any herb
material on you--just blot or air dry-- if possible. I find that blossoms make my skin sooooo soft.
Be sure to put the remaining plant material back to the mother earth in an honorable way--don't throw
into a trash!! It is sacred.
Try this! It's a special way to pray and bring your love to yourself. --- Terra Rafael, healer & midwife
THE QUALITIES OF SATTWA, RAJAS, & TAMAS - Mano maya kosha

Cultivating Our Own Native Intelligence - Ayurvedic Wisdom of the Gunas
There are three main sources of "seeds" for the mind which we have some control over:
• the focus of the mind itself on thoughts & emotions
• the focus of the senses on the sensations
• the balance of energy created in the body and mind by the things we eat & drink
Whatever kind of seeds we plant in the soil of our mind will grow there, unless we let them wither, without our attention. This is
what meditation & other spiritual practices can do. Psychotherapy usually focuses attention on less uplifting aspects to pluck them

out. Either method when done without right understanding may actually add energy to seeds which will cloud the mind and spread
them in the field of the mind.
Ayurvedic treatment of the mind uses the ancient understanding that all of creation evolves through the interplay of the three gunas
or attributes born of the Primal Matter (or Primal Mother). These three attributes are:
sattva = light, intelligence, clarity, perception, peacefulness, focus
rajas = movement & action
tamas = inertia, darkness, dullness and resistance.
Everything in creation has a mixture of these three qualities. The mind is by nature more sattvic, so that if rajas or tamas become
predominant the mind does not perform its tasks according to its inherent nature.
The mind may be clouded by tamas and therefore the person does not see the proper thing way to behave or relate to others.
Delusion may reign, the person being lost in negative or destructive thoughts.
Or the mind may be agitated by rajas and thus be so active that clarity & intelligence is lost --even though the person knows what is
proper, s/he still cannot act in accord with it because of distraction from the quiet source of inner wisdom. Thoughtless violence may
occur.
Unlike the Ayurvedic doshas, rajas & tamas do not balance each other out. So following one quality after another will just add to
agitation. ( Occasionally a tamasic situation will require rajasic means to move it out of tamas. After that, moving it to sattva would
be the most uplifting.)
By avoiding the planting of seeds of tamas and rajas in the mind and by cultivating sattva, the native intelligence called buddhi can
shine forth. This native intelligence can inform us of the proper course of action in the moment -- such as the right foods to eat, the
proper way to relate to someone in a given situation. In this way the light of cosmic intelligence is reflected in our daily life through
our own native intelligence.
Ayurveda and Yoga recommend methods to work with these gunas. As your native intelligence grows you will see even more ways
to increase it within yourself. I believe native intelligence is not only the key to spiritual upliftment to the individual, but also the
way to harmony between people, with other species, and with the Earth herself. By its cultivation, we are truly serving all of
humanity.
To reduce Rajas guna – Excess movement & action:

Avoid routinely eating these foods & substances as well as avoiding eating too fast:
Stimulants Coffee Caffeinated beverages Hot, spicy or fried foods
Excess sweets Garlic Onions Hot peppers
Tomatoes Corn Radishes Especially red meat
Eggs Fish Poultry
To reduce Tamas guna – Inertia, dullness, &/or resistance:

Avoid routinely eating these foods :
Aged Cheese Pickles Tamari Vinegar
Wine, other alcohol Drugs Red meat

Stale foods, leftovers Mushrooms Microwaved food
Processed foods Frozen foods Fried foods
To increase Sattva guna – Peaceful, intelligent, focus:

Follow Rajas & Tamas reducing regimes and regularly include the following in your diet:
Fresh foods Almonds Pure Milk Ghee
Fresh fruits Most veggies Vegetarianism
Grains, esp. wheat & brown basmati rice, whole wheat, oats
Foods that are light to digest and nourishing Proper doshic diet
AYURVEDIC SELF MASSAGE

This is a is a firm, dynamic massage with a warm, specified oil to loosen toxins & excess doshas and begin to
bring them into the digestive tract for elimination. The warm, oil massage is useful to balance excess Vata
dosha, in which case it is helpful to do it several times a week. It relaxes the nerves and the mind – so
especially helpful in supporting healthy women’s hormone balance.
• Oiling must be done on an empty stomach (at least 3 hrs after last meal), so for most people the
morning is the best time.
• Oil from head to foot, with most attention to head and feet, where there many marma energy points.
Oiling & massaging them will help energetic balance of the organs. Use firm, brisk strokes to push the oil
into the skin – circular on the head and joints and lengthwise strokes on the long bones of the body.
Continue at least ½ hour for a cleanse time; otherwise—do as much as you can.
• Warm the oil by putting a small plastic squeeze bottle of it in a sink or bowl of hot water for several
minutes. If you are toxic by self assessment (heavily coated tongue) then use only castor oil for
massage. Otherwise—sesame oil is best for Vata, sunflower oil for Pitta, and sesame for Kapha. There
are also medicated oils for balancing the doshas available for the doshas from
www.BanyanBotanicals.com , for example.
• Be sure to have old towels available to sit on and for under your feet (you will also need old towels for
drying yourself after the showering or bathing.)
• Let the oil soak in a few minutes while you prepare your bath, or go in the steam/sauna. Be sure not to
become chilled at any point.
• To remove excess oil from your scalp & hair, mix the shampoo with your oily hair BEFORE getting your
hair wet. This will allow the shampoo to dissolve the oil more effectively. You may need to lather twice.
(If the “messiness” of the oil in hair keeps you from the massage, try to at least massage the rest of the
body with oil – some is better than none!)
• Be careful when oily not to slip in the tub and injure yourself. When you’ve completed your bathing, be
sure to carefully clean the tub so no one will accidentally slip on the oily residue.
• Be sure to wash towels with plenty of soap & hot water to remove oil from them as much as possible.
Videos available on Self Massage of Head, Body, and Feet at:
http://youtu.be/_HQLsfZh5js?list=PLRANToKAjU_BIhs2G-lAhC9sKMZg6wEOd

GINGER/SODA BATH
• 1/3 cup each of dried ginger & baking soda for each bathtubful of tolerable hot water (avoid excessive heat).
Total amounts needed: dried ginger 1/3 cup baking soda1/3 cup
• Be sure the bathroom is warm--avoid getting chilled at any time.
• Have extra "oil" towels available.
• Soak after oiling and then get out when begin to sweat.
• Cover with towels and continue to sweat in the warm bathroom until you are beginning to cool down.
BASTIS
At 7 pm or sunset time, instead of dinner prepare the recommended basti for that day,
Day 1: Oil basti ; usually sesame for Vata soothing; body temperature
Day 2:Herbal basti; often Dashmula tea to soothe Vata: 1 ½ pints pure water & 2 Tablespoons Dashmula tea.
Simmer with lid on for 10 min. Then strain really well, through a silk cloth or coffee filter. Do not use the
roots/powder portion in the enema bag, only use the strained liquid. Then add ½ cup of warm sesame oil, mix
& put in enema bag at blood heat temperature.
Day 3: Another oil basti; usually sesame oil for Vata soothing again, body temperature
• Prepare & warm up the bathroom or other location where you will be administering the basti.
• Have towel handy for "diaper", if needed to safely get to toilet.
• Be sure you have a comfortable, cushioned place to recline during the basti. There may be some
leakage while administering the enema, so have appropriate old towels etc under you (ie. Not your
favorite blanket). Most people arrange a "nest" in the bathroom or bathtub.
• You will want to have a place to hang up the enema bag - most have a hook or loop on the top which
you can use directly on something or can put on a clothes hanger & then hook onto a towel rack or
shower head, etc.
• After preparing the basti put it in the previously cleaned & air-dried enema bag
• Check the action of the bag while doing the previous cleaning - how to release the clasp; letting air out
of the nozzle before insertion
• Lubricate the nozzle (part to be inserted in the anus) with sesame oil. Also lubricate your anus with
sesame oil .Do not use KY jelly even if this is indicated in the instructions that come with your enema
kit. ( KY jelly is a petroleum product.)
• Lie on your left side. Gently & slowly insert the nozzle (if it's uncomfortable try another angle inward)
Release the clasp holding the liquid in and allow it to flow slowly into the rectum. Lie on the left side
for 10 minutes. Then move to lie on the back for 10 minutes. Then turn & line on the right side for 10
minutes. Trying to retain the enema for 30 minutes is ideal. If you feel like you aren't retaining it, oil
your belly and massage counter-clockwise for five minutes to help keep the basti in.
• When it has emptied from the bag, slowly remove the nozzle from your anus
• When the urge arises after 30 minutes, use the towel "diaper" under you to avoid leakage, and go to
the toilet. Relax for awhile.
• Clean the toilet as needed and then take a shower
• Eat a small amount (1/2 -1 cup of very soupy kitcheree) with plenty of ghee, to keep the vata moving
downward
• After 1 ½ to 2 hrs (when kitcheree has gone past stomach digestion) go to bed for the night.
SIMPLE KITCHEREE RECIPE

Recipe:
▪ ½ cup split mung beans
▪ 1 cup basmati rice: wash both thoroughly, (soak both overnight to increase digestibility &
reduce cooking time),
▪ melt ghee & add spices: (adjust spices to your taste)
• 1 tsp grated fresh ginger,
• ½ tsp tumeric,
• ½ tsp cumin,
• ¼ tsp coriander ;
▪ add rice, beans to 6 cups water in cooking pot, then bring to boil , turn down to simmer for 45
minutes or until mung beans are very soft in pot on stove –
▪ or make in crock pot, cooking overnight – be sure there’s plenty of water or you’re making a
much larger batch to activate the heating elements in the crock pot without drying out.
▪ See later for instructions to gently go back to a regular diet, by stages, when the cleanse time is
finished.

PRIMORDIAL SOUND HEALING

MAYA ABDOMINAL THERAPY TECHNIQUES
While these techniques are from Central America,they are excellent for soothing doshas, especially Vata. The
Abdominal massage also stimulates all the abdominal marma points.
CARING FOR OUR CORE

Arvigo Techniques of Maya Abdominal/Uterine Massage
Our belly is where we begin—the umbilicus was our original root to nourishment from Mother. This area continues to nourish us
physically, emotionally, & energetically throughout our lives—when it is free to do its work. When the area is constricted by the
uterus being out of place and/or stored tensions, this work does not happen properly. When the constrictions are released we are
freer to have belly laughs and feel our gut reactions—as well as avoiding many discomforts & female complaints, such as menstrual
cramps & irregularities & fertility problems.
I experienced first-hand that these techniques work to move the uterus. My uterus had been sitting low in my yoni for some time
now—it had to be scooped up to see the cervix when doing a speculum self exam. When I received the massage I felt my uterus
move!! It’s a unique sensation. After having the massage done on me & practicing self massage for a couple of days I checked my
cervical position and it had risen up. My next moon time was absolutely free of cramping and in subsequent cycles my blood
remained fresh—no brown blood came out at the beginning or end as I HAD thought was normal. (The old, brown blood indicates
that the uterus is not releasing all the blood from each period and there is build-up inside.)
Then I was blessed to attend two incredible workshops taught by Rosita Arvigo: Self Care & Professional training in the Arvigo
Techniques of Maya Abdominal/Uterine Massage. Her teacher Don Elijio Ponti gave her permission to share what he had taught her
to her American people, to help us care for our cores. Rosita had apprenticed with him for 12 years in Belize. She has integrated his
teachings with American knowledge of anatomy & physiology; the work of Wilhelm Reich on energy bands; and her training in
napropathy (a form of chiropractic which includes graduate level massage training).
At the Professional training we learned techniques for the upper abdomen. This helps to loosen tight diaphragms and increases
circulation, digestion and the ability to breathe deeply. Tightening here can be a way to store old unspoken & unresolved traumas
in our body. By gentle work these can be healed. I personally experienced a deep healing with upper abdominal & other techniques
regarding past sexual abuse. With the prayers and support of my Arvigo therapists I was able to release some very old yucky stuff
from my body in a safe & simple way.
The techniques for pregnant women are specially designed for gentle support of the growing uterus, allowing it to go from the usual
4 oz of weight to about 15 lbs while staying in its physiological position. The increased blood flow, lymph drainage & nerve & energy
flows allows for optimum growth of the baby and function of the uterus in labor. By properly position, the uterus can “aim” the
baby out most easily. There are also special techniques reserved to use at 38 weeks to be sure the body is primed for labor.
Practitioners report less incidence of overdue labors on women regularly receiving this technique. Also reported were successes
with breech babies moving head down when the uterus is properly positioned.
I’m excited to include this work as part of my healing practice & look forward to serving women with these new ways to enhance
your health & happiness.

Herbal Pelvic Steam/ Yoni Steam
Especially Vata soothing.
Pelvic steam baths, or “Bajos”(ba-hoes), as they are known in Spanish, are used to assist the cleansing of the uterus for
the treatment of numerous female symptoms in conjunction with the Maya Massage or warming of the pelvic area to
reduce Vata or wind in the area, supporting the apana vata. Stimulates circulation of blood.
They are not safe during any type of bleeding, including menses. They are not safe during pregnancy.
PLANTS: Most commonly used are marigold, oregano, basil & rosemary. Other herbs useful are: motherwort, St.
John’s wort, chamomile, damiana, red clover, dandelion, yellow dock, squaw vine, horsetail, Mexican wormseed
(epazote). Pick three types to use.
Collect your plants outside or at the store, but always with prayer and intention of healing. If using fresh plant,
use about 1 quart full total; if using dry, use about 1 cup full total.
DIRECTIONS:
• In a large pot of hot water place the above plants.
• Crush the herbs into the water thanking them for helping with your healing
• Offer prayers nine times. These prayers can be to whatever Spirit offers you guidance: Goddess, Jesus, Christ,
God, Mother Earth, Father in Heaven, etc. It is the Prayer & Intention that are important
• Bring the pot of blessed herbs to a soft boil for 10 minutes, steep for 5 minutes more with the lid on.
• Place the pot under a commode, slatted chair, lawn chair, etc. that allows the steam to come up through to your
yoni when you sit on it. Be sure it is not so close or so hot to burn you with the steam.
• Sit with your bottom naked. Wear socks to keep your feet warm. Drape fully with a blanket around your waist
to the floor. Be careful not to allow any draft underneath you. Be sure you are enclosed by the blankets from
the waist down, something warm from the waist up. It’s making a mini-steam cabinet around your lower half.
• Sit quietly over your pot of herbal steam for 20 minutes. Meditate, read, enjoy with pleasure of the herbal
healing. Be careful not to burn yourself. The heat should feel pleasant. If it is too warm, remove the pot for a
few minutes.
• Rest quietly after the herbal steam bath in a warm room, free of drafts, open windows or air conditioners.
• After 20 minutes of rest (more if needed), you may get up, & dress warmly, being careful for the next 24 hours
to protect your entire body from cold drafts;. Keep warm and avoid any sudden temperature changes.
Expect changes in your vaginal discharge & menses; these are normal cleansing reactions. Inform your practitioner if
you have any unusual discharge or response to this treatment.
Saltwater Footbaths
These footbaths can help reopen the circulation in your feet. When used along with the Maya Abdominal Massage, the
blood will flow more easily from above and the vessels will relax to receive the blood flow.
Miss Beatrice Waight, Maya midwife and healer, taught me that one reason our feet get cold and stay that way is that
when they get chilled somehow, they react by contracting the blood vessels. This protects the blood from getting too
cold. But when the vessels get stuck in a contracted state the circulation in the feet will be continuously diminished. To
help circulation we need to keep the feet warm—no walking barefoot on cold tiles, cement or ground. Wear slippers or
at least socks on cold floors. If your feet get cold, use a footbath to warm them up again as soon as possible.
To do a saltwater footbath:
Do this before bedtime.
Have a container to do the bath in so that your feet and calves will be covered up to and just above the point where you
feel naturally warm. That is where the circulation is still working—we want to carry that downward. Some people need
a deep bath.
Put fairly warm water in the bath—but be sure not to burn yourself!!! Add a handful of sea salt and stir it. Then sit with
your feet in the water until it starts to cool.
Pat your feet dry with a towel and put on warm socks. Wear the socks to bed.
Repeat this bath 3 nights in a row, during which time you should avoid getting your feet cold in any way. If your feet get
cold again for some reason, you can repeat the foot baths as often as you wish.
Healing with Castor Oil Packs

CASTOR OIL PACKS – ADDRESSING CONGESTION/STAGNATION
What is Castor Oil?
Castor oil is derived from the bean of the Ricinus communis or Palma Christi plant (palm of christ). The Palma Christi has
been used for therapeutically for centuries in the folk medicine of ancient India, China, Persia, Africa, Greece, Rome, and
the Americas. It has large, beautiful palmate leaves hence the name, Palma Christi.
Castor oil has been used in many cultures for its healing properties. As an external oil pack, it has been used to treat a
variety of health conditions such as arthritis, liver and intestinal disorders, tumors, cysts, and skin conditions. Taken
internally, castor oil is a strong cathartic and is not recommended as there are ways to relieve constipation that are not as
harsh.
Some of the numerous uses of castor oil include the treatment of breast cysts, fibroids, ovarian cysts, congestion of
abdominal organs, skin conditions, small benign cysts, and adhesions from surgery. Wherever there is congestion,
decreased blood flow and need for healing, castor oil can be an effective treatment option.

How does castor oil work?
Research has shown that castor oil has a unique chemical profile rich in ricinoleic acid which is known to exist in nature
only in castor oil. Double blind studies conducted by the Association for Research and Enlightenment, Inc. demonstrated
an increase in lymphocyte production and the level of activity of T-cell lymphocytes in the group that used castor oil
packs. T-cell lymphocytes originate from bone marrow and the thymus gland, identify and kill invaders such as virus,
bacteria, and fungi.
In addition to strengthening the immune system, castor oil appears to have a balancing effect on the autonomic nervous
system, increasing liver activity and improving digestion.
What is a castor oil pack?
The standard pack recommended consists of several layers of white wool flannel, (holds heat better), but cotton flannel is
also used with excellent results. Castor oil is soaked on the material and applied to the area in need of healing.
How is it used?
Be sure that the castor oil is skin temperature, warming the bottle by placing it in a full container of very hot water. Soak
the flannel in the oil to make it well saturated but not dripping. Place the pack over the area to be treated, and cover the
pack with plastic food wrap or bag. Place a heat source, a heating pack or hot water bottle (best choice), on top of the
pack. Secure this in place with a heavy towel. Adjust the heat setting to your comfort, but do not fall asleep while
using a heating pad.!! Continue treatment for one hour or until the hotwater bottle has cooled down. An alternative to
using the pack without a heat source: secure pack with a towel wrapped around your body, secure with pins, and leave it
in place overnight
While the pack is working, quietly meditate to connect the mind and body healing energies. This assists the spiritual
essence of the plant to assist in your healing. Often people find the thoughts that occur in a meditative state are as
important as the properties of the oil to their healing process. Journal any thoughts, feelings, images that occur during
this meditative treatment.
How do I prevent staining from the oil?
Protect any bedding or clothing from staining since castor oil is highly penetrating. Plastic sheeting from dry cleaning
bags, old plastic table cloths, shower curtain, old heavy bath towel etc. are typically effective. Washing soda (sal soda)
may be used during laundering to remove some of the stains on fabric.
How are the packs maintained?
To re-use a pack for multiple treatments, just re-saturate with oil. Packs can be stored in a plastic bag or glass jar for six
months to a year as long as it does not become rancid or soiled. Packs should not be shared among persons.
How often do I use the packs as a treatment?
A typical regimen for non-acute conditions is three times a week, every other night for three weeks with the fourth week
off. Repeat this for two more cycles, take a week off, and then continue once a week until symptoms subside.
For acute situations, use for 30 minutes nightly for five nights, take two nights off, then repeat the cycle for two weeks or

until the condition is resolved.
In either case, individual response will differ depending on the symptoms that are being treated, please consult with your
health care provider.
Are there any contraindications to usage?
Do not use the packs during times of heavy bleeding, gaseous stomach, intestinal conditions, or during pregnancy. Again,
consult with your health care provider.
On rare occasion a rash can occur at the site. To avoid this you can wash the oil off after your treatment with a weak
solution of 1 TBL baking soda to one cup of warm water.

Women’s Health – Yoga Veda Institute Terra Rafael, Instructor
Class 3 - Treating Menstrual Disorders with Ayurveda
REMINDERS - Weighing Factors that Aggravate the System
• Constitutional factors are stronger than environmental factors. ex. Vata person tends to Vata disease even in another
climate or season.
• Lifestyle has a greater effect than the general environment. Ex. If you always stay up late (pitta aggravating) it will
overcome the Kapha of winter and could still cause a pitta disease.
• Internally ingested has more influence than an external exposure. Ex. Diet has a stronger effect than the climate or season.
• Mental and emotional factors outweigh physical factors. Ex. Consistent anger increases pitta even if not a pitta body type,
season or climate
• Degree of the factor is important consideration - an extreme case or happening regularly increases its weight in
aggravating. Ex. Being in a car accident (vata-trauma) is likely to cause imbalance beyond any injuries for anyone. If you
always eat yogurt and bananas for every breakfast and have ice cream for dessert every night you are likely to get a Kapha
imbalance - but not if it’s just occasionally.
• The more factors combine, the more likely there is aggravation. Ex. If you skip meals, drink cold liquids, talk constantly, have
a changeable schedule every day - these will all add up to a vata imbalance- but if you just did one of these it is less likely.
First , some ancient Ayurvedic wisdom from a root teacher -
Disorders of female genital tract -Charaka Samhita Ch 30- “The tract affected with these defects does not
hold the semen and as such the woman does not conceive and gets inflicted with various disorders.” These disorders,
while possibly causing infertility, also include menstrual problems. Some simple care is listed in brackets after the
description for most of them.
1. Vatika constitution following vata-aggravating diet & practices- pain, stiffness, feeling of ants crawling, hardness &
numbness of vagina, exhaustion & other vatika disorders. Menstrual discharge appears with sound, painful, frothy, thin
& rough. [Treatment: vata calming with diet, lifestyle, herbs]
2. Paittika constitution– due to excess pungent, sour, salty, alkaline things. Burning sensation, inflammation, fever &
heat; menstrual flow blue, yellow or black and excessive, hot discharge with “cadaverous smell” [Treatment: pitta
calming with diet, lifestyle, herbs, including pitta soothing herbs that target the uterus-- Musta and Hibiscus. ]
3. Kapha aggravated. Slimy, cold, itching discharge, with mild pain and pale with menstrual flow pale and slimy.
[Treatment: kapha calming with diet, lifestyle, herbs]
4. All three doshas vitiated in genital tract; burning sensation, pain and white slimy discharge. {ch s 30/9-15}
Page 1
5. Aggravated rakta-pitta – blood overflows from genital tract, even after conception. sasrja yoni [pitta calming
including Ashoka, pitta soothing herbs that target the uterus-- Musta and Hibiscus,raspberry leaf, rose petal. as
indicated]
6. Pitta in genital tract & uterus –affects blood- arajaska – produces leanness & abnormal complexion {16-17}
Amenorrhea ( heavy bleeding leads to anemia leads to weakness, paleness and amenorrhea- [pitta soothing, including
treatment of anemia]
7. Organisms arise in genital tract, cause itching – acarana- by which women have frequent desires for man {18][treat
itchy vaginal infection - yeast or other]
8. Vayu due to excessive coitus – swelling, numbness & pain in genitals- aticarana {19} [educate re: problems of
excessive coitus, calm vata in pelvis – with soaks/steams/ yoni basti]
9. Sexual intercourse in a too premature woman – vayu – pain in back, waist, thighs and groins -prakcarana {20}
[prevent when possible through education; treat with warmth and oil massage; poss yoni basti]
10. Kapha aggravation during pregnancy then suppresses urge to vomit, vitiated vayu carries kapha to the genital tract
– pale fluid w piercing pain or white mucus - upapluta {21-22} [ gentleVata/ Kapha balancing foods and vaginal
treatment if pregnant!]
11. Pitta woman suppresses sneeze & belch during coitus, vayu combines w pitta in genital tract – genital s swollen,
tender, painful & menstrual flow is blue & yellow. pain in pelvis, groins & back – paripluta {23-24}[educate; treat vata
and pitta- pitta soothing herbs that target the uterus-- Musta and Hibiscus.]
12. Natural urges suppressed, vayu takes an upward course in genitals – menstrual blood painful due to upward
tendency (instant relief after discharge of blood.) udavartini {25-26} [educate; treat apana vayu with dashamula,
ashwini mudra]
13. Untimely straining during labor leads to vayu obstructed by the baby, combines w kapha & rakta produces
prolapsed which obstructs the passage of menstrual flow – karnini {27} [Educate birth attendants when possible;
replacement of uterus – treat apana & various techniques in protocol]
14. Vayu morbidity in sonata (menses or ovum) destroys the fetus formed over & over due to roughness – putraghni
[Educate to avoid; Treat vata in artava – diet, herbs, soak/steams]
15. Overeating before sexual intercourse and lying in faulty postures- vayu with food curves the opening of vagina along
w vata distress in bones & muscles. Vagina becomes exceedingly painful & intolerant to coitus. antarmukhi {29-30}
[educate; vata reduction]
16. Female fetus if vayu due to roughness affects the genital tract , makes it minute opening – maternal defect –
sucimukhi {31} [ Educate mothers about need for pregnancy balance; may need surgery]
17. Suppressing natural urges during coitus – vitiated vayu causes painful retention of feces & urine & dryness of
vaginal opening. shushka yoni {32} [educate; treat vata, apana vayu]
Page 2
18. Semen having entered the uterus comes out after six or seven days, w or without pain – vamini {33}[?]
19. Genetic defect in the female fetus – vayu destroys the ovary – woman averse to males and devoid of breasts.
incurable – shandhi {34}{no ovaries or non-functional ovaries}
20. Abnormal postures during coitus on uncomfortable bed – vayu vitiated dilates the opening of the uterus and
genital tract. Tract becomes unclosed opening, painful and with rough & frothy menstrual discharge. Also growth of
flesh w painful joints & groin. maha-yoni {35-36} [educate to prevent; treat vayu with herbs, steam/soaks; ashwini
mudra/vaginal squeezes to tone]
***“WHATEVER REMEDY IS SAID FOR VATIKA DISORDERS, SHOULD BE APPLIED IN ALL DISORDERS OF FEMALE
GENITAL TRACK, PARTICULARLY IN MAHAYONI. THE GENITAL TRACK OF WOMEN DOES NOT GET AFFECTED WITHOUT
VATA. HENCE ONE SHOULD PACIFY IT FIRST AND THEN TREAT OTHER DOSHA.”***
“THUS WHEN THE GENITAL TRACK IS NORMALIZED, THE WOMEN CONCEIVE IF THE SEED IS NORMAL AND UNDAMAGED
AND THE CONSCIOUSNESS HAS MOVED IN.”
Herbs for Artavavahasrotas (always check for pregnancy safety, including for fertility if not using birth control-
see Ayurveda for the Childbearing Years for list of herbs contraindicated in pregnancy)
• Trifala-tridosha –ama reducing
• Ashoka VK+P- prevents miscarriage, uterine sedative, endometriosis, vaginal discharge or burning, PMS, various
gyne/ob problems - good esp for Pitta cramps: very cooling - Ashoka milk (cow or almond): 1-2 tsp Ashoka/1 cup
milk/ 1 cup water - cook down to 1 cup; imbibe 3-5x day
• Brahmi VPK= eases ovulation pains
• Berberis V+PK- excess menses
• Chrysanthemum V+PK- dysmenorrheal
• Fennel VP- menstrual cramps
• Guggulu -reduces all-Leucorrhea, dysmennorrhea, amenorrhea, 3rd stage of labor to remove placenta
• Hibiscus V+PK- emmenagogue, dysmenorrheal, menorrhagia, venereal disease
• Jasmine V+(if excess dose) PK- emmenagogue, cleanses uterus, aphrodisiac
• Jatamansi V+PK- spasmodic cramps of uterus
• Licorice V-P- (not if hypertensive)oogenesis, vaginal dryness, cervical dysplasia
• Lotus VP-K+ menorrhagia, leucorrhea, venereal disease
• Mace K- agni+ tones uterus
• Musta V+PK- menstrual cramps, PMS (w/shatavari)
• Pippili V-K-P=– to help placenta delivery
Page 3
• Punanarva V-P+K--regulates menses, menorrhagia; for fibroids - inhibits blood supply for fibroids ;
endometriosis; tone of uterus; rejuvenative of female reproductive
• Rose P- uterine hemorrhage, menstrual regulation with safflower or hibiscus
• Saffron – tridoshic but heating – menstrual pain, female revitalize
• Sesame V- amenorrhea
• Shatavari VP- K+ female tonic, fertility
• Vidari VP-K+ increase fertility, cystic ovaries, endometriosis
• Chandra Prabha heating - ovarian cysts, menstrual irregularity, balance the heat w/shatavari
• Dashmula VPK- postpartum recovery
• Sulphur and borax - PURIFIED PROPERLY - orally for female genital diseases - per Dr. Sarita Shreshtha
• Unexplained Infertility formula per Dr Sarita - Kapikacchu (aka Macuna), Ashwaganda, Shatavari, and Guduchi:
equal parts. Give ½ tsp with milk , Twice a day to both partners for 3 months
•
If genital track is displaced – bring back to normal position after uncting (oiling) & fomenting (moist
warmth) it: the covered one should be pressed with hand, the contracted one should be dilated, the bulged out should
be put inside and the dilated one should be manipulated for contraction. Women’s genital tract, if displaced is regarded
as a foreign body. (*Maya abdominal therapy is helpful for this problem *)
All cases of disorder of genital tract should be managed with mild application of five evacuative measures after unction
and sudation. (PANCHAKARMA)
Then: vata – vatika alleviating : tube or pitcher fomentation (steam) followed by meat of aquatic & marshy animals, milk,
sesame seeds and vata alleviating drugs.. She should first be massaged with lavanataila (oil processed with salt) and then
fomented by stone, bed or bolus methods of fomentation. Thereafter she should be sprinkled with warm water & fed
vata-alleviating meat soups. {41-48}
Remember our non-herbal tools:
STRESS REDUCTION!!! Mudras Yoni bastis
Diet & Digestion Marma points Self massage & Maya Abdominal
Massage
Meditation & Pranayama Vaginal steams and sitz baths
Cleansing & Pancha Karma
Page 4
Love/Connection/Mind
How does love or lack of love affect menstrual/fertility health?

• Lack of self-love – manifests as poor self care
• Dislike of body – poor self care; blockage of 2nd chakra
• Dislike of being a woman- poor self care ; blockage of 2nd chakra
• Dislike of menses/fertility – poor self care; blockage or 2nd chakra
• Blocked creativity – blockage of 2nd chakra
• Grief can cause periods to stop- temporarily or permanently
How can love help, and why?

• Self-love – Choosing to be healthy and happy – what can you avoid that stresses you?
• Loving body – Mirror contemplation and affirmation; healthy living choices to nurture yourself
• Loving being a woman – Feminine Power/Feminine Vulnerability
• Loving menses/fertility – Uterus meditation; menstrual altar
• Doing what you love to express your Creativity – list of what you love/love to do
• Use flower essences to gently go through the grief process, for long-standing grief use basil or tulsi
tea with prayers.
How does stress affect cycles, and why?
Cortisol and adrenaline increased – interfere with reproductive hormones
How can meditation and breath work help, and why?

Reduce stress, build ojas (resiliency of body/mind)
Body or imbalance types Meditation/ breathing techniques

Vata Mantra repetition or following breath meditation; Alternate nostril; deep belly
breathing; (ashwini mudra-not during menses)
Pitta Follow breath meditation; Moon/water meditation; Cooling breath; alternate
nostril; deep belly breathing; pearl/moon water
VP Use above per cycle – vata before bleed; pitta as bleeding; alternate nostril
breathing
Self massage/ Abhyanga = no massage during menses-;For other days (at least a few days a week)
whole body massage: V use sesame oil; P use almond oil; then shower or bathe warm, not terribly hot
water; Maya abdominal important!
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Common Menstrual Disorders
• Amenorrhea
• PCOS
• Dysmenorrhea
• Endometriosis
• Heavy Periods
• PMS
Amenorrhea
Absent, widely spaced, very scanty periods - This generally is a Vata problem, unless anemia (Pitta problem)
has gotten so serious that it turns off reproduction. Similarly, Pitta can cause amenorrhea due to over exercise
through the competitive nature pushing the woman past her physical capacity to create reproductive cycles.
Main Challenges (symptoms): Irregular &/or Skipped Periods due to:

a. depleted artava apana disorder
b. Menopausal Change/ Pregnancy
c. hypothyroid/adrenal / other hormonal imbalance (prana vayu involved)
d. excessive exercise/travel/fasting apana disorder - STRESS
e. anemia
f. post- birth control pill usage - may take 6 months to cycle for some
g. other drugs: Cyclophosphamide, Heloperidol, Imipramine, Clordiazepoxide, Methyldopa .
Desired results: Healthy Menstrual Cycles for stage of life
Food
Worst foods and drinks why?
Vata provoking diet Starves depleted tissues and reproduction
Empty calories Starves depleted tissues and reproduction
Caffeine Adrenal stress – reduces hormones
Soy Anti-calcium, anti-thyroid
Worst eating habits, and why?

Irregular eating habits – tissues starved
Undereating nourishing foods - tissues starved, any anemia is left untreated
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Best foods, drinks, herbs, and Why?
supplements
Vata soothing diet Nourishes tissues, reduces Vata
Reproductive foods Nourish reproductive tissues
Rejuvenative drink Nourishes all tissues
Seaweeds Thyroid nourishing
Oatstraw infusion – for anxiety -VP, nourishes nerves with minerals and adrenal
glands
Bala strengthens
Shankapushpi -VP; strengthens nerves; repels negative energy
Ashwaganda -V calms nervous system
Shatavari in milk – daily nourishes the blood and female reproductive;
throughout cycle positive phytoestrogens effect
Vidari -V, adrenal rejuvenation; feeds all tissues, esp ovaries
Iron rich foods -chlorophyll with iron, -P for anemic condition leading to amenorrhea
B12, raisins, currants, beet juice, carrot
juice / Floradex, nettles infusions
Guduchi Gentle liver support for -P esp after BCP
Ashokarishtam - if available- Nourishes endometrium
1-2 tbsp of the tonic should be taken
with warm water twice a day. It
contains herbs in proportions safe for
long term use (over 1 year).
Best eating habits, and why?

Regular mealtimes and snacks – to maintain even blood sugar, avoid insulin spikes
Vata soothing diet
Sleep
Worst sleeping habits, and why?
Irregular bedtime and rising – doesn’t allow body to relax into rhythms
Sleeping in room that isn’t dark, cool
Worst exercise habits, and why?

Over exercising, especially during menses – eventually increases vata and activates the adrenals
Lack of exercise – poor circulation, hormonal imbalances increased
Jarring exercise – increases Vata
Best sleeping habits, and why?

8 hours of sleep
Bed by 10 -10:30 pm – allows liver to detox well at night
Sleep herbs if needed – Ashwaganda/Shankapushpi milk –calms for better sleep
Essential oils – to help calm and ground – vetiver, ylang ylang, vanilla
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Best exercises, habits, and why?
Gentle exercise only on days just before and during menses – prevents uterine stress and Malposition
Yoga =proper, regular exercise for body type=– reduces all menstrual symptoms
Marma points for irregular menses= Basti (yarrow eo),Guda, Nabhi, Katikataruna(yarrow eo),
Kukundara
Further herbs for amenorrhea

• For hypothyroid condition leading to irregular/absent menses: (amended, from Alakananda Ma) When
the thyroid is under functioning, fertility may be lowered, menstrual cycles disrupted. Punarnava, Chitrak
and Guduchi support optimal thyroid function, as does shilajit. Trim Support, by Banyan Botanicals,
containing most of the above herbs, not only helps with obesity-related fertility issues but also helps
optimize thyroid function. Blood test standards may not be sufficiently sensitive for fertility issues. If you
suspect hypothyroid - check the thyroid pulse to check for doshas there AND the BBT - if it is a flat or low
level consistently, then treat for hypothyroidism with herbs above, added seaweed in diet, marma point for
the thyroid ( Kanthanadi - (where they do tracheostomy-in suprasternal notch; you can feel the trachea- for
hypothyroidism use Hena, ginger or vacha oil clockwise (as if the clock is on the area facing outward) for
this Kapha disorder ) and the bija mantra HRIM (like “him” with an r in it).
• Purified Borax= increases flow. Available from Louis Sanchez: Louise@earthnet.net

• Aloe=emmenagogue- take throughout cycle, slowly withdraw (take a few cycles if hot flashes there)
• Decoction of Carrot seed 20 ml twice a day - increases estrogen
Fenugreek Decoction - increases estrogen
• Dashmula Decoction - balances apana
• Dong quai before ovulation; vitex, continuously – vitex encourages progesterone; dongquai, estrogen
Teachings of Atreya:
Herbs for immediate emmenagogue:
• Tincture of myrrh (20 drops 4 x day ) immediate use or
• Tea of fresh ginger and pennyroyal in equal amounts, together=4-6 Tablespoons/ quart- simmer ginger only 10
minutes, add pennyroyal leaves cover & take off heat. Let steep 10 minutes, strain and drink 4-6 cups/day.
For longer term treatment of amenorrhea from Atraya:
Vata formula Pitta formula Kapha formula
3 Dong Quai (P+) 3 Dong Quai 3 Dong Quai
2 Vitex (V+) 2 Vitex 3 Tumeric
2 Pennyroyal 2 Raspberry 2 Vitex
2 Mugwort 2 Dandelion 2 Pennyroyal
2 Tumeric 2 Turmeric 2 Licorice
2 Licorice 2 Licorice 1 fennel
1 Fennel 1 Fennel 1 cumin
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1 cumin 1 cumin 1 ginger
1 Ginger 1 cinnamon
o Dosage: 1 tsp ( ~ 3grams) 2 x day w warm water & honey for V & K, natural sugar for P
▪ between meals
▪ for 2-4 mos depending how long problem has lasted
More Ayurvedic Herbs for Amenorrhea

• Camphor – increase menses
• Manjistha - Reproductive – stimulates uterus. Increases menses Cold infusion of manjistha improves menstrual
bleeding and relieves pain of menses. Stimulates and cleanses the uterus Oligo menorrhea or amenorrhea.
• Fennel -: induces menstruation, increases breast milk secretion. Useful in dysmenorrhea, menstrual obstruction
-moderate doses increased weight of oviduct, endometrium, cervix & vagina in rats
• Nutmeg - for Menstrual Irregularity : with shatavari, rose (may constipate)
• Ashwaganda - Excellent tonic to the uterine muscles. Used in menstrual imbalance caused by a deficient condition with an
aggravation of vata and uterine spasms, dysmenorrhoea, amenorrhoea and weakness. Bala, licorice and shatavari for use in
reproductive disorders
• Aloe vera gel - promotion of menstruation; all types of menstrual disorders (long-term use may cause reduced
libido)
• Shilajit - It treats deficiency and weakness due to high vata in the female reproductive system with symptoms of
weakness, infertility, dysmenorrhea and PMS, as well. (Pole, 2006)
• Cinnamon - A painkiller as well as a uterine stimulant, cinnamon is essentially the herbal equivalent of many
over-the-counter menstrual medications. The Chinese, who along with other Asians use it as a treatment for
PMS, agree that cinnamon promotes regular and easy menstruation. (avoid overdosing)
• Vitex - Normalizes pituitary communication with ovaries—pulsing of FSH & LH—organizes hormonal stimulation
better
o Normalizes blood flow, libido for men & women
o For cycle irregularities—amenorrhea, post BCP irregularities, polycystic ovaries,
o Stress or exercise induced amenorrhea
o Strengthens corpus luteum – helps with low progesterone conditions – not strong enough if need to
maintain a pregnancy – use progesterone cream, medical stuff
o PMS—progesterone low in relation to estrogen levels during luteal phase 1500 mg twice a day of EPO
for pms also, exercise, baths, rest
o Skin issues with hormonal imbalances
o Long term tonic – lasting change after 6 months If formula w/ other herbs – all month If simple – luteal
phase
• Cottonroot bark - The sole activity of Cotton Root bark seems to be to stimulate those tissues that respond to
the pituitary hormone oxytocin. It facilitates & acts synergistically with the hormone; without some oxytocin
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present in the blood stream the herb has no effect. It is therefore used to increase the tone & contractability of
the uterus, seminal vesicles and the myoendothelial tissues of the breast.
o For late menstrual period it is used as an emmenagogue. Used in place of ergot, being not so powerful
but safer; it was used largely in this way by the slaves in the south. The earlier taken the better but not
before the day preceding the expected period. Effectiveness 60-80% when begun the first 6 days. If
begun only after the period is 6 days overdue then effectiveness falls to 20%. Dispensare des Femmes
recommends using two associated herbs from these two lists: cottonroot bark, pennyroyal, or
mugwort WITH parsley, blue cohosh, or black cohoshl
PCOS
Polycystic Ovarian Syndrome by Alakananda Ma
In this article we will look more deeply into one of the most common causes of menstrual irregularity,
hormonal imbalances and infertility, a grouping of symptoms known as polycystic ovarian syndrome. We will
see how Ayurveda brings added depth to the understanding of this poorly understood condition and can offer
treatment options that are more than merely symptomatic.
With a prevalence of 6-10% of the female population, PCOS is a common cause of morbidity, infertility and
quite possibly of increased risk of mortality. (1) PCOS is a syndrome characterized by multiple small cysts on
the ovaries, menstrual irregularities and features of excess androgen production such as hirsutism (excess
facial or body hair), male or female pattern balding, acanthosis nigricans and acne. Not all women affected
with PCOS have all three features but to make a diagnosis of PCOS, at least two of these three characteristics
must be present. In terms of menstrual irregularity, menses may be irregular; there may be oligomenorrhoea
(reduced frequency of menstruation) or amenorrhoea (periods of six months or more without menstruation).
Menstrual irregularity is noted from menarche on. As one menopausal patient noted, “First I was told that my
periods were irregular because I was young, then because I was under stress in school, then because I was
travelling and then because I was premenopausal. From the day of menarche, my periods were never regular.”
While not all women with PCOS have menstrual irregularity, those who do not must have both other sets of
characteristics fully established in order to meet diagnostic criteria for PCOS. Typical androgenic features may
include sideburn or chin hair, chest or belly hair, nipple hair, balding, acne and acanthosis nigricans, a
darkening of skin on the nape of their neck, skin folds, knuckles, or elbows. If there are more intense
symptoms of excess androgens such as enlarged clitoris, baldness, dropped voice and increased muscle mass,
referral to an endocrinologist is needed to exclude other, more dangerous diseases that may lead to excess
testosterone production. Polycystic ovaries must be established by ultrasound. Again, while not all PCOS
sufferers actually have polycystic ovaries, those who do not must clearly show menstrual irregularities and
hyper-androgenic features.
As well as these diagnostic features, PCOS is associated with obesity, particularly central obesity, insulin
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resistance, hypertension, raised blood lipids and metabolic syndrome. After a girlhood of menstrual problems
and adult years of fertility issues, a woman with PCOS may enter her elder years with an increased risk of type
II diabetes and heart disease (2). Yet despite the added mortality and morbidity associated with this condition,
for many women, the most devastating feature of PCOS is its impact on fertility. Although not all women with
PCOS experience fertility issues, many do. Conception may be difficult to impossible or there may be a history
of miscarriages. For those who do become pregnant, there is an increased risk of gestational diabetes and
hypertension.
After hearing these features of PCOS, the Ayurvedic practitioner has noticed the strong correlation with kapha
issues. Although there may be pitta features such as acne and hair loss or vata features like menstrual
irregularity, it is kapha that lies at the root of this syndrome. By the same token, although PCOS may affect any
prakruti, as a kapha condition it is typically most severe in kapha prakruti. A majority of all women with PCOS
seen in the author’s practice have been of kapha prakruti.
A woman with PCOS may present complaining of hirsutism, acne, obesity or menstrual and fertility issues. In
making a diagnosis of kapha syndrome with suspected PCOS, it is important to exclude other causes of similar
issues. For example, a thirty two year old Indian woman of tridoshic vata, i.e. V3P2 K2, constitution presented
to an Ayurvedic physician complaining of hair loss, weight gain, acne, sluggishness and fertility issues. Her
menstrual cycle was regular. The physician diagnosed PCOS, based on her reported symptoms. While booking
an ultrasound to screen her ovaries, she presented for a second opinion. Based on her complaints of
sluggishness, weight gain, hair loss and impaired fertility as well as clinical findings of leathery skin and
abnormal thyroid pulse, we told her that thyroid issues were the likely cause of her complaints. Sure enough,
her ultrasound showed normal ovaries, excluding the diagnosis of PCOS since she had both normal ovaries and
a normal menstrual cycle. She unearthed three old thyroid tests all of which showed sub-optimal thyroid
function. Although she did have some kapha syndrome issues, these were expressing more in terms of
metabolic rate and the thyroid than in terms of PCOS. She was fortunate to have a treatable cause of her
fertility concerns.
A thirty year old woman of kapha prakruti complained of central obesity, dropped voice, facial hirsutism,
amenorrhoea and infertility. Polycystic ovaries were shown on ultrasound. She had other kapha symptoms
including chronic sinus congestion and was allergic to dairy. Although a vegan diet was a crucial self-care
method for her, she found that exercise including strength training and cardio made the greatest difference to
her symptoms, particularly to central obesity. Her journey with infertility was a tortuous one. After two
devastating failed in-vitro fertilizations, she was able to carry a child successfully after IVF but could not
establish lactation, a not-uncommon finding in PCOS (3). Nevertheless, she is happy with her precious baby.
A twenty seven year old kapha African-American woman had polycystic ovaries demonstrated by ultrasound.
Eight years ago, she had one pregnancy which was complicated by hypertension and oedema. She had a
strong family history of hypertension and raised blood lipids and was a former smoker. Two years ago, she was
found to be hypertensive with raised cholesterol. She normalized these parameters by quitting smoking,
exercising and giving up cheese. Currently she had significant hirsutism with sideburn hair, beard and
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moustache hair and belly hair and was suffering from irregular menses, overweight and malaise. At 165 lb she
was 20 lb over her optimum. She responded extremely well to a kapha-soothing diet and to a formula which
included Punarnava as dosha pratyanika for kapha, Shardunika to help insulin production and Chitrak for agni.
Shilajit is a crucial component in the herbal management of PCOS, so clients will respond well to a formula
which contains shilajit, such as Trim Support, as well as to a blend containing Shardunika, such as Sweet Ease.
A thirty seven year old Caucasian woman of kapha prakruti presented with an array of kapha complaints
including sluggish digestion, plugged ears and chronic sinusitis. She had experienced amenorrhoea since her
teens, menstruating only once a year and was developing female pattern baldness. Ten years ago she had an
ultrasound and was found to have polycystic ovaries. She had also been diagnosed with insulin resistance.
Currently she took depot provera which induced a period every 45 days. She had a strong tendency to gain
weight. She was married and experiencing infertility. She tried to prepare healthy foods at home but had lunch
most days at McDonald’s, Burger King or Taco Bell. After switching to a kapha soothing diet and eliminating
gluten and cow dairy, she improved significantly. And amazingly, after taking Trim support and Triphala, she
became pregnant. Yet the sweeping extent of her kapha syndrome turned joy to tears when she gave birth to
a stillborn child as a result of multiple thromboses in the placenta. As a complication of PCOS, she suffered
from thrombophilia—a tendency of the blood to clot in the blood vessels. Current research suggests that
thrombophilia plays a key role in stillbirth and miscarriage in patients with PCOS. “Undetected thrombophilia
is not only additional cause of infertility but sometimes the basic cause of infertility in patients with PCOS and
MS (metabolic syndrome).” (4)
This patient had difficulty implementing a full program of ayurvedic treatments due to an extremely busy life
as a business owner. Her history reminds us of the importance of treating kapha at depth, including diet,
lifestyle, kapha soothing herbs and pre-conception pancha karma, in an attempt to promote a positive
outcome of pregnancy in PCOS. A rejuvenative and hormonally balancing formula such as Women’s Support
can be given following pancha karma to enhance fertility. During pregnancy, herbs such as Vidari should be
given to nourish the placenta as well as kapha reducing herbs to lower stickiness of the blood and control
kapha syndrome. Since Ashwagandha may be androgenic in action, it is wise to avoid using it in PCOS.
In Western medicine, there is no definitive treatment for PCOS. Management is largely symptomatic.
Ayurveda can make a significant contribution to the wellbeing of women with PCOS by offering kapha
soothing diet and lifestyle, kapha balancing yoga and kapha soothing herbs. Blood sugar and insulin resistance
issues can be managed using Shardunika, neem, turmeric, bibhitaki and Sweet Ease, while scraping formulas
like Trim Support will not only support weight management but also may normalize the polycystic ovaries.
Triphala Guggulu and turmeric will reduce blood stickiness, mitigating symptoms of thrombophilia (note that
neither of these herbs is recommended during pregnancy). Vidari will support fertility and nourish the
placenta. And pancha karma will normalize kledak kapha, helping to reduce thrombotic symptoms. Developing
a good program of self-care for kapha will not only help support the best possible outcomes during the
woman’s reproductive years but will also help prevent her developing diabetes and heart disease later in life.
1. Andrea J. Cussons, Bronwyn G. A. Stuckey and Gerald F. Watts Metabolic syndrome and cardiometabolic
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risk in PCOS Current Diabetes Reports, 2007 – springer link
2. Polycystic ovarian syndrome (PCOS): a significant contributor to the overall burden of type 2 diabetes in
women.Talbott EO, Zborowski JV, Rager JR, Kip KE, Xu X, Orchard TJ.J Womens Health (Larchmt). 2007
Mar;16(2):191-7
3. Lisa Marasco, BA, IBCLC089033440001600211 Polycystic Ovary Syndrome: A Connection to Insufficient Milk
Supply? Journal of Human Lactation, Vol. 16, No. 2, 143-148 (2000)
DOI: 10.1177/
4. Perederyaeva EB, Pshenichnikova TB, Makatsaria AD. Inherited and Acquired Thrombophilia in Patients
With Metabolic Syndrome in Obstetric-Gynecologic Practice. J Thromb Haemost 2007; 5 Supplement 2: P-T-
608
Alakananda Ma is a British-trained physician who was one of the first Western medical doctors to practice Ayurveda in the US. She is
a renowned teacher, lecturer, writer of insightful articles on Ayurveda and also principal of Alandi Ayurveda Gurukula, a traditional
gurukula, in Boulder, Colorado. For more information on Alakananda Ma and Alandi Ayurveda Gurukula please visit
http://www.alandiashram.org
Diagnosing PCOS Diagnosing PCOS: What is the Underlying Cause?
As a naturopathic physician, I am dedicated to finding the underlying cause of your condition, so treatment
can correct a problem at its source. Although we have studied and can describe the many complex
relationships between the brain and ovaries and the liver and fat cell chemistry that are present in women
with PCOS, medical researchers have not yet put their finger exactly on what comes first. What is the original
trigger that produces the cascade of events in a woman’s body that leads to PCOS?
This is still technically a mystery. However, it is clear that PCOS is a condition that requires a chronic lack of
ovulation plus high levels of androgen hormones (testosterone is the most familiar of the androgen
hormones). Other consistent elements of PCOS are problems with blood sugar and insulin levels. Testosterone
production will be increased in women who have chronically higher levels of insulin, as a result of eating too
many sweets and too much refined carbohydrate in the form of white flour products. The effects of too much
blood sugar and thus elevated insulin levels, leading to excessive androgen hormone production, can effect all
of the problems that we collectively call PCOS. So, while genetics certainly seem to play a role in whether a
woman (and her daughter) develops PCOS or not, the single most influential factor in the lives of women
with PCOS is the carbohydrate content of their diet.
Some of us are more genetically sensitive to the tissue changes any hormone imbalance produces. Some of
our systems may ‘wake up’ to the chemical insults and give us symptoms earlier in the process of developing
PCOS (while we are still lean, for instance) and some of us may not notice anything we can complain about
until much later (when we are obese, are having trouble conceiving a child or have developed type 2
diabetes.)
There are some studies that show testosterone can cause excess insulin production. But a substantial body of
research supports excess insulin as the primary problem from which all else flows in PCOS. For instance:
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• The administration of insulin to women with PCOS increases circulating androgen levels.
• The administration of glucose to women with excess androgen levels increases both insulin and androgens.
• Weight loss decreases the levels of both insulin and androgens and increases other hormones typically
elevated in women with PCOS.
• Insulin stimulates the production of androgens from ovarian tissue in vitro (“in the test tube”).
• The experimental reduction of insulin levels in women reduces androgen levels in women with PCOS, but
not in women who do not have PCOS.
• After experimental normalization of androgens in obese women with PCOS, their systems still responded
with abnormal glucose tolerance test result.
Therefore, my best guess about the fundamental cause of PCOS is based on current medical science, including
studies showing rising rates of childhood obesity that parallel rising rates of PCOS, as well as my clinical
experiences successfully treating women with PCOS. I treat PCOS as if it is a condition that starts in our
childhood, when we typically eat a diet over-loaded with sweets and highly refined carbohydrates (white
bread, jelly and jam, crackers, sugary cereal, cookies, soda etc., etc.) and are not physically fit or active enough
to use all the fuel we swallow. We begin early on to ask too much of our insulin and blood sugar control
mechanisms. The effects are subtle at first and pile up so that eventually symptoms that bother us send us to
the doctor. Evidence suggests that sisters and daughters of women with PCOS have about a 50% chance of
also having it. That may mean there is a genetic link and/or that dietary and exercise habits we learn in our
families are part of what cause the changes in a woman’s body that collectively we call PCOS.
Women with PCOS typically report to their health care provider with at least 2 of the following complaints
to receive a diagnosis of PCOS:
1) Either no menstrual periods or irregular and often heavy menstrual periods
2) Excess androgen hormone effects (ex. acne, thinning scalp hair, excess facial or body hair
3) Enlarged ovaries with multiple small follicular cysts seen on ultrasound exam.
Early in the last century, the first doctors to describe and treat PCOS had mostly obese patients in their
studies. It turns out they were working with and describing the most advanced cases of what we now call
PCOS. At that time PCOS was referred to as Stein-Leventhal Syndrome. Actually, about half of women with
PCOS are also obese, and roughly half appear to be lean women.
Today we have a better understanding of the relationships between obesity, insulin resistance, excess
androgen hormones and PCOS. As the prevalence of obesity, diabetes and heart disease (collectively known as
metabolic syndrome) increases in our society, it is expected that the incidence of PCOS will rise as well.
Because PCOS is not a single disease, but rather a collection of signs and symptoms that when occurring
together indicate a certain underlying condition exists, there is no simple diagnostic test. It is essentially a
hormonal disorder that puts a woman at risk for the eventual development of multiple possible other
conditions or specific diseases: acne, skin discoloration, heavy and irregular or absent menses, infertility,
Page 17
obesity, fatty liver disease, insulin resistance, diabetes, heart disease and uterine or possibly ovarian cancer.
Testing is also important to rule out other conditions that may have similar features.
Lab tests you should have:
• Testosterone, total and free-

• Dehydroepiandrosterone sulfate (DHEA-So4)
• Luteinizing Hormone
• Follicle Stimulating Hormone
• Thyroid Stimulating Hormone
• Prolactin
• 17-Hydroxyprogesterone
• Vitamin D level
• a 2-hour glucose tolerance test
• a fasting metabolic panel that includes blood glucose, insulin level, lipids and liver function tests
Some of these tests are most informative when done at particular points in your menstrual cycle. Be
sure to ask your doctor to help you maximize the value of the information you are purchasing with
these tests, by scheduling accordingly, whenever possible. © 2005 by Nancy Dunne, N.D.
Meal Timing Can Significantly Improve Fertility in Women With Polycystic Ovaries
Aug. 13, 2013 — Polycystic Ovarian Syndrome (PCOS), a common disorder that impairs fertility by impacting
menstruation, ovulation, hormones, and more, is closely related to insulin levels. Women with the disorder
are typically "insulin resistant" -- their bodies produce an overabundance of insulin to deliver glucose from the
blood into the muscles. The excess makes its way to the ovaries, where it stimulates the production of
testosterone, thereby impairing fertility.
Now Prof. Daniela Jakubowicz of Tel Aviv University's Sackler Faculty of Medicine and the Diabetes Unit at
Wolfson Medical Center has found a natural way to help women of normal weight who suffer from PCOS
manage their glucose and insulin levels to improve overall fertility. And she says it's all in the timing.
The goal of her maintenance meal plan, based on the body's 24 hour metabolic cycle, is not weight loss but
insulin management. Women with PCOS who increased their calorie intake at breakfast, including high protein
and carbohydrate content, and reduced their calorie intake through the rest of the day, saw a reduction in
insulin resistance. This led to lower levels of testosterone and dramatic increase in the ovulation frequency --
measures that have a direct impact on fertility, notes Prof. Jakubowicz.
The research has been published in Clinical Science and was recently presented at the Endocrine Society's
annual meeting in June. It was conducted in collaboration with Dr. Julio Wainstein of TAU and Wolfson
Medical Center and Dr. Maayan Barnea and Prof. Oren Froy of the Hebrew University of Jerusalem.
Managing insulin to increase ovulation
Page 18
Many of the treatment options for PCOS are exclusively for obese women, Prof. Jakubowicz explains. Doctors
often suggest weight loss to manage insulin levels, or prescribe medications that are used to improve the
insulin levels of overweight patients. But many women who suffer from PCOS maintain a normal weight -- and
they are looking for ways to improve their chances of conceiving and giving birth to a healthy baby.
In a recent study, Prof. Jakubowicz and her fellow researchers confirmed that a low-calorie weight-loss plan
focusing on larger breakfasts and smaller dinners also lowers insulin, glucose, and triglycerides levels. This
finding inspired them to test whether a similar meal plan could be an effective therapeutic option for women
with PCOS.
Sixty women suffering from PCOS with a normal body mass index (BMI) were randomly assigned to one of two
1,800 calorie maintenance diets with identical foods. The first group ate a 983 calorie breakfast, a 645 calorie
lunch, and a 190 calorie dinner. The second group had a 190 calorie breakfast, a 645 calorie lunch, and 983
calorie dinner. After 90 days, the researchers tested participants in each group for insulin, glucose, and
testosterone levels as well as ovulation and menstruation.
As expected, neither group experienced a change in BMI, but other measures differed dramatically. While
participants in the "big dinner" group maintained consistently high levels of insulin and testosterone
throughout the study, those in the "big breakfast" group experienced a 56 percent decrease in insulin
resistance and a 50 percent decrease in testosterone. This reduction of insulin and testosterone levels led to a
50 percent rise in ovulation rate, indicated by a rise in progesterone, by the end of the study.
A natural therapy
According to Prof. Jakubowicz, these results suggest that meal timing -- specifically a meal plan that calls for
the majority of daily calories to be consumed at breakfast and a reduction of calories throughout the day --
could help women with PCOS manage their condition naturally, providing new hope for those who have found
no solutions to their fertility issues, she says. PCOS not only inhibits natural fertilization, but impacts the
effectiveness of in vitro fertilization treatments and increases the rate of miscarriage.
And beyond matters of fertility, this method could mitigate other symptoms associated with the disorder,
including unwanted body hair, oily hair, hair loss, and acne. Moreover, it could protect against developing
type-2 diabetes.
Journal Reference:
1. Daniela Jakubowicz, Maayan Barnea, Julio Wainstein, Oren Froy. Effects of caloric intake timing on insulin resistance and
hyperandrogenism in lean women with polycystic ovary syndrome. Clinical Science, 2013; 125 (9): 423 DOI:
10.1042/CS20130071
American Friends of Tel Aviv University (2013, August 13). Meal timing can significantly improve fertility in women with polycystic
ovaries. ScienceDaily. Retrieved August 14, 2013, from http://www.sciencedaily.com /releases/2013/08/130813121626.htm
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Dysmenorrhea – Painful Menstrual Cramps

Main Challenges (symptoms):Cramps
a. before bleeding/with spotting – V type
b. during heavy bleeding – P type
c. both – V & P
d. congestion- bloating - K
d. secondary to- endometriosis
e. secondary to – uterine displacement
Desired results: Comfortable menstrual cycles
(video - Getting to the root of your menstrual cramps )
Food
Worst Foods and Drinks for Cramps Why?
Caffeine Reduces digestion , + V, + irritability (P)
Vata + foods Reduces digestion , + V
High glycemic foods, including alcohol + insulin then - SHBG then + estrogens
Bad fats, fried foods, alcohol, caffeine Stress liver
Non-organic dairy Artificial hormones then stress liver
Excess dairy, chicken, turkey, red meat and + Arachnidonic Acid (AA) then +
egg yolk inflammation (elimination diet to test
sensitivity to this)

Skipping meals and irregular mealtimes lead to irregular insulin levels, lowered Sex hormone binding
globulin and increased estrogens in system
Best Foods, Drinks, Herbs, & Supplements Why?

Hibiscus tea with a dash of cinnamon – sip Symptomatic relief - Cools excess pitta,
warm, not hot tea throughout bleeding day controls heat of uterus
Cod Liver oil Vit A – regulates estrogens
Ashwaganda, yogaraj guggulu, vidari -V – calm
Shatavari (phyto-estrogen), ashok , women’s -P – reduce inflammation, irritability
support tablets
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Crampbark tincture Symptomatic relief
Vit E : spinach, turnip greens, broccoli, and Reduces cramping pain
chard, almonds, peppers, asparagus, tomatoes,
and carrots, grass-fed meat
EFA – fish or hemp oil with -Inflammation , thin blood
B vit + anti-inflammatory prostaglandins, -pain
prostaglandins
Magnesium Muscle relaxant
Bromelin + anti-inflammatory prostaglandins, -pain
prostaglandins, smooth muscle relaxant
Cruciferous vegies Stable blood sugar/insulin/SHBG/-estrogen
Low glycemic diet Stable blood sugar/insulin/SHBG/-estrogen
Bioflavinoids: bilberries, or any berries Relax smooth muscle, -inflammation
Regular, moderate meals with low glycemic snacks if needed to stabilize blood sugars
Sleep
Worst sleeping/rest habits, and why?
STAYING UP PAST 10 PM – REDUCES LIVER DETOXIFICATION; ENCOURAGES LATE NIGHT EATING
Irregular sleep habits – disrupts body’s inner clocks
NOT RESTING DURING BLEEDING TIME- irritates the uterus

Over exercising, especially during menses – increases vata
Jarring exercise, especially days before and during menses – irritates or displaces heavy uterus

Sleep by 10-10:30 pm – allows liver detoxification; avoids eating at night
Regular bedtime – allows body to form inner rhythms
RESTING DURING BLEEDING TIME – allows energy to go to cleansing and bleeding

GENTLE EXERCISE ONLY – DAYS BEFORE AND DURING MENSES – PREVENTS UTERINE STRESS AND
MALPOSITION
Regular exercise for body type – reduces all menstrual symptoms by increasing serotonin, which helps
with pain; stabilizes blood sugar – reduces active estrogens; helps body deal with stress better
Yoga =
Menstrual hygiene products –
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Worst: tampons – can promote cramping by irritating the cervix/block energy flow
Best: sanitary pads – allow free flow without affecting the uterus
Marma points for cramps =(clary sage oil-), Basti,Guda, Nabhi, Katikataruna, Kukundara
Essential oils = mix with small amount of oil to apply or use on a compress with hot water bottle on
abdomen (NO HEAT IF HEAVY BLEEDING)
-German Chamomile (Matricaria chamomilla, Matricaria recutita)to reduce inflammation. some pain reducing
effects, promotes calming of the nerves, reduces anger, irritability and depression..
-Sweet Fennel (Foeniculum vulgare, Foeniculum officinale, Anthum foeniculum)Helps to regulate the menstrual
cycle, may help reduce hormone fluctuation. It is also aids in reducing muscle spasm.* Do not use if you have
epilepsy.
Castor Oil packs = useful for those with premenstrual cramps without bleeding and scanty periods, this
will help loosen the adhesions that may be holding the uterus in a position making it hard for her to drain
during menses
Maya Abdominal massage = learn this in your individual skype or in-person session with Terra – helps
circulation of blood, lymph and energy in the abdomen, helping the area to function optimally
Sex/Energy
Sexual practices that affect menstrual cramps, and why?
SEX DURING MENSES – IRRITATES, displaces uterus, goes against downward energy flow
AVOID SEX DURING MENSES
How does stress affect menstrual cramps, and why?
Stress promotes estrogen dominance, which can increase flow and cramps
EXCESS OR LONG-TERM CORTISOL – DECREASES PROGESTERONE RECEPTOR SITES; LOWERS THYROID
FUNCTION; CAN CAUSE HYPERGLYCEMIA – SHBG +ESTROGENS
Cortisol and adrenaline increased – interfere with reproductive hormones
Basti =Dashmula or Rasp/rose yoni basti; Dashmula basti - 1 week before expected period
Vata Dysmenorrhoea (by Alakananda Ma)

Vata dysmenorrhoea consists of intense cramps which occur before the onset of bleeding or when the
bleeding is still only light. Such cramps can be severe and disabling. Yogaraj Guggulu is an excellent remedy for
this condition and should be taken daily throughout the cycle as the intention is not just for immediate relief
of pain but to pacify the underlying vata. Alternatively, and more suitable for an underweight vata, a
combination of Ashwagandha and Vidari will help to reduce menstrual cramps and regulate the menstrual
cycle. Again, this remedy should be taken all month long as the intention is to calm vata systemically rather
than to act as an alternative to Ibuprofen. As mentioned in context of vata PMS, Dashamula basti can be done
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a week before the onset of menstruation and can help calm the vata so that cramps are lessened. At that
time, it can also be helpful to do a Dashamula douche with some of the same decoction. This can help remove
vata from artava dhatu. Supported supta vajrasana is an excellent yoga pose for menstrual cramps. With
adequate support, it is possible to remain in this position for as much as twenty minutes, with great relief. A
woman who suffers every month from intense cramps will be likely to get significant relief by doing pancha
karma, with emphasis on internal oleation, abhyanga with Vata Massage Oil and sesame oil and Dashamula
bastis.
Pitta Dysmenorrhoea and Menorrhagia

Pitta dysmenorrhoea and menorrhagia go hand in hand as manifestations of excess pitta in the system.
Because of the sara (creeping) nature of pitta, excess ranjak pitta can overflow from the liver and collect in the
pelvic cavity, causing excess menstrual bleeding and pitta type cramps. Symptoms of pitta dysmenorrhoea
include tenderness and cramps which occur when the flow is at its heaviest. Symptoms of menorrhagia
include soaking through a pad or tampon each hour or less or needing to use double protection, passing large
clots, being woken at night by excess flow, and feeling breathless or dizzy during the flow as a result of excess
bleeding. Causes of menorrhagia can be complex and multifactorial. Sometimes HRT can provoke pitta causing
excess bleeding. EDS, a genetic disorder in which the mridu (soft) quality of pitta is in excess can lead to heavy
menstrual bleeding as well as easy bruising. Vitamin K deficiency can be caused by pitta provoking medication
such as aspirin as well as by malabsorption conditions such as celiac syndrome. Von Willebrands disease is a
little known bleeding disorder characterised by excess menstrual bleeding, easy bruising and frequent and
prolonged nosebleeds. Iron deficiency is both an effect and a cause of menorrhagia since when serum iron is
low the blood vessels are unable to constrict effectively to stop the bleeding.
Aloe vera is the anupan of choice for pitta dysmenorrhoea and menorrhagia. Guduchi will help address the
root cause of menorrhagia in the excess ranjak pitta, Shatavari will support healthy balance of hormones and
reduce pitta throughout the system, Ashoka is an excellent remedy for excess bleeding and menstrual cramps
and Rose is astringent and reduces excess bleeding. Hibiscus will also balance the female reproductive system
and reduce pitta, so Rose and Hibiscus tea with a touch of cinnamon, a warming emenogogue, can be an
excellent beverage for pitta menstrual symptoms. Musta is an herb of choice for pitta PMS and pitta cramps
and will also help with yeast infections. Containing many of these pitta soothing herbs, Women’s Support
(www.BanyanBotanicals.com ) is a good all purpose women’s formula that can bring relief for dysmenorrhoea
and menorrhagia.
Moon salutations, shitali and gentle forward-bending poses can help bring relief for pitta dysmenorrhoea,
menorrhagia and indeed for PMDD. The women cited earlier in context of PMDD notes that, “Although I had
no choice about being irritable and upset, I still had a choice of how to deal with it. Eventually I learnt to run
into another room before I yelled, and to do some shitali until I felt calmer. Then I could have some hibiscus
tea or some warm milk with cardamom. These small victories gave me a sense of self respect and achievement
even in the face of the mood disorder.”
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Kapha Dysmenorrhoea
A dull ache, heavy, congested feeling, lethargy and fogginess characterise kapha dysmenorrhoea. The kapha
woman should avoid dairy products such as milk and cheese during her menstrual period and should
concentrate on light, kapha reducing food such as fruits and vegetables. Unlike vata and pitta, who need to
rest during menstruation, the kapha woman needs gentle, low impact exercise at this time, including flowing
vinyasa and walking. This will stimulate circulation which will relieve much of the sensation of heaviness. As
during kapha PMS, Punarnava in honey is an herb of choice. She can also try some emmenogogue teas such as
Hibiscus tea, without the rose and with more cinnamon and a little ginger powder. Women’s Support may be
very beneficial, especially if she has heavy bleeding or clots. Hot packs such as castor oil packs or ginger packs
can also give great relief to the feeling of congestion.
Prostaglandins - a cause to take into consideration

Another cause of painful periods can be the excess production and release of hormone-like substances called
prostaglandins. Many of the prostaglandins are actually ‘healthy’, and have a beneficial effect on the body.
However, two types of ‘bad’ prostaglandins, known as PGF2 Alpha and PGE2, can be increased in some
women. PGF2 Alpha is a vasoconstrictor, which means that it works to reduce the blood flow to the womb
muscle, and PGE2 is a highly inflammatory substance that can trigger muscle contractions and increase the
sensitivity of your nerve endings to pain.
Research has shown that women with primary dysmenorrhoea have significantly higher levels of of both
prostaglandins PGF2 Alpha and PGE2.
Prostaglandins are present in every cell in your body. They tend to be low in the first half of the cycle and then
rise sharply towards your period, and can cause a variety of other symptoms including headaches, nausea and
fatigue.
Dietary Changes
What you eat is the foundation of your health. Taking that one step further, diet is also extremely important –
even critical – to the treatment of painful periods. Why? Because the substances (prostaglandins) that are
normally at the root of the pain are increased or decreased according to what you eat.
As you have seen, there are both ‘good’ and ‘bad’ prostaglandins. PGE2 is classed as a ‘bad’ prostaglandin
because it increase the womb contractions and increases the pain. PGE1 is classed as a ‘good’ prostaglandin
because, among other things, it also does the following:
• Relaxes and widens blood vessels, which improves blood flow

• Prevents inflammation
• Improves the way your body gets rid of sodium (salt, which is connected to water retention and
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bloating
• Regulates the immune system
PGE3 can also be classed as a ‘good’ prostaglandin because it helps to reduce inflammation and abnormal
blood clotting.
It’s fairly obvious that you need more of these ‘good’ prostaglandins if you are suffering from period pains, but
your body has to produce them in order for them to be there to have an effect.
How are prostaglandins produced?
Essential fatty acids (EFAs) in your diet provide the raw materials for the production of prostaglandins. So the
starting point is the amount and quality of essential fatty acids (oils) that you eat.
Below you will see how your body makes the choice between producing ‘good’ or
‘bad’ prostaglandins.
What you need to do as a starting point is to adjust your diet so that you are
increasing those foods that begin the process of producing beneficial prostaglandins
(PGE1 and PGE3) and reduce the foods that cause your body produce too many of the
negative ones (PGE2), which increase contractions and inflammation. As well as
providing your body with the right foods to kick start the beneficial prostaglandin
process, you also need to make sure that there is nothing in your diet or your lifestyle
that will prevent your body from converting the right foods into healthy
prostaglandins.
The best way to get to grips with this system is to imagine that there are two trains (Omega 3 and Omega 6)
running along a number of tracks. The Omega 3 train needs to reach the PGE3 station and the Omega 6 train
needs to reach the PGE1 station. If there are any obstacles on the Omega 6 track, the train will be redirected
towards the PGE2 station.
Foods that encourage the production of ‘bad’ prostaglandins
As you can see from the chart below, it is very important that you avoid all of those foods that are high in
arachidonic acid (AA). Your body produces PGE2 from AA, of which the main sources are dairy products. This
means eliminating or at least reducing dairy in any form, including milk, cheese, cottage cheese yoghurt,butter
and even dairy ice-cream. AA is also present in red meat and although the saturated fat content of red meat is
higher than in white meats, AA is higher in chicken and turkey than in red meat.
You may then be concerned about your calcium intake without dairy produce in the diet, but there are many
other good sources of calcium, including leafy green vegetables and even sesame seeds (see page 176). If you
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want to be extra sure, take a multivitamin and mineral supplement that contains good levels of calcium as well
as other nutrients for your bones.
Factors that can block the conversion of essential fats.
In order to start the ball rolling, your body has got to convert the Omega 6 series,
linoleic acid (LA) into GLA (gamma-linoleic acid). It has been discovered that many
women have an inherent (naturally occurring) problem in their bodies, which means
that there is some difficulty converting the essential fatty acids to GLA.
If you are one of these women, and you are also a big dairy food eater, you will
undoubtedly end up with very little PGE1 (good) and too much PGE2 (bad). Obviously
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when the balance is tipped in that direction, you’ll be much more likely to suffer
some nasty symptoms, and one of those can be period pains.
There are a number of other factors that can hamper the conversion of linoleic acid to GLA and these include
stress, a diet that is high in sugar, and deficiencies of vitamin B6, magnesium and zinc. An enzyme called delta-
6-desaturase helps your body make this conversion (see chart, page 157) and this enzyme needs B6,
magnesium and zinc in order to do its job.
If you are suffering from painful periods, it is important that you take nutritional supplements for between
three and six months, to ensure that the nutrients required for the conversion are present in adequate levels.
Supplements
Vitamin B6 - Vitamin B6 is needed to help produce ‘good’ prostaglandins, so it is worth taking a good B-
complex supplement. This vitamin has been shown significantly to reduce the intensity and duration of period
pains.
Vitamin B1- This vitamin is very effective in helping with period pain. In one study, it was given to 556 women
(aged 12 to 21 years), who had moderate to severe dysmenorrhoea. Some of the women were given the B1
first for 90 days and then changed to a placebo. Others were given the placebo first for the 90 days and the B1
next. A full 80 per cent of the women were completely cured after starting the treatment. This effect
remained for at least two months after the B1 was stopped.
Vitamin B12 - Because both vitamins B1 and B6 are helpful with treating period pains, the best approach is to
take a vitamin B complex. This will also give you vitamin B12, and it has been found that a combination of fish
oil and B12 is actually more effective than just fish oil on its own for relieving dysmenorrhoea. The scientists
could not explain why the B12 made the treatment more effective.
Vitamin E - Up to 70 per cent of women have found the supplementation of vitamin E to be useful in treating
painful periods. The reasons for this effect are unclear, but it may be that vitamin E’s antioxidant properties
help with the pain, or control the levels of prostaglandins.
Vitamin C and bioflavonoids - Bioflavonoids are helpful with period pain because they help to relax smooth
muscle and reduce inflammation. Bilberry is one of the best bioflavonoids for this, but other bioflavanoids can
be helpful. Include berries of any kind (including blackberries, blackcurrants, raspberries and even grapes in
your diet).
Magnesium - Magnesium acts as a muscle relaxant and it has been shown to have a beneficial effect on
painful periods and lower back pain, so it is worth taking as a supplement. Magnesium also has the ability to
lower the ‘bad’ prostaglandins that may be causing the womb to over contract.
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Finally, along with the vitamin B6, magnesium is required by your body to help convert the essential fats into
beneficial prostaglandins. Try always to take them together.
Zinc- -This mineral is important for eliminating period pains because it is needed for the proper conversion of
LA to GLA.
Essential fatty acids (EFAs) - Taking EFAs in supplement form is extremely important in the treatment of
painful periods. Research has shown that women with low intakes of Omega 3 fatty acids (the ones that come
from fish, linseed and walnuts), have more painful periods than women who have a good intake. The study
that found this link also discovered that the extent of the pain was connected to the ratio or balance of the
Omega 3 and Omega 6 fats. The women with the worst period pains ate a much lower ratio of Omega 3 fats in
relation to Omega 6 fats – a one to four ratio.
I would suggest adding either fish (EPA) or linseed oil capsules or hemp seeds in order to keep the ‘bad’
prostaglandins (PGE2) under control.
Bromelian- This is an enzyme contained in pineapples and it has been found to be extremely useful for
treating painful periods. It has anti-inflammatory properties and helps as a natural blood thinner. Bromelain
also acts as a smooth muscle relaxant and is thought to decrease PGE2 and increase PGE1 (the ‘good’
prostaglandins).
Above information on Dysmenorrhoea and Prostaglandins was taken from:‘The Natural Health Handbook For
Women’ by Dr Marilyn Glenville PhD. Published by ‘Piatkus’ Publishers Limited, London 2001. ISBN 0 7499
2191 9
Effect of Dysmenorrhea on Agni according to Dr. Lad
Any disease first manifests into the astral body (emotional). Many people don't know how to deal w/emotions
& suppress/control/run away. Unresolved emotions are stored up like tape recordings of every experience in the
chakras. Experiences of past lives are recorded in the brain. Temporal experience is always limited. Emotions
accumulate in chakras and are the cause of most gynecological problems due to blockage in I, II Chakras so that prana
doesn't move to the respective organ.
o Chakra I = survival, groundedness, security, reproduction

o Chakra II = sensual experience, sensual expression, lovemaking, spleen, lymphatic, adrenal, kidney,
bladder Chakra II constantly influences chakra III
o Chakra III - Agni, self power, control, ambition, achievement, pancreas, duodenum, stomach, liver,
gallbladder, gastrointestinal system. (Agni = digestion, absorption, assimilation, metabolism)
Therefore dysmenorrhea, dysfunctional uterine bleeding may influence agni. The dosha which is accumulated in the
womb reflects to affect agni. Agni is bombarded by the dosha from the womb.
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Heavy Periods
Menorrhagia - Heavy menstrual bleeding
Main Challenges (symptoms): Excessive bleeding
a. primary – P (& anemia)
b. Menopausal Change
c. fibroids
d. endometriosis/ adenomyosis
Desired results: Normalized blood loss in menses
Food
Foods with pesticides & herbicides Xenoestrogens=> + estrogen=more endo lining
“Bad” fats or too much fat and oil Liver stressed=>estrogen not processed out of system
Spicy-hot foods (Pitta) Increase inflammation
Alcohol, caffeine, drugs Liver stressed=>estrogen not processed out of system
High glycemic foods + Insulin then - SHBG then + estrogens
Non-organic dairy or meat Liver stressed=>estrogen not processed out of system

Eating after sun-down – inhibits liver cleansing time
Warming food in plastics – increased xenoestrogens into system
Irregular eating habits - + Insulin then - SHBG then + estrogens

supplements
Cruciferous veggie-cooked, chopped Contains Glucosinolate which reduces circulating
estrogens and eliminate toxins
Low glycemic foods Stable insulin => +SHBG=>- estrogen
Pitta soothing diet Reduces inflammation and bleeding tendencies
Nettles infusion -P, nourishes, esp iron for blood and adrenal glands
Ashoka in milk – 1 tablespoon in milk Astringent ; tones endometrium; removes negative
daily week before menses energies; reduces P
Shatavari in milk – daily throughout -P; nourishes the blood and female reproductive;
cycle reduces inflammation; positive phytoestrogens effect
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Shepherd’s Purse Tincture – Symptomatic relief through oxytocic and clotting
1 dropperful to 1 tsp (6 dropperfuls) up to every actions
15 min for very heavy bleeding
Yarrow Tincture – Symptomatic - Stops excessive bleeding; bitter
2-4 dropperfuls extract, 3x daily more frequent if
needed in combination formulas

Organic foods and Avoid heated in plastics; plastic #1 or #7 are safe from xenoestrogens-
– avoid xenoestrogens that increase estrogen dominance
Regular mealtimes, cut sugars & flours – to maintain even blood sugar, avoid insulin spikes
No eating after sunset, unless needed for blood sugar regulation (then avoid low glycemic)
Sleep
Staying up past 10 pm – doesn’t allow liver to detoxify leading to more estrogen build-up

Over exercising, especially during menses – increases vata
Jarring exercise, especially days before and during menses – irritates or displaces heavy uterus

Gentle exercise only – days before and during menses – prevents uterine stress and Malposition
Yoga =
Regular exercise for body type= less overheating, less competitive – reduces all menstrual symptoms by
increasing serotonin, which helps with pain; stabilizes blood sugar – reduces active estrogens; helps body deal
with stress better
Marma points for menorrhagia =(clary sage oil), Basti (yarrow eo),Guda, Nabhi, Katikataruna(yarrow eo),
Kukundara
Essential oils = mix with small amount of oil to apply – Clary sage= cooling, calming rose = astringent cooling
woman’s herb yarrow=hemostatic
Sex
Sexual practices that affect menstrual cramps, and why?
Sex during menses – irritates, displaces uterus, goes against downward energy flow
Avoid sex during menses
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How does stress affect menstrual cramps, and why?

Excess or long-term Cortisol – decreases progesterone receptor sites; lowers thyroid function; can cause
hyperglycemia which – SHBG and then +estrogens leading to increased flow
Cortisol and adrenaline increased – interfere with feedback loop of reproductive hormones
How can meditation and breathing help, and why?
Moon meditations , water meditations, pearl water/moon water – cools excess heat of estrogens and stress
Cooling pranayama – reduce excess pitta in body – reduce bleeding tendency
Dysfunctional Uterine Bleeding

Excess, random bleeding – worst case=may be symptomatic carcinoma of uterus ; during menopause – may be normally
irregular and healthy with lesser and lesser amt flow over the year
If sudden heavy bleeding that keeps coming back, not seeming to be regulated by a hormonal cycle:
For flooding (could be menopausal)
• Motherwort every 20 minutes

• Shepherds purse & lady’s Mantle & comfrey leaf tea
• Yarrow - I’ve used tincture effectively
• **Ashok or Ashokaristham
• Bilva
• Pradarantak ( a mixture of herbs)
• Rose
• Aloe vera gel as vehicle
Watch for anemia if flooding – if capillaries are iron deficient – can’t contract and stop bleeding
Iron –
• Punanarva mandura
• Nettles
• Boost – nettles, burdock, yellow dock
• Floradex
• Ferrum Phosph – cell salt
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Fibroids & Ovarian Cysts
Uterine fibroids are benign tumors. Small ones may be symptom-free. Larger or more numerous ones may cause pain,
bleeding between periods & excessive bleeding during periods. Large fibroids may also cause infertility, miscarriage,
block the birth passage of the baby or cause heavy bleeding if the placenta is planted near the fibroid. Their cause is
unclear but, again, they do seem stimulated by estrogens. Lowering estrogens slows their growth and after menopause
they often naturally shrink or disappear due to the lower estrogen levels of that stage of womanhood.
Ovarian cysts are created when the follicles which are developing to release an egg at ovulation fails to rupture or
release an egg. Susun Weed calls these angry poor sport cysts that didn't get to do the job they thought they would so
they get hot & inflamed. It is a sac containing fluid. Small ones may be symptom-free. Larger ones can cause excessive
bleeding, painful menstrual cycles, and pain in the pelvic area. The most common symptoms are lower abdominal
discomfort, with distention of the abdomen. They rarely will resist herbal treatment.
"According to the work of Dr. Catherine Kousimine, who has treated degenerative illnesses like cancer for over forty
years, cycst & fibroids are a part of the body's normal defense system.
When the liver isn't able to detoxify the system, she believes, a "second liver" is created in the form of a cyst or fibroid
This second liver performs the role of storing toxins and maintaining the organism's equilibrium." Gladstar, p 160
Therefore, if these occur - support your liver & clean up your diet & lifestyle to prevent further need of these "second
liver"s.
If you are told after a routine pelvic exam that you have fibroids or cysts and that you need surgery always get a second
opinion!!! These are not life threatening conditions and using natural remedies for at least 6 months would be worth
avoiding having someone cut into your abdomen, uterus, or ovary!
-Suggested herbs include chitrak, vidari, punanarva, Ashoka

Fibroid formula Dr V’s Class
: ashok 3 , kanchanar guggulu 3, deodar, shatavari 2, manjistha 2, kumara 3, turmeric 2
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P – fibroid inside uterus – creates blood (submucosal)

K – water retention - subserousal
P&K – Intramural fibroid (in the muscle wall)
Pitta-type – excessive bleeding
• Pitta-pacitying diet
• Lifestyle pitta soothing
• Herbs to pacify pitta – rose, hibiscus and lotus root.
• Aromatherapy – gorse, lotus, and jasmine
• Aloe Vera gel – 2 T tid w a pinch of black pepper.
• Amalaki
• Restore rakta – improve hemoglobin and iron – Punanarva mandura – ½ tsp bid
Formula for Pitta type fibroid
• Ashoka 5
• Vidari 5
• Hibiscus 3
• Chitrak 2
• Rose 1
Take ½ tsp tid after meals w 2 T aloe vera gel
Kapha type gulma (tumor) - bloating, less heavy bleeding
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Kapha pacifying diet
Avoid provoking kapha in lifestyle
Emotional roots
Herbs-
Formula for Kapha type fibroid
• Punanarva 5
• Vidari 5
• Chitak 2
• Ashoka 3
• Trikatu 1
Take ½ tsp tid daily after meals w hot water
– AND bibhitaki decoction – half teaspoon steeped in one cup boiling water at bedtime
Flu
Three types of herbs are used to treat fibroids and cysts
1. Lekhaniya – scraping – ex. shilajit and Chandra Prabha
2. Bhedaniya – break tumors into pieces and remove – ex. eranda (or castor oil). Chitrak is both lekhana &
bhedan; Punanarva regulates menses, menorrhagia; for fibroids - inhibits blood supply for fibroids ; also good
for endometriosis; tone of uterus;rejuvenative of female reproductive
3. Female aphrodisiacs – specific action on female system – shatavari, Vidari, Ashoka
Ashoka – uterine sedative – relieves cramps, reduces profuse flow, shrinks fibroids and cysts. Both pitta and kapha types
fibroids. Cool energy after prolonged use may provoke kapha. ½ tsp tid (3x daily) w one tsp honey. Constipating – use
laxative herb also.
Vidari – calms vata and pitta- endometriosis. Treat pitta and kapha type fibroids: ½ tsp bid in warm goat’s milk.
Shatavari – pacifies v and p can increase kapha. Strengthens uterine wall and regulates ovarian and uterine functions.
Nag Keshar – inhibits worsening of problems of female reproduction and reduces bleeding
ALSO: in all cases include-

Yoni basti (douche) – 1-2x weekly w/ 2 T cold-pressed castor oil or Shatavari and castor oil douche
Castor oil packs to uterine area daily (at least 6 months)
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Fibroid
Treatment - Maya Abdominal Therapy
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Maya Abdominal Therapy and Rainforest Herbs for Fibroid

We who practice the Maya Techniques of Abdominal Massage see the advantage of using these
techniques to improve circulation and normal flow around a fibroid. However we cannot specifically
state that this technique will change the size of your fibroid.
Many of our practitioners have had some shrinkage of fibroids using this technique and often
combine it with a Maya herbal formula produced by Miss Hortense - a 70 year old midwife from
Belize. Small fibroids may be helped if they are under 5 cm (one inch) in diameter determined by an
ultrasound test. (available only from Maya Therapists)
We also do not recommend the use of this formula at the same time a person is taking medication
for their heart, liver or kidneys, or hormones. If you use any kind of medication please advise your
practitioner. If you have liver or kidney problems please advise the practitioner. We recommend
the formula be taken for three cycles unless under the care of a medical professional.
While you are taking this formula it is our recommendation that you abstain from alcohol, coffee,
sugar or use of other treatment modalities unless under the recommendation of your health care
practitioner.
We are not aware of interactions between the use of this formula with accupuncture, Reiki, and
the many other healing techniques that are available to us. It is recommended you speak with your
practitioner who will be able to assist you in making the best health care choices to meet your
needs.
Some women report an increase in menstrual blood flow while taking this. If you experience
excessive bleeding; heavier or longer than you normally bleed or experience bleeding between your
normal cycle, please contact your health care practitioner. If you have stopped bleeding for more
than 6 months and start bleeding again please notify the practitioner. Until you speak with the
practitioner, please stop the herbs.
We practitioners of MAM have other ways of working with you and your fibroid, such as vaginal
steams, dietary recommendations, yoga, and castor oil packs. As with any health issue, lifestyle
such as diet, exercise, stress management, emotional and spiritual needs must be addressed.
Your MAM practitioner can assist you in your path to healing and in managing your fibroids.
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Endometriosis/ Adenomyosis
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Endometriosis: A comparison of the Allopathic and Ayurvedic models
of the disease and its treatment (by Daya Deyhim C.A.S)
Introduction
Endometriosis is the abnormal growth of endometrial cells outside the uterus. It is a complex and painful
disease affecting women in their reproductive years. The name comes from the word “endometrium” which is
the tissue that lines the inside of the uterus and is built up and sloughed off each month during the menstrual
cycle. In endometriosis, such tissue is found outside the uterus and in these areas, the endometrial tissue
develops into what are called growths, implants, nodules, lesions or tumors(1).
The most common locations of endometrial growths are in the abdomen involving the ovaries, the fallopian
tubes, outer surface of the uterus, the bladder and the lining of the pelvic cavity (1). Sometimes the growths are
also found on the intestines, in the rectum or the rectovaginal septum, the vagina, cervix or vulva. Endometrial
growths have also been found outside the abdomen in lungs, arms, and thighs however, these locations are
uncommon (1).
Endometrial growths are generally not malignant; they are a normal tissue growing outside the normal location
(1). Like the lining of the uterus, endometrial growths respond to the hormones of the female reproductive
system. They build up tissue each month, then break down and cause bleeding. However, unlike the lining of
the uterus, the endometrial growths outside the uterus have no way of leaving the body. The result is internal
bleeding, inflammation and scarring (1). The most serious consequence of this scarring is infertility (1). Other
complications can include rupture of growths, which may spread these cells to other areas.
Endometrial lesions first appear as clear vesicles, then become red, and then progress to black over a period of
7-10 years. Clear lesions are seen at an average age of 21.5 while black lesions are seen at 31.9 years (2). This
relationship between age and color of lesions confirms the progressive nature of the disease. In 47-64% of
women, this disease will progress without therapy (2). The incidence of endometriosis is about 5 percent among
American women, compared to less than one percent in European women (3).
Symptoms
The most common symptoms of endometriosis include chronic pelvic pain, pain before and during periods,
painful intercourse, heavy or irregular bleeding, repeated miscarriages and infertility (4). Other symptoms may
include painful urination or bowel movements, back pain and intestinal upset with periods. Infertility affects 30-
40% of women with endometriosis and is a common result with the progression of the disease (2).
Some women with endometriosis have no symptoms even in the more advanced stages of the disease. However,
pain during or around the time of the period is experienced by most women affected (2). This pain which
interferes in some way with all activities of daily living can be excruciating at times (5). In a recent German
survey, of the 20-29 year old women being treated for endometriosis, 90% reported menstrual pain, 80%
infertility, 71% pelvic pain, and 46% menstrual irregularities (5). In another study, the pain was found to
interfere with sleep in 78% and caused depression in 81% of the women (5).
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It is interesting to note that the amount of pain experienced is not necessarily proportional to the extent of the
disease or size of the growth. Small growths called “petechial” have been found to be more active in producing
prostaglandins which explains the severity of the symptoms that occur with small growths (6). Prostaglandins
are a group of fatty acids found in most tissues of the body where they act as second messengers within cells
and are acted upon by hormones. Prostaglandins are involved in the normal shedding of the endometrial lining
during menstruation and can contribute to pain, cramping, and digestive disturbances of dysmenorrheal (1).
Etiology
The cause of endometriosis is not known. A number of theories have tried to explain the causative factors of
this disease, however none can account for all the cases. The most common theory is the “retrograde
menstruation” also called the “trans-tubal migration” theory (1). This theory suggests that during menstruation
some of the blood and endometrial tissue backs up into the fallopian tubes, implants in the abdomen, and grows.
In other words, the blood backs up instead of exiting through the vagina and the endometrial cells present attach
to the nearby pelvic organs and begin to grow (1). Some of the experts on endometriosis believe that all women
experience some menstrual tissue back up however, not all women develop the disease. It is believed that an
immune or a hormonal problem allows this tissue to take root and grow in women who develop endometriosis
(7). Retrograde menstruation may involve an increase in estrogen or an increased sensitivity to estrogen (7).
Another theory suggests that the endometrial tissue is distributed from the uterus to other parts of the body
through the lymphatic system or the blood (7). This theory is supported by some rare cases were endometrial
tissue has been found in such distant areas as the lungs and the retina. Another group of researchers cite the
same evidence to suggest that remnants of embryonic tissue, from when the woman was an embryo, may later
develop into endometriosis in different parts of the body (7).
There are also a number of other theories which suggest that the disease may begin before the woman is born
(8). Those who subscribe to this theory are of two slightly different opinions. One group believes that portions
of adult tissue may retain the ability they had in the embryonic stage, to transform into reproductive tissue under
certain circumstances (8). Others suggest that during the embryonic stage, the endometrial cells may develop in
the wrong location, giving rise to endometriosis during the woman's reproductive years. In both cases,
researchers believe that the influx of reproductive hormones which begins with the onset of puberty, create
conditions that triggers this transformation (8).
The cause of endometriosis remains a mystery. Some clues point to an excess of estrogen (1,8). The North
American women who have the condition are typically between the ages 25-40 and are childless (2). Both
pregnancy and progesterone treatment alleviate the symptoms. Women who have not had a full-term pregnancy
are more likely to have endometriosis because apparently, the longer a woman does not have a child, the more
estrogen she is exposed to during her lifetime (7).
Other clues indicate that endometriosis may have an autoimmune component (7). In one study, all women tested
had high levels of auto antibodies which are secreted when the body mounts an immune response to its own
tissue (7). These auto antibodies are responsible for the inflammatory response which causes the pain associated
with endometriosis.
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Other risk factors for the development of endometriosis include environmental toxins and alcohol (9). In 1994,
the environmental protection agency linked endometriosis to dioxin exposure in several animal studies. Female
monkeys exposed to dioxin developed endometriosis. Similarly, PCB exposure was also implicated in
development of endometriosis (9). Dioxin, a highly toxic substance, is a chemical component of some
herbicides and is also a by-product of waste incineration. PCBs are a highly toxic byproducts of waste
incineration. It is interesting to note that the chemical structure of dioxin and several other pesticides are similar
to that of human estrogen (9). These substances are present in the food supply as contaminants and are ingested
and stored in the adipose tissue (9). Other than environmental toxins, alcohol also seems to have a role in the
development of endometriosis. A study found that women who drink alcohol have a 50% higher risk of
developing endometriosis than those who abstain (3).
Diagnosis
Diagnosis of endometriosis is considered uncertain until proven by laparoscopy (2). Laparoscopy is a minor
surgical procedure done under anesthesia in which the patient's abdomen is distended with carbon dioxide gas
in order to make the organs easier to see (3). Then, a laparoscope, a small tube with a light at the tip, is inserted
into a tiny incision made on abdomen. The surgeon can then move the laparoscope around the abdominal cavity
and see the endometrial implants. Endometriosis is categorized by and diagnosed in four stages based on the
location and type of growth (2). Stage 1 or minimal disease is characterized by superficial filmy adhesions;
stage 2 or mild disease has superficial and deep filmy adhesions; stage 3 or moderate disease has both filmy and
dense adhesions; and stage 4 or severe disease has only dense adhesions either superficially or deep (2).
It would seem that the symptoms would be sufficient to diagnose a patient with endometriosis however
laparoscopy is the only conclusive method (2). This is primarily because many of the symptoms associated with
endometriosis can have other causes and secondly, some of the women afflicted do not have any symptoms
even in stage 4 of the disease (2). A doctor can often feel the endometrial implants during a pelvic exam but
medical protocols consider it bad practice to treat this disease without confirmation of the diagnosis (2).
Ovarian cancer sometimes has the same symptoms of endometriosis and treatment with hormones, particularly
with estrogen, which is a common treatment for endometriosis could cause a cancer to grow faster (2).
Laparoscopy also shows the locations, extent and size of the implants and may help the doctor and patient make
better informed decisions for long-term care and pregnancy.
Researchers are looking into a blood test to assist in the diagnosis of endometriosis. Ca-125 is a cellular protein
found in pelvic organs that appears to be elevated in cases of moderate to severe endometriosis (6). This is still
in the experimental stages and laparoscopy is expected to remain the conclusive diagnostic method.
Treatment
The medical treatment of endometriosis is aimed at controlling the pain and/or shrinking the endometrial tissue
(4, 6). Treatment has varied over the years but no cure has been found. A total hysterectomy, which is the
removal of the uterus and the ovaries is considered to be the only definitive cure (6, 10). There are three broad
treatment methods: treatment with drugs, treatment with surgery, and combination of drugs and surgery (10).
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Drug or hormonal therapy aims at suppressing the activity of ovaries and slowing the growth of endometrial
tissue (6). Some doctors recommend the long-term use of low-estrogen, high-progestin birth control pills unless
a woman is trying to get pregnant (6). This form of treatment tends to lighten or even stop menstruation which
keeps the stray endometrial tissue from growing. Of the drugs used to treat endometriosis, birth control pills
have the mildest side effects (6, 10).
Another hormonal treatment approach is to suppress the body's production of estrogen. There are a number of
drugs in this category and they generally work by reducing or shutting down the production of Follicle
Stimulating Hormone (FSH) and Leutenizing Hormone (LH). One such drug is called Danazol which is a
powerful drug with actions similar to that of the hormone Testosterone (10). It works by reducing FSH and LH
levels and is taken for six to nine months at a time. Danazol has been shown to improve symptoms and shrink
the size of the implants for 89% of the women who take it (10). However, women who use it may have serious
side effects including pseudo-menopause, hot flashes, vaginal dryness, joint pain, muscle cramps, weight gain,
depression, irritability, and acne (6). In extreme cases, there is masculinization which manifests as voice
changes, reduction in breast size and overgrowth of body hair (10). In addition to these, about 30% of women
treated with Danazol experience infertility later on and for those who conceive, there is a high rate of recurring
pain after pregnancy (10). Because of its many side effects, Danazol is seldom used anymore.
The most commonly used hormonal drugs are called Gondotropin-releasing hormone agonists (GnRHa) (6).
These are derived from Gonadotropin-releasing Hormone (GnRH) which is a hormone secreted by the pituitary.
These drugs shut down the production of FSH and LH by overloading the pituitary's production facilities. In
effect, the GnRH analogs put an end to ovulation without removing the ovaries (6,10). The resulting condition
is a near menopausal state characterized by an absence of menstruation and a significant reduction in estrogen
levels which in turn stops the endometrial growths and reduces the pain of endometriosis. Side effects include
hot flashes, mood swings, vaginal dryness, and calcium loss from bone. The side effects are halted by going off
of these medications and fertility is regained (10). GnRH analogs can be taken as a nose spray called Nafarelin
(synarel) which relieves the symptoms and shrinks the implants. In a study involving 247 women treated with
Nafarelin for six months, 85% had their implants shrink or disappear and other symptoms relieved (10).
However, six months after treatment, the symptoms returned to half the women who had been initially helped.
Side effects of Nafarelin are similar to discomforts of menopause and include hot flashes, vaginal dryness, less
frequent or no menstruation, as well as headaches and nasal irritation (10). Another GnRH-a used in the
treatment of endometriosis is Leuprolide which is administered as an injectable drug called Lupron or monthly
implants beneath the skin called Zoladex (2, 10). The mechanism of action and the side effects are the same as
that of Nafarelin. Treatment with Lupron consists of one injection a month for six months. In clinical studies,
the effectiveness of Lupron can be compared to Danazol without all the potential side effects (2, 10).
In addition to hormonal drugs, pain killers are commonly prescribed. These are non-steroidal anti-inflammatory
drugs (NSAIDs) and include Naprosyn, Ponstel, Rufen, Meclomen, Motrin and a few others. In cases of severe
pain, narcotic drugs such as Codeine, Oxycodone, or even Morphine may be prescribed (6, 10).
When there is moderate to severe endometriosis, drug therapy will not be sufficient to alleviate the symptoms
and surgery may be necessary (10). In general surgery is needed when patches of endometrial tissue are larger
than 1.5-2.0 inches, when there are significant adhesions in the lower abdomen or pelvis, for endometrial
growths that are obstructing one or both fallopian tubes, or when the pain is severe and not alleviated by drug
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therapy (10). Often the tissues are removed during laparoscopy when the definitive diagnosis is made (2).
Laparoscopy is a minor surgical procedure done under anesthesia in which the patient's abdomen is distended
with carbon dioxide gas to make the organs easier to see and a laparoscope (a tube with a light at the end) is
inserted through a tiny incision made on the abdomen (3). Laparoscopic surgery may involve electrocautery,
burning of the tissue with electrical current, or laser to remove endometrial tissue. The advantage of this
surgical approach, besides a shorter and less expensive hospital stay, include less likelihood of complications;
reduced tissue injury , bleeding and scar tissue formation; rapid diagnosis and treatment; and an easier, faster
and less painful recovery (10). It is an effective method of directly attacking the causes of pain and infertility
which are the main concerns of the sufferers. The potential side effects of laparoscopy are mainly associated
with instrument insertion, heat injury, and potential anesthetic complications (10).
Another surgical approach is Laparotomy (6). Unlike laparoscopy, this procedure involves the opening up of the
abdominal cavity and is considered major surgery. This is done when endometriosis is so widespread and
perhaps accompanied by other related diseases that it cannot be handled through the tiny incision used in
laparoscopic surgery (10). For example, bladder, bowel and kidney involvement may require special surgical
procedures only possible with Laparotomy (10). Also if there are very large cysts to be removed or large
endometrial growths that form a mass involving a number of organs, Laparotomy is the only practical method.
(10) There are a number of other operations and related tests that may need to be performed as part of the
treatment for endometriosis. These may include: Neurectomy, cutting or blocking the nerves that transmit the
pain of endometriosis; Salpingectomy, removal of a fallopian tube; Intravenous pyelogram, an X-ray
examination of kidney, bladder, and uterus using an injected dye; as well as several other procedures to look for
adhesions in colon, lungs and other areas (10).
The third approach in the treatment of endometriosis is to use the combination of drugs and surgery (6,10). In
this method, medicines are used for six weeks prior to surgery to shrink endometrial tissue and ease the surgical
removal. Following the surgical removal, doctors may prescribe a low dose estrogen-progestin birth control pill
to be taken for up to nine months (6).
Unfortunately, the relief of symptoms that follows surgery is frequently only temporary (10). As a last resort, a
total hysterectomy is performed which involves the removal of the uterus and both ovaries. Menopause also
generally ends the activity of mild to moderate endometriosis. In cases of severe endometriosis, post-
menopausal hormone replacement therapy can reactivate the disease (10).
Etiology of Chronic Disease According to Ayurveda
According to Ayurveda, most chronic disease come about when toxins (ama) accumulate in tissues and start to
disrupt the delicate balance of the tissues. Toxic build up can also obstruct the channels of circulation and
elimination in the affected areas (11, 12). This blockage prevents proper nutrition from reaching the tissues and
also prevents the removal of the tissue waste. As a result of this toxic buildup, the natural defenses are lowered
and the natural biological rhythms are disrupted (11,12).
This is the very process whereby all chronic disease, including endometriosis is created. In the case of
endometriosis specifically, chronic toxin accumulation in the reproductive tissue irritates the tissue into
responses that result in the slow accumulation of excess tissue (13). Since the accumulation of ama is the
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underlying factor here, it is vital to stop the process of ama creation and accumulation. This can be done
through various means including: improving digestion by regulating the digestive fire (Agni), eating foods that
are nourishing and easy to digest, ensuring proper elimination, and by balancing the mind (12,13).
Endometriosis According to Ayurveda
According to Dr. David Frawley, Endometriosis is primarily a Kapha problem due to the increasing buildup of
cells and overgrowing much like a tumor (11). Endometriosis can also be thought of as a Pitta problem because
of the involvement of blood, hormones, and menstruation as well as the inflammatory nature of the disease (14).
Vata is also involved in a number of ways. One is the painful nature of endometriosis which places Vata at the
center of the imbalance. Then, there is the involvement of Apana Vayu in the downward movement of
menstrual flow and also the involvement of vata in the circulation of blood. Perhaps the most obvious sign of
the role of Vata is the displacement of endometrial cells from their original location in the uterus to places
outside. Therefore, endometriosis is a Sannipatika condition involving all three doshas although the proportion
of each may vary to a certain extent according to the individual patient.
Let us examine the Charaka Samhita for verification of above statements. According to Charak, that which can
be diagnosed as a vatic disorder has the qualities of roughness, instability, dislocation, division, attachment and
piercing pain (15). Among these qualities dislocation (dislocation of cells from inside to outside of
endometrium), attachment (of ectopic endometrial cells to other organs), and piercing pain are the main
characteristics of endometriosis. Of the pittika symptoms mentioned, only hemorrhagic patches and thickening
of skin are present in endometriosis (15). Among the kaphaja symptoms mentioned, chronicity is the only one
that applies to endometriosis (15).
Of the three sources found, one strongly emphasizes the role of pitta in the etiology of endometriosis and
another considers vata as the main cause through the involvement of the mind (12-14). I personally consider it a
condition of Vata pushing Pitta pushing Kapha out of balance. My rationale for this is the very definition of
endometriosis which is the growth of endometrial cells outside the uterus. This to me, places Vata at the base of
the problem. Also, if we consider the modern medicine's theory of retrograde menstruation, we can see the
involvement or rather the obstruction of Apana Vayu which holds Pitta (blood) and causes it to move up and
around. Pitta then becomes vitiated causing heavy bleeding and inflammation. This pitta vitiation creates an
irritation which induces kapha to enter to provide comfort by coating the irritated area. The kapha influence
then causes a buildup of cells and overgrowth. Thus, the Sannipatika nature of the disease.
According to the Charak, there are twenty types of Yoni Vyapat or vaginal disorders, none of which seem to
describe endometriosis individually. However, Madhava Nidhanam, a text of clinical symptomology, has
references to disorders that have some similarities to endometriosis. The reference that I considered closest to
endometriosis was that of Yoni Kanda or vaginal tumor (16). The text states:” If the mass is rough, discolored,
and fissured, it is of vata origin; burning sensation, red color, accompanied by fever, is of pitta origin; blue and
resembling a flower of linseed and having itching are found in that of kapha origin. Presence of all three
symptoms is that caused by the increase of all three doshas are seen as the features of this disease” (16).
Treatment
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Since disease is a result of toxin accumulation, poor nutrition, poor digestion, and imbalances of the mind and
nervous system, treatment must include steps to correct the imbalances and reverse the process of disease
(12,13). The goal of the Ayurvedic approach is to enliven the body's natural self-healing abilities to not only
treat endometriosis, but also to prevent disease in general and create a state of health and well-being.
Since endometriosis is a condition of ama accumulation, the treatment should focus on detoxification/reduction
or Shodana therapy in order to remove the ama and get the doshas back into their original locations (13,14).
Therefore, Pancha Karma is indicated along with Agni therapy. Most importantly, the liver should be cleansed
or tonified as it has a role in menstruation and hormone production (14).
Prior to Pancha Karma the dietary and digestive issues must be addressed. There are two parts to the digestive
issues: one is the problem of insufficient Agni which is a precursor to ama formation and the other is the issue
of proper nutrition (12). A highly nutritive and easily digestible diet with sufficient amounts of digestive herbs
should be the first step toward treatment. A good example of this is the CCA Sannipatika food program (17).
The patient can be placed on the food program for forty days and given herbs to support proper digestion and
elimination. This will help cleanse some of the ama, provide nourishment and enough time to nourish all seven
tissues, and regulate the agni to prevent further ama production. At the end of this period the patient will be
ready to proceed with Pancha Karma for deep cleansing.
The process begins with daily Ayurvedic oil massages and body treatments to loosen up the ama, collect it from
different parts of the body, and bring it back to the digestive system for elimination (17). These treatments will
also help pacify the mind and the emotions as the patient undergoes cleansing. According to several sources, a
combination of Abhyanga, Swedana, shirodhara and Basti are given daily for seven days or more while the
patient consumes a diet of broths and light kitchari (13,14,17). At the end of this period, the ama has returned to
the digestive system and needs to be eliminated. Also, by this time during the course of treatment, Vata dosha
has become pacified and it's excess eliminated. The next step is to eliminate the excess pitta through Virechena.
Patient is given castor oil and placed on a diet of broth for 24 hours (14, 17). Through the purgation that results,
pitta ama is eliminated from the small intestine, thus pacifying the second dosha involved in the causation of
endometriosis. None of the sources studied mention the use of Vamana therapy for kapha elimination in the
treatment of endometriosis. Perhaps this is because endometriosis is primarily a condition of Vata pushing Pitta
which eventually pushes kapha out of balance. As it was hypothesized earlier in this paper, it is likely that the
irritation caused by Pitta induces Kapha dosha to thicken the tissue in some areas, resulting in endometrial
buildup which later on form the adhesions. Thus, it is believed that when Vata and Pitta doshas are successfully
reduced, Kapha dosha will retract in response.
In an innovative approach, Dr. Frank Ros combines diet, herbal medicine, Pancha Karma and Ayurvedic
acupuncture (Marma Therapy) to treat endometriosis (14,18). The acupuncture portion of the treatment focuses
on the reproductive and endocrine systems and on the organs liver, gallbladder, spleen and stomach. They also
consider kidney and bladder due to their association with the reproductive system. Pitta will relate to the liver
and gallbladder as well as spleen, Vata will relate to the kidneys and bladder and kapha will relate to the spleen
and stomach. The dhatus affected are Rasa dhatu (menstruation) and Rakta dhatu (blood) as well as majja dhatu
(nervous system/ pain). The srotas involved are artavavaha srota and also manovaha srota due to the
involvement of pain and emotions that accompany the condition. There are acupuncture points for each of the
above organs, dhatus, and srotas but their names and descriptions are beyond the scope of this paper.
Page 48
In a case study, Dr. Ros and his team outline their therapeutic approach to endometriosis (14). Their patient was
a 31 year old mother of two with severe endometriosis for 2 years. She had tried laser cauterization to remove
the endometrial growths but that had not reduced her pain. She also suffered from frequent migraines and
outbursts of anger. The patient was first evaluated ayurvedically to determine Prakruti and vikruti. She was
diagnosed as Sannipatika with a primary pitta vitiation based on a full Ayurvedic evaluation including pulse and
tongue diagnoses. She was given castor oil virechena and asked to fast for the day until the evening. At the
second visit a week later, she was counseled on remembering and releasing past emotional trauma which was
successful in revealing some deeply suppressed emotions. The patient was given a combination of turmeric,
fennel, coriander, ginger, cumin, fresh aloe gel, mixed in ghee and honey, 2 grams to be taken three times a day
for three weeks. She was also asked to drink two liters of warm water in the morning for a week. She was also
asked to do virechena just prior to the onset of her menstruation for the next two cycles.
The following week she continued with counseling and began a series of treatments starting with an abhyanga
with marma pressure and acupuncture simultaneously and then swedaana in the form of sauna heat. The needles
were placed on one side of the body at a time following the application of massage to the side. The needles were
then removed and the patient was asked to turn over and the same thing was repeated on that side. The massage
which focused on the lymph nodes and marma points, started with the patient lying on her stomach, lasted about
an hour and a half, and was done so that each needle remained inserted for at least twenty minutes. On this visit
she was given an extract of angelica, vitex, black cohosh, and myrrh to be taken 5 mls, initially three times a
day for a week, then twice daily to be taken for six weeks altogether. On the fourth week, she was prescribed a
cleansing diet of vegetable juices in the morning and kitchari for noon time and evening to be continued for a
month. She was also given a commercial liver cleanser to be taken for two months.
The results of this combined treatment are as follows: After the first week patient felt %50 improvement at the
time of her period, which continued to improve over time. After undertaking the liver cleansing regimen, she
suffered several severe migraines until they went away altogether. Eight weeks after the start of the treatment,
she no longer experienced any pain during her periods nor did she have any more migraines. The patient was
followed up for eighteen months and she remained completely symptom free during this time.
This case study once again demonstrates the strength of the Ayurvedic model in understanding the imbalances
on a fundamental level and visualizing the root causes of all disease. The treatment focuses on balancing the
imbalances in the person and not on the treatment of the disease or its symptoms. The western model, though
advanced in diagnostics, remains largely unsuccessful in treatment. This is not surprising given that the etiology
remains unknown. Although there are a number of theories that try to explain the causes of endometriosis, none
can account for all the symptoms nor could they ever reach the depth necessary to arrive at the underlying
causative factors. Indeed, it is in the treatment of complex diseases such as endometriosis that the gifts of
Ayurveda can be truly appreciated.
References
1. Farquhar C. Endometriosis. Clinical Evidence, Dec 2002, (8) p1864-74

2. Frackiewics EJ, Zarotsky V. Diagnosis and treatment of endometriosis. Expert Opinions in
Pharmacotherapy, Jan 2003, 4 (1)p67-82.
3. Deevey S. Endometriosis: Internet Resources. Medical Reference Serv Q, Spring 2005, 24 (1)p67-76.
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4. Schattman GL. Treatment of chronic pelvic pain in patients with endometriosis. Human Reproduction,
Apr 2002, 17 (4) p1128-36.
5. Jones G, Jenkinson C, Kennedy S. The impact of endometriosis on quality of life: a qualitative analysis.
Journal of Obstetrics and Gynecology, Jun 2004, 25(2) p123-33.
6. Olive DL, Pritts EA. The treatment of endometriosis: a review of the evidence. Annals of NY Academy
of Sciences, Mar 2002, 955 p360-72.
7. Wells M. Recent advances in endometriosis with emphasis on pathogenesis, molecular pathology, and
neoplastic transformation. International Journal of Gynecological Pathology, oct 2004, 23 (4) p316-20.
8. Bischoff F, Simpson JL. Genetic basis of endometriosis. Annals of the NY Academy of Sciences , Dec
2004, 1034 p 284-99.
9. Louis GM, Weiner JM, Whitcomd BW, et al. Environmental PCB exposure and risk of endometriosis.
Human Reproduction, Jan 2005, 20 (1) p279-85.
10. Olive DL. Medical therapy of e3ndometriosis. Seminars in Reproductive Medicine, May 2003, 21 (2)
p209-22.
11. Frawley, David. 1989. Ayurvedic Healing. Passage Press.
12. Lad, Vasant. 2000. Textbook of Ayurveda. The Ayurvedic Press.
13. WWW.theraj.com . The Root Causes of Fibroids and Endometriosis.
14. Roper, Jack. Ayurvedic Treatment of Endometriosis. 1998. Australian college of Ayurvedic Medicine
Publication .
15. Caraka Samhita. Sutrasthana. Chapter XX, verses 12-18.
16. Madhava Nidhanam. Chapter 62, verses 3-4.
17. Halpern, M. 2002. California College of Ayurveda. Year one student workbook, section 8.
18. Ros, Frank. 1994. The Lost Secrets of Ayurvedic Acupuncture. Lotus Press.
- See more at: http://www.ayurvedacollege.com/articles/students/endometriosis#sthash.gyImcMxN.dpuf
Herbs for Endometriosis - Ayurvedic
Medicines include usage of herbs that help strengthening the immune system which in turn helps the glands
function properly and create a hormonal balance
1. 20gms of Daruharidra (Oregon grape root) [Berberis aristrata] Pitta Reducing - boil in 8cups of water
[500ml] reduce to 1 cup[50ml]. Filter and drink every morning empty stomach for 3 menstrual cycles.
This tea can be taken 2 times a day. This strengthens the uterus controls bleeding and also alleviates
pain. The following herbs can also be used instead of Daruharidhra; Lodhra [Symplocos racemosa],
Arjun [Terminalia arjuna].
2. 5gms of Shatavari [Asparagus racemosus var. javanica], 5gms of Vidari kanda [Pueraria tuberosa], 3
gms of Arjun [T. arjuna]. PV- Boil this herbs in 50ml of cow’s milk and 150ml of water till milk remains.
Page 50
Filter and drink once a day. This is very effective tonic. This medicine must be used once the bleeding is
controlled and menses become regular by medicine 1
3. Soak Anantmool root[Hemidesmus indicus] 10gms in a ceramic vessel in a cup of boiling water. Next
morning filter and consume by adding 1tsp of cumin and 1tsp of sugar. repeat the procedure in
evening and night. This medicine effectively controls bleeding and helps the quality of blood improve.
It can be combined with medicine 1 if symptoms are severe.
4. Chandraprabha vati [with shilajit] is a generic Ayurveda preparation. 2 tablets [250mg each] two times
a day with pomegranate juice/ cow’s milk must be taken. This strengthens the ovaries and helps
prevent cysts.
5. Ashwagandhaaristha is a medicated wine which is an excellent medicine to strengthen the uterus. 5ml
of the wine diluted with 10ml of warm water two times a day for 3 -4 months. The above tablets can
be consumed with it for better results.
6. Use of a mild laxative is recommended to strengthen the intestine and prevent build up of toxins. A
simple formulation is as follows. Rose petals 20gms, Triphala powder 20gms, Senna leaves powder
[Cassia senna] 10gms, Fennel seeds 10gms, Black salt 5gms. Mix this powders and store in a clean glass
jar. 1tsp of the powder with warm water at bedtime does the job. If powders are difficult to intake, one
can boil 5gms rose petals, 20gms of black raisins in 3 cups of water, reduce to 1 cup [60ml], filter and
consume. This is also a good remedy for constipation.
7. The drug Bala which is potentially a vata soothing and helps in making the endometrium responsive for the
hormones and preparing a healthy nidation for the zygote. It also helps the ovaries to produce a matured follicle
and release of oocyte. Bala not only pacifies vata but also pitta calming. It is also acts as pain killer and anti-
inflammatory which reduces the inflammatory reaction induced in the surrounding pelvic tissues which is
occurred because of endometriosis. It reduces the chronic pelvic pain. It is also helps in controlling menorrhagia.
8. The other important drug is Guduchi. The Guduchi oil explained in Charaka chikitsa and Sarangadhara samhitha
indicates it as the best tridoshic action. Guduchi oil cures all the vata disorders. Guduchi is also rasayana. This
can be used to treat the arthava vaha srotas imbalance as it is best Rasayana and it alleviates the chronic pelvic
pain and dysmenorrhoea.
9. Ashoka is another drug which is most useful in endometriosis. It acts as pain reliever (vedana sthapaka),
haemostatic (raktha sthambaka). It stimulates uterine myometrium and regulates the contractions which help in
preventing retrograde menstrual flow and it also helps to stimulate the ovaries which promote the proper
functioning of ovaries. It prevents the dysmenorrhoea. Ashokarishta is an herbal preparation of Ashoka and
other herbs that is very helpful for most gynecological conditions, including endometriosis.
More Endometriosis-healing herbs
With endometriosis there is a lot of inflammation and pain. A smart plan to reduce and heal endometriosis
would be to reduce inflammation, promote circulation, reduce pain, promote hormonal balance, support
proper immune response, work to reduce excess tissue growth with astringent and toning herbs.
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• Ashwagandha (Withania somnifera): Supports overall endocrine system function. Supports proper
immune response, aids in possible autoimmune fertility issues. Vata soothing (pain).
• Bee Propolis: Bee Propolis is a resinous mixture of tree sap, tree buds, tree leaves and other botanical
sources that the bees make to seal small openings in their hives. A study published in Fertility and
Sterility (2003;80:S32) showed that 60% of women with endometriosis related infertility who took
500mg of bee propolis twice a day for 9 months became pregnant as opposed to 20% in the placebo
group. Endometriosis pain, scar tissue and adhesion formation is thought to be triggered by
inflammation response. Bee propolis has been shown to be extremely anti-inflammatory which may
reduce endometriosis. Bee propolis may also contain immunomodulating properties. This may be
beneficial for autoimmune related fertility issues. Some doctors theorize that endometriosis may be an
autoimmune disorder.
• Burdock root (Arctium lappa): pitta reducing. Supports overall liver function for improved hormonal
balance. Cleansing for the entire body, especially where congested tissues and organs are present.
• Castor Oil, oil pressed from bean (Ricinus communis): When Castor Oil is applied as a pack to the
abdomen it can be used to enhance circulation and promote healing of the tissues and organs
underneath the skin. Castor oil works to dissolve foreign tissue growth, including endometriosis.
• Cinnamon bark (Cinnamomum spp.): Reduces heavy menstrual bleeding. Improves circulation to
reproductive system for improved healing of congested tissues.
• Dong Quai root (Angelica sinensis): Dong Quai increases circulation, which helps to bring in fresh
healthy blood to remove excess tissue growth, heal tissue damage, limit scar tissue and adhesion
formation. Healthy circulation ensures healthy natural cleansing of the body as well. Proper circulation
is required to remove toxins, dead tissue, diseased tissue, metabolic waste from our bodies. This is
very important for women with endometriosis. Dong Quai stimulates healthy immune response,
reduces depression, fatigue and psycho-emotional symptoms associated with endometriosis.
• Feverfew aerial parts (Tanacetum parthenium): Has been used for hundreds of years for painful
menstruation, and migraine headaches associated with the menstrual cycle.
• Ginger root (Zingiber officinale): Anti-inflammatory. Increases circulation, which also helps to reduce
inflammation. Supports proper digestion, very important for inflammatory conditions. Reduction in
inflammation reduces pain.
• Goldenseal root (Hydrastis canadensis): Anti-inflammatory. Reduction in inflammation may help to
prevent scar tissue and adhesion formation. Reduction in inflammation reduces pain. (endangered so
use sparingly)
• Horsetail aerial parts (Equisetum arvense): Excellent astringent action for toning, healing of excess
foreign tissue growth and bleeding. Promotes proper tissue growth and function. (not for long-term
use)
• Jamaican Dogwood root (Piscidia erythrina): This herb is extremely antispasmodic and analgesic. It
reduces muscular pain associated with foreign tissue growth and bleeding that comes with
endometriosis.
• Maca (Lepidium meyenii): Helps to balance the hormones, but does not contain any hormones itself. It
is able to do this by nourishing and balancing the endocrine system. This is essential in preparing for
women with endometriosis because healthy hormonal balance contributes to healthy fertility
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• Nettles aerial parts (Urtica dioica): Supports healthy iron levels, which is important for conditions
where internal and/or excessive menstrual bleeding is taking place. Supports proper liver function as
well for hormonal balance support.
• Red Raspberry leaf (Rubus idaeus): Raspberry leaf works to tone the uterine muscles and normalize
blood flow during menses. This is one of the best normalizing herbs for the female reproductive
organs. Raspberry leaf is astringent, contracting and shrinking internal and external body tissues. May
help prevent hemorrhage excessive bleeding. Helps to reduce bleeding of endometrial tissues.
• Rehmannia root (Rehmannia glutinosa): Effective at reducing inflammation and
uterine spasm. It works to curb mid-cycle bleeding, as well as excessive bleeding,
two common issues endometriosis patients often deal with.
• White Peony (Paeonia officinalis): Peony has been found to aid in increasing
progesterone levels, lower testosterone and balance estrogen. Overall this herb has
excellent hormone balancing support. It also aids in pain reduction and relaxation.
Moves the blood in the pelvic area, good for uterine stagnation.
• Yarrow (Achillea millefolium): It promotes circulation, yet is extremely astringent, stopping excessive
blood flow associated with endometriosis. Yarrow is one of the best herbs to stop heavy bleeding due
to endometriosis. Yarrow has been used to stop internal bleeding caused by endometriosis. Relieves
pelvic congestion.
In Addition to Herbs-
Diet should be followed -
DIET: Vata soothing but respecting Pitta and Kapha

• Consume a vegan/vegetarian (pitta/kapha reducing) diet in week before menses, and soups in the day
before and through the heavy flow days if there is bowel pain present.
• Reduce Gluten (or eliminate if you have bowel pain – it causes inflammation)
• A diet of no wheat, dairy and red meat has been found to help drastically reduce painful symptoms of
endometriosis during the period. Dairy and eggs are full of estrogen, and best to be cut out in people
who are estrogen dominant
• Follow principles of an anti-inflammatory diet, limit or eliminate all High Fructose Corn Syrup, refined
sugars, refined pastas and breads, and fried greasy or fast foods or snack foods. There seems to be a
correlation between endometriosis and candida
• Eat ‘Live’ Fermented foods
• Avoid Xenoestrogens and Metallo-estrogens (non-organic food, pesticides, plastics, chemicals in your
body and hair care, etc.) Estrogen is what contributes to the pain of endometriosis.
• Avoid exposure to plastics-as xenoestrogen (don’t drink bottled water, don’t store food in plastic, etc.)
• Juicing during painful days
• On the first day of menses, when bowel pain is often worse, eat broth. A nourishing broth idea, from
herbalist Kami McBride: 1 cup miso to 1/2 cup tahini and 1 tbsp spirulina powder...blend together and
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• store in fridge. To eat, use 1 or 2 tbsp of this to a cup of warmed bone marrow broth or plain water to
taste.
Foods with pesticides & Xenoestrogens=> + estrogen=more endo lining

herbicides
“Bad” fats or too much fat and oil Liver stressed=>estrogen not processed out of
system
Spicy-hot foods (Pitta) Increase inflammation
Alcohol, caffeine, drugs Liver stressed=>estrogen not processed out of

system
High glycemic foods including + Insulin then - SHBG then + estrogens

alcohol
Non-organic dairy or meat Liver stressed=>estrogen not processed out of

system
Soy Anti-calcium
Yoni bastis - during the luteal phase do Pitta reducing yoni bastis - raspberry leaf and rose with ashoka
Pitta reducing lifestyle - inflammation is a big part of Pitta discomfort - this may be an important factor.
Meditation and pranayama - to strengthen and calm the nervous system; reduce stress hormones- thereby
rebalancing progesterone/estrogen balance
Mudras - energetic support of the female organs
Marma points - for uterus/reproductive points, liver & gallbladder, spleen, kidney & bladder
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Adenomyosis requires a bit different handling than endometriosis as along with hormonal changes there is
physical trauma. If D&C is done it increases adhesions leading to uncontrolled bleeding. A strict diet is required
along with meds
Anantamul is a good herb I have found to control bleeding.
Along with this,+- Apple Cider vinegar [with mother] , (not refined )and Black Strap molasses [unsulphured]
help: 2 tsp of ACV + 1tsp of BSM and dilute with almost 300ml water. taken once morning empty stomach
and at bedtime.
The herb Lodhra [Symplocos racemosa] along with above helps dissolve masses. However this has to be
coupled with good diet and strict lifestyle. Results seen usually within 3 menstrual cycles
from: Sumit Ashok Kesarkar
PMS – Premenstrual Syndrome

Mood swings with Menses
Main Challenges (symptoms): Menstrual Mood Swings – a. anxiety
b. anger/irritability
c. depression
Desired results: Happier Menstrual Cycles
Food
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Warming food in plastics – increased xenoestrogens into system
Irregular eating habits - + Insulin then - SHBG then + estrogens

supplements
Cruciferous veggie-cooked, Contains Glucosinolate which reduces circulating
chopped estrogens and eliminate toxins
Low glycemic foods Stable insulin => +SHBG=>- estrogen
Pitta soothing diet- for anger Reduces inflammation and bleeding tendencies
Nettles infusion – for anger & -P, nourishes, esp iron and calcium for blood and
anxiety adrenal glands
Oatstraw infusion – for anxiety -VP, nourishes nerves with minerals and adrenal
glands
Brahmi tea with a little honey -VP; serotonin precursors (not w antidepressants)
Shankapushpi -VP; strengthens nerves; repels negative energy
Ashwaganda -V calms nervous system
Shatavari in milk – daily -P; nourishes the blood and female reproductive;
throughout cycle reduces inflammation; positive phytoestrogens effect
Vidari -V, adrenal rejuvenation; nerves work better
Flower essences - personalized Smooths emotional body allowing emotions to flow
more functionally
Regular mealtimes and snacks – to maintain even blood sugar, avoid insulin spikes
Vata soothing diet – if mainly anxiety
Pitta soothing diet – if mainly anger/ irritability
Sleep
Staying up past 10 pm – doesn’t allow liver to detoxify leading to more estrogen build-up
Irregular bedtime and rising – doesn’t allow body to relax into rhythms
Sleeping in room that isn’t dark, cool

Over exercising, especially during menses – eventually increases vata and activates the adrenals

Sleep herbs if needed – Ashwaganda/Shankapushpi milk –calms for better sleep
Lemon balm bath – calms
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Essential oils – to help calm and ground – vetiver, ylang ylang, vanilla; to cool – rose, sandalwood

Gentle exercise only – days before and during menses – prevents uterine stress and Malposition
Yoga =
Regular exercise for body type= less overheating, less competitive – reduces all menstrual symptoms by
increasing serotonin, which helps with pain; stabilizes blood sugar – reduces active estrogens; helps body
deal with stress better
Marma points for moods =(), Basti (yarrow eo),Guda, Nabhi, Katikataruna(yarrow eo), Kukundara
Self massage= no massage during menses-;For whole body massage: V use sesame oil; P use almond oil;
then shower or bathe warm, not terribly hot water
Essential oils = mix with small amount of oil to apply – Clary sage= cooling, calming rose = astringent
cooling woman’s herb yarrow=hemostatic
Sex
How does stress affect mood swings, and why?
Cortisol and adrenaline increased – interfere with feedback loop of reproductive hormones
How can meditation and breathing help, and why?
Body or imbalance types Meditation/ breathing

Vata Mantra repetition or following breath meditation; Alternate nostril; deep belly
breathing; (ashwini mudra-not during menses)
Pitta Follow breath meditation; Moon/water meditation; Cooling breath; alternate
nostril; deep belly breathing; pearl/moon water
VP Use above per cycle – vata before bleed; pitta as bleeding
PMS Study: Mood Swings From Menstruation May Not Exist, Study Finds
The Huffington Post Canada | Posted: 10/18/2012 1:02 pm EDT Updated: 10/18/2012 5:23 pm EDT
Women may be cheery one minute and angry the next — but whatever mood they're in, you officially can't blame their periods.
Premenstrual syndrome, or PMS, may be an utter myth, according to new research from the University of Toronto. The study found
that there was no obvious link between women's negative mood swings and the premenstrual phase of their cycles, according to a
press release.
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The university studied 41 research reports that tracked the change in women's moods throughout their periods, both before and
during. Their findings showed no evidence that PMS itself even existed.
“There is so much cultural baggage around women’s menstrual cycles, and entire industries built around the idea that women are
moody, irrational — even unstable — in the phase leading up to menstruation,” says Dr. Gillian Einstein, director of U of T’s
collaborative program in Women’s Health in a press release. “Our review — which shows no clear evidence that PMS exists — will
be surprising to many people, including health professionals.”
People have blamed mood swings on a woman's "time of the month" for years, with women dubbed irrational or emotional by men,
friends or even themselves. A Glamour magazine poll found that 58 per cent of women blamed their periods for their emotional
outbursts.
Recently, the stereotype of getting emotional while having your period has been challenged. Besides this U of T study, some
companies like Kotex created satire tampon ads highlighting the stupidity of twirling around in your white spandex while
menstruating. And earlier this week, feminine hygiene company BodyForm created a hilarious and sarcastic video response to one of
their Facebook users, who'd found out the "ugly truth" of what a period was really like.
The university's research also found that out of all the reports that were examined, only six (or 13.5 per cent) showed links between
negative moods and the premenstrual phase, Einstein added. The research also concluded that these reports in particular may be
skewed for preconceived notions.
“Before women even get their first period, they have heard about PMS. The notion is so ingrained in our culture that some of these
studies are actually biased because women know the study is about PMS,” says Einstein,
The research, however, did not touch on premenstrual dysphoric disorder (PMDD), a clinical disorder that affects the mood while a
woman is on her period. PMDD symptoms are often more severe than mood swings in general and these may include depression,
anxiety, insomnia, fatigue and headaches, according to Mood Disorders Association Of Ontario.
And even if PMS may not exist, cramps still do. At least 40 to 70 per cent of women feel some type of discomfort or pain when
they're on their periods and this can include feeling bloated and losing energy.
Do you still think PMS exists? Let us know in the comments below.
http://www.huffingtonpost.ca/2012/10/18/pms-study_n_1979965.html#slide=more240828
Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)
Many women experience symptoms of Premenstrual Syndrome (PMS). In some instances the mood symptoms and
emotional components of PMS are the most troubling. To women in such cases, PMS is often referred to as
Premenstrual Dysphoric Disorder (PMDD).
Premenstrual Dysphoric Disorder is a more severe form of PMS, affecting 5-10% of women in their reproductive years. In
contrast to PMS, PMDD is characterized by more significant premenstrual mood disturbance that can seriously impact
relationships and impair functioning. Many women with PMDD experience clinical levels of depression or anxiety during
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the week or two before each menstrual cycle. It is not uncommon that the emotional symptoms of depression anxiety
and irritability can seriously interfere with normal functioning and relationships.
Common symptoms include: irritability, depressed mood, anxiety, or mood swings. Mood symptoms are only present for
a specific period of time, during the luteal phase of the menstrual cycle. Symptoms emerge one to two weeks before
menses and resolve completely with the onset of menses. Women with PMDD should experience a symptom-free
interval between menses and ovulation. An estimated 40% of women who seek treatment for PMDD actually have a
premenstrual exacerbation of an underlying mood disorder rather than PMDD. Therefore, it is important for patients to
be carefully evaluated for the presence of an underlying mood disorder in order to develop the best treatment plan.
Biology behind PMDD
UNC Center for Women’s Mood Disorders, Dr Susan Girdler, professor of psychiatry UNC ,“It’s not all in their head…
going home and trying to reduce stress and taking midol won’t help in this case.”
What makes it so frustrating for these women is that much of medical community doesn’t appreciate this as a true
disorder.
5 yr study of PMDD with a history of physical / sexual abuse - these women have a higher bp and heart rate response
to stress. Tend more headaches and emotional syptoms; greater pain sensitivity later in life.
https://www.med.unc.edu/psych/wmd/mood-disorders/menstrually-related
Premenstrual Problems
by Alakananda Devi (Alakananda Ma), M.B., B.S. (Lond.)
The moon, the tides of the ocean and woman, these three cycle together each month. A woman’s monthly
bleeding sets her apart from all other females, none of whom have menstruation as part of their reproductive
physiology. Mysterious and powerful, a woman’s cycle is a source of her deep connection to the moon and the
cycles of nature. Yet all too often, her cycle is experienced as troublesome and painful rather than as enriching.
One of the most important things an Ayurvedic practitioner can do in the care of a younger woman is to help
her have a positive experience of her menstrual cycle. PMS and menstrual cramps rob a woman of the potential
richness of this experience and can lead to her feeling negative about her femininity. This in turn can create
worse problems such as malignancies in the reproductive system.
Vata PMS
Vata type PMS manifests in stress, anxiety, insomnia, low back pain and constipation occurring during the
week or ten days before the onset of menstruation. This condition is best dealt with by gentle vata soothing
measures such as regular self abhyanga using organic sesame oil or Vata Massage Oil, and sweat therapy in a
tub with one third cup of ginger root powder and one third cup of baking soda mixed in the warm water. A
basti using Dashamula tea can be done one week before menstruation, to ease both vata type PMS and vata
dysmenorrhoea. This basti is best preceded and followed by oil basti. For insomnia and anxiety, a good remedy
is a teaspoon of Ashwagandha in a cup of warm cow’s milk or almond milk at bed time. For constipation, it
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may be sufficient to add a teaspoon or two of ghee to the Ashwagandha milk. An alternative choice is a half
teaspoon of Sat Isabgol in warm water or milk at bed time. Below are typical instructions we give out for home
sweat and Dashamula basti.
Ginger-Soda bath:
1/3 cup each of dried ginger & baking soda for each bathtubful of tolerable hot water (avoid excessive heat).
Total amounts needed: dried ginger 1/3 cup; baking soda 1/3 cup.
Be sure the bathroom is warm — avoid getting chilled at any time. Have extra “oil” towels available. Soak
after oiling and then get out when begin to sweat. Cover with towels and continue to sweat in the warm
bathroom until you are beginning to cool down.
Basti
o At 7 pm or sunset time, instead of dinner prepare the recommended basti for that day.
▪ Day 1 : 4 oz sesame oil, blood heat temperature (body temperature)
▪ Day 2: Dashmula tea: 1 ½ pints pure water & 2 Tablespoons Dashmula tea. Simmer with
lid on for 10 min. Then strain really well, through a silk cloth or coffee filter. Do not use
the roots/powder portion in the enema bag, ONLY use the strained liquid. Then add ½
cup of warm sesame oil, mix & put in enema bag at blood heat temperature.
▪ Day 3: 4 oz sesame oil again, blood heat temperature
o Prepare & warm up the bathroom or other location where you will be administering the basti.
▪ Have towel handy for “diaper”, if needed to safely get to toilet.
▪ Be sure you have a comfortable, cushioned place to recline during the basti. There may
be some leakage while administering the enema, so have appropriate old towels etc under
you (ie. Not your favorite blanket). Most people arrange a “nest” in the bathroom or
bathtub.
▪ You will want to have a place to hang up the enema bag – most have a hook or loop on
the top which you can use directly on something or can put on a clothes hanger & then
hook onto a towel rack or shower head, etc.
o After preparing the basti put it in the previously cleaned & air-dried enema bag
o Check the action of the bag while doing the previous cleaning – how to release the clasp; letting
air out of the nozzle before insertion Lubricate the nozzle (part to be inserted in the anus) with
sesame oil. Also lubricate your anus with sesame oil .Do not use KY jelly even if this is
indicated in the instructions that come with your enema kit. ( KY jelly is a petroleum product.)
o Lie on your left side. Gently & slowly insert the nozzle (if it’s uncomfortable try another angle
inward) Release the clasp holding the liquid in and allow it to flow slowly into the rectum. Lie
on the left side for 10 minutes. Then move to lie on the back for 10 minutes. Then turn & line on
the right side for 10 minutes. Trying to retain the enema for 30 minutes is ideal. If you feel like
you aren’t retaining it, oil your belly and massage counter-clockwise for five minutes to help
keep the basti in.
o When it has emptied from the bag, slowly remove the nozzle from your anus
o When the urge arises after 30 minutes, use the towel “diaper” under you to avoid leakage, and go
to the toilet. Relax for awhile.
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o It is not unusual for no oil to come out, especially with the first oil enema, and for vata people or
situations. Do not be alarmed. The oil will be beneficial if your body has chosen to absorb it.
You can just carry on with your day- maybe keeping a little pad or toilet paper in your underwear
in case oil leaks out.
o Usually the tea enema will lead to some results. If not, inform your practitioner for further
consultation. You can continue with the 3rd enema if s/he hasn’t gotten back to you yet, and stay
on kitcheree until after talking with her/him.
o After the results, clean the toilet as needed and then take a shower
o Eat a small amount (1/2 -1 cup of very soupy kitcheree) with plenty of ghee, to keep the vata
moving downward
o After 1 ½ to 2 hrs (when kitcheree has gone past stomach digestion) go to bed for the night
Pitta PMS
Pitta PMS can be a devastating problem that destroys lives and marriages. In its most severe form, it may be
diagnosed as premenstrual mood disorder, also known as PMDD—premenstrual dysphoric disorder. Affecting
5% of women, PMDD expresses in moodiness or out of control anger outbursts during two weeks or before
menstruation. Depression, mood swings, suicidal thoughts, irritability and cravings for sweets and chocolate are
typical pitta symptoms that mark this disorder. Matters are only made worse when the woman blames herself or
experiences blame from family members. One woman says, “Only after menopause did I fully realize the
devastating impact PMDD had exerted on my life. Once my hormones were no longer cycling I realized that I
was in fact a very patient and well balanced person who had been blamed for a physical ailment that did not
reflect my true personality.” PMDD is a serotonin-related imbalance treated in Western medicine with SSRI
anti-depressants. Hence it will respond well to either Brahmi or Bacopa, both of which elevate serotonin
levels. In addition, the underlying pitta condition can be managed with Shatavari Kalpa: Roast an ounce of
Shatavari with one or two tablespoons ghee in a cast iron pan until light brown and add two tablespoons of
sucanat, rapadura or turbinado sugar, two pinches saffron and a pinch of cardamom. A teaspoon of this recipe
can be taken in the morning to prevent tikshnagni (very strong hunger) and provoked pitta. For tender breasts,
another typical symptom of pitta PM S, breast massage with Organic Coconut Oil or Breast Balm can be
extremely helpful.
In addition to these herbal remedies, a strict pitta-pacifying diet should be followed, with especial care to avoid
nightshades such as eggplant and tomato sauces. PMDD may be a result of our unnatural indoor lifestyle which
does not expose us to natural alternations of light and dark. Moon bathing and moonlight strolling can be
helpful for this condition. If possible, the woman should place the head of her bed near a skylight or large
window so she can get exposure to moonlight and be influenced by the moon’s cycle while sleeping, as her
ancestors were.
When PMDD manifests as a significant illness, pancha karma will help speed the rate of recovery. An
appropriate PK regime for pitta should be followed, including abhyanga with Pitta Massage Oil, virechan
(purge) with either castor oil or a larger-than-usual dose of Amalaki and basti with Guduchi in place of
Dashamula.
Kapha PMS
Bloating, fluid retention, crying, weepiness, fatigue and lethargy characterize kapha PMS. This condition can be
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helped by a kapha soothing diet with emphasis on salt reduction, and by Punarnava, half a teaspoon twice daily
mixed in honey, which will have a mild diuretic effect and will in addition soothe kapha. Triphala or Bibhitaki
taken at bedtime will also be of help in balancing kapha, reducing toxins and limiting fatigue.
Western Herbs -
-from Susun Weed : PMS: in luteal phase, take Motherwort. It’s like we are in the moodlodge, in the laps of all our
female ancestors. This is the time we need to say NO and take care of ourselves the most. If you can’t say no when you
bleed, you may have terrible time w/thyroid at menopause, or with the entire menopause transformation. How can you
reward self for taking a moon day? Leonurus helps us be in our power before we bleed.
Nutrition for PMS
The affects of nutrition regarding maintaining a proper reproductive cycle are profound. Sub- optimal levels of
certain nutrients can exacerbate symptoms of PMS, PMDD, and Primary Dysmenorrhea. Vital Nutrients such
as: B vitamins, Essential Fatty Acids, Iron, and Magnesium help control symptoms associated with the late
luteal phase.
B Vitamins are important for controlling PMS/PMDD symptoms. Subclinical levels are associated with
decrease dopamine, fatigue, interruption of hepatic estrogen elimination, and depression due to decrease
seratonin production from lack of B6. B vitamins, as with all vitamins, should be in a complexed form. Before
advising patients on a vitamin regimen, a blood chemistry can be ordered( this may need to be done through
their primary care physician) to identify any sub-optimal vitamin or mineral levels.
As coenzymes, the B complex vitamins are involved with metabolism of carbohydrates, fats, and proteins. Sub
optimal levels will directly affect energy production. B5, known as the stress vitamin, works with other B
vitamins in complex to abate feelings of being overwhelmed or irritable. B6 acts as an anti-inflammatory,
dopamine co-factor, and as a coenzyme in the production of seratonin.
Magnesium is responsible for the phosphorylization of B vitamins. Subclinical deficiency indirectly affects
symptoms of PMS, PMDD, and Dysmenorrhea due to its direct affect of B vitamin bioavailability.
Supplementation of a B complex supplement, significantly decreased both the intensity and the duration of
menstrual cramps. (23)
Magnesium is responsible in assisting nerve conduction, muscle function and bioavalability of B vitamins.
Deficiencies can activate the cascade of inflammation. It acts as inhibitor to pro-inflammatory modulators,
PGE2 and PGF2 alpha. Without optimal levels, systemic inflammation and pain can occur.
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Essential Fatty Acids represent another nutritional source for managing PMS and PMDD. Inappropriate
amounts of EFAs, omega 3 FAs, in conjunction with dietary intake of improper fat (high omega 6 FAs) will
influence inflammatory modulators PGE2 alpha and PGF2 alpha to be produced.
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Class 4 Notes - FEMALE FERTILITY

Terra’s General Protocol for Female Fertility
Many clients will not want to consider this long of a time frame, although it would usually be optimal. You must work
out with the client what their timing is, while explaining the upsides of taking longer to prepare before conception.
(Male Fertility and problems discussed in Class 5)
1. Be sure digestion and tissues are working with functional agni. Teach about healthy food choices if needed.
Support digestive repair if needed.
2. Ensure that the menstrual cycle is working cleanly. If not, treat the menstrual cycle first (as in Classes 2 & 3).
Recommend healthy menstrual cycle practices to all.
3. Consider whether Pancha Karma is possible and if client would do it. If not, evaluate liver/Small Intestine - Pitta
seats- whether they need to be cleansed or balanced using herbs, diet, marma points, etc.
4. After Pancha Karma or Pitta balancing , if possible , recommend 3 months of rejuvenation of ovaries . Consider
where any blockages to fertility are happening besides the ovaries themselves and address. Discusses in Class 6.
5. Teach principles of fertility awareness to allow for proper timing of intercourse for fertilization.
Ashtanga Ayurveda - the 8 Branches of Ayurveda

1. Kaya Chikitsa = Internal Medicine, Charaka the main authority
2. Shalya Tantra (tantra = science/art) = Surgery, Sushruta the main authority
3. Agada Tantra = Toxicology (& medical jurisprudence) , types of poisoning, student of Charaka , main authority
4. Bhuta Vidya = Psychiatry
***5. Stri Roga = Gynecology & Obstetrics
Kaumar Bhritya Tantra = Pediatrics , including how to prepare for pregnancy
6. Rasayana = Rejuvenative Science to maintain health of the healthy & cure disease of the unhealthy
to erase the "fingerprints" of disease in the body to avoid future complications
7. Vajikarana = Aphrodesiacs, including Geriatrics " even old man can become strong like a horse"
----Notes from Dr. Vasant Lad, Lecture on Fertility, Pregnancy, and Birth 1999
THE NECESSITIES FOR HEALTHY CONCEPTION according to Kasheppa (Kasheppa - about 900 BC, was
great gynecologist. His work is still available in sanskrit/ poetry.) ----Notes from Dr. Vasant Lad, Lecture on Fertility, Pregnancy, and
Birth 1999

Class 4 - Female Fertility Page 1
Ruta = proper season : Timing
Kshetra = ripe field : Womb
Ambu = female ovum: Water gush
Bija = male sperm : Seed
Proper time:
From the day menses stops each month for 16 days = Rutu Mati = woman agreeable to love making
(individualized of course) Today we can also pay attention to the fertility signs of the woman’s cycle and body to know
when she is about to ovulate, thus narrowing the window.
According to the Lunar cycle: Shukra Paksha = white fortnight = waxing moon = Kapha time
Krsna Paksha = dark fortnight = waning moon = Pitta time
1/2 moons = Vata times
Keep track of menses for 6 mos to see where the 1st day tends to fall
near full moon then lunar energy/ Kapha energy of menses cycle
near waning moon then solar energy/ Pitta energy of menses cycle
near 1/2 moon then Ashta moon, balances cosmic prana / Vata energy of menses cycle
Ripe Field:
Before trying for conception it is important to treat menstrual and vaginal imbalances/diseases. They will effect
conception and health of the developing baby. It is also more difficult to treat problems during pregnancy due to
needing to protect the pregnancy from toxins, disturbance of the apana, and harsh herbs.
Water gush & Seed:

Male seed = SHUKRA = white color, apya cool & watery
Female egg = ARTAVA = red color, fiery (I differ on this - to me the egg is much more Kapha than the sperm: larger,
more fluid, more static- they were just going by the menses of women and didn’t note the mid cycle fertile mucuous,
which is most Kapha and feeds the less Kapha sperm so they can make it to the egg.)
These carry - the blueprint of doshic qualities (VPK)
-ojas, tejas, prana
- micro forms of the 7 dhatus
Each generative cell contains 20 qualities & 3 gunas = 23 prs = 23 chromosomes in each cell

Molecules in sperm have soma X or Y chromosome egg have soma & tejas X chromosomes only (AGAIN -
I differ on this - sperm is much more tejasic - they swim after all, while the egg rolls through the body with the help of
cilia in the fallopian tube)
X+Y= boy tejas predominates
X+X=girl soma predominates
80 million sperm / ejaculation & only a few hundred make it to the fallopian tube then only one lucky completes the
journey
Sex Determination of child-
Ancient Teachings - a male child was frequently considered more advantageous

With 1st day of menses = Day 1
Baby conceived on odd days = 7,9,11= male child
even days = 8, 10, 12 = female child
Breath cycles - Swara normally changes every 90 minutes between r/l nostrils
Male R & Female L on ejaculation leading to conception creates male child.
Male L & Female R """"""creates female child
Deviated septum may lead to all one sex children --can repair surgically.
Psychological issue of making love--

-If a man makes love to express stress, it’s NOT a Creative form
-Making Love is like food -- must be right time/ way; can be a creative potential or like a drug or violence or
destructive
-Conscious awareness is most auspicious -- lust is destructive; love is creative.
REQUIREMENTS/PREPARATION FOR CONCEPTION FOR A HEALTHY PREGNANCY

Both woman & man important for preconception -
examine each thoroughly : pulse, prakruti/vikruti; dhatus, diet,
specific issues of preconception: for man is shukra vaha srotas; for woman is artava vaha srotas
Preconception examination/ Treatment per Dr. Vasant Lad

Healthy Shukra : semen= suspension of sperm from prostate, cowpers gland, etc.

-seminal quantity = 1/8 anjali

-2-4 ml/ emission
-100-200 million sperm
-whitish gray color is normal for shukra
-sweet taste, esp. for K person (= fructose); sour for VP person (=citric acid); if pungent=secondary infection
-consistency = viscous, unctuous (due to lipids); slimey (due to prostatic secretion)
-painless - yields bliss w/ emission; no burning
-coagulates within 10 min ( = fibrin content due to K dosha)
Impotency ( Sanskrit= klaibya) no erection

may be due to 1. psychological cause - stress
2. constitutional low sex drive
3. organic disease factor such as diabetes mellitis, MS, tabes dorsalis, anterior
pituitary deficiency, adrenal deficient, thyroid low, high cholesterol in blood can reduce blood
supply to penis
Treatment of klaibya: Herbs

1. ashwaganda
-stimulates sex in male; aphrodesiac; active principle is ashwagandriline, saponins
-stimulates blood flow to penis ( also lowers cholesterol)
-anabolic steroid action but no toxicity because eliminated from body easily
Dose = (500 mg) or 1/2 tsp 2 x day w/ milk
2. atma gupta - vanari (=monkey) = kapikacchu (kapi= Hanuman/ monkey also)
-has ingredient similar to L dopamine
-food precursor of testosterone, steroidal action
Dose 1/2 tsp or (500 mg) 2x a day w/ milk
3. Makaradriwaja
-red sulfide of mercury (Hg) -- semen of Shiva= Hg ovum of Parvati = sulphur :
processed it becomes humanized
-also contains gold ashe - catalytic also; stimulates spermatogenesis in seminiferous
tubules; increases tone & ciruclation of glans penis
- nervine tonic ( S2 S4 enervate the penis- if nerves not working well then leads to
impotence
- also tissue restorative
Dose 200 mg 1/day w/ milk ; 15 days only
4. Shilajit
-looks like tar ; it's mineral pitch
-cobalt, iron, minerlas in it

-aphrodesiac, mild diuretic, alterative tonic, regulates blood sugar (reduces impotence in
diabetes)
Dose 1/4 tsp 2-3x day after food (caution: can cause a drop in blood sugar levels)
Male Infertility-Oligospermia (reduced sperm count) or azoospermia (absence of sperm) are depleted shukra; poss
hypogonadism
-mobility and motility low in sperm are lack of prana ; poss. blockage of vas deferens, hydrocele
-Treatment: Herbalized milk:1/3 tsp bala ; 1/3 tsp vidari; & 1/3 tsp ashwaganda boiled in 1 cup of milk - take
at bedtime (milk also enhances sperm/ shukra)
-Sperm antibodies -- after a vasectomy, the sperm are still formed, jammed into epidydimus. This can cause the
creation of sperm antibodies; it can effect the man's immune system, leading to reduced immunity over a couple of
years.
Preconception Examination Of Artava/ Treatment per Dr Vasant Lad
First menstrual period age (FMP) Kapha is later , age 13-16; Pitta is earlier, ages 10, 11; Vata medium
Last menstrual period regular delayed = K irregular=v short=p
Flow scanty=v plenty=p normal=k
sexual disorders in woman
Anartava - amenorrhea
Primary amenorrhea -- causes
1 chromosomal
2 autoimmune (tejas burning ojas ; tejas of one dhatu can burn ojas of another)
3 pituitary tumor
4 congenital adrenal hyperplasia
5 infantile uterus - congenital Vata disorder
Secondary amenorrhea
due to excess activity; fasting; spiritual practices; traveling; stress, emotional factors
also check for: anemia, tuberculosis, emotional, retroverted uterus; endometiosis (v pushing K in
endometrium can block fallopian tubes)

(Oral contraceptives increase Pitta
integration of VPK changed leads to high BP, pulmonary embolism, breast/cervical cancer)
Treatment of artava Herbs

1. shatavari asparagus racemosis 500 mg
female aphrodesiac, antispasmodic, uterine action, antacid (changes ph of yoni so not too acidic)
niutritive tonic, glucosides -active ingredient =souce of estrogen w/out side effects)
(also high in estrogenic is aloe vera - Kumari)
2. punanarva - regulates menses, menorrhagia
for fibroids - inhibits blood supply for fibroids ; endometriosis;tone of uterus
rejuvenative of female reproductive
3. ashoka araca indica 500 mg
has tannins etc.
hemostatic - for profuse menses, threatening miscarriage
romantic tree - flowers when beautiful woman touches it -- but not good to grow by house,"it will
bring grief"
4. for vaginal discharges/ infections: need healthy genital passages before conception
licorice 1 tsp in 1 pint of water boil 10 min, cool & strain then::
--For yeast/fungus: add tumeric 1/2 tsp & tikta ghee 1 tablespoon
Repeat according to severity - do daily if severe
(Jupiter in 8th house w/ sun leads to increased yeast infections)
--For bacterial infection (burning, profuse, some blood poss); add guduchi 1 tablesp
and tikta 1 tablesp (or mahasudarshan)
Boil & cool then add Neem oil 1 tablespoon
Douche every Thursday & Sunday
trifala
5. for genital herpes -- worrisome for conception/pregnancy; viral infection that goes dormant/then active
formula for active or inactive; ok for use in pregnancy:The dormant virus is killed by the oral herbs; swab
heals active virus –this formula is for pregnancy specifically
abrak bhasma 200 mg moti bhasma` 200 mg
kama dhudha 200 mg (anti inflammatory) gulwel sattwa 400 mg
take 1/2 tsp orally 2-3x daily depending on severity
Also swab sores w/ steriled water & tikta ghrta 2x day morning & evening Do this treatment for 3 months
Pulse: rasa /rakta pulses w/ pitta spike can mean shedding herpes virus w/out lesion visible
(for herpes zoster -- moti chandan churna applied locally)

6. For warts - paparkhat - to cauterize; use 1 % solution, apply w/ Q tip to wart & it will be gone
(a mineral substitute for salt, also astringent)
7. Dysmennorhea
-V= spasmodic; os constricted; apana vayu dysfunction; before onset of bleeding
w/ lots of clots, if do a D& C and feel better after
Herbs:
Trifala guggulu 200 mg
Dashamula 500 mg orally (500 mg = 1/4 tsp)
Castor oil compress over uterine area topically
-K=congestive; endometrium thickened; during bleeding; water retention; sweating; likttle white discharge
Herbs:
Punanaravadi guggulu 200 mg
Kutki (scraping) 300 mg (herbal curretage by kutki)
w/ honey & hot water 1/2 tsp 2-3x day
-P= endometritis; inflamed endometrium; puofuse bleeding; pain w/ menses/ nipples sensitive; irritable ; judgemental;
Herbs:
Shatavari 500 mg
Guduchi 300 mg 1/2 tsp 3x day w/ warm milk or water
Take these formulas any time in the cycle; particularly for the week before menses.
Healthy Woman/Man Preparation for Conception

Panchakarma : 15 days if very toxic; 1 week if 1/2 tongue coat
High vata=basti High P=virechan High K=vamen Then proper Rasayana
Apana Vayu - rules the pelvic flow; to regularize it Dashamula tea (1 pint) basti AND sesame oil basti
Ovulation & menses bring order in the system:
General Recommendations for Preconception

1No naps
2 No eyeliner - disturbs ovum; relation between lacrymation & ovulation
3 No heavy exercise, loud music or vata increasing activities = ear problems in baby
4 Incompatible food combining avoided
5 For Fair baby - eat white foods; saffron w/ milk during menses & pregnancy
6 No sex during menses
7 Dont lie in prone position after sex
8 Proper timing of conception
9 After copulation -- almond milk or cashew milk

Three Month Cycle of Ovarian Development - Window for Improving Ovary Quality

Understanding the Fertility Cycle and its Signs

The following excerpt is from the website www.tcoyof.com . for full information read the book: Taking Charge of Your
Own Fertility by Toni Wechsler (a good reference) OR take free study course from www.fertilityfriend.com
The Clues to Fertility
Summary: Menstruation, cervical fluid, and waking temperature are the primary clues to determining fertility. Cervix
position and texture is used as a means of corroborating the temperature and cervical fluid signs. Menstruation, or
menses, marks the beginning of a new cycle and its onset is a positive sign of the pre-ovulation low fertility phase
("Phase 1"). In many cases, FAM relies on the accurate recording of the menstruation start date to properly compute the
arrival of the pre-ovulatory fertile phase "Phase 2").
Cervical fluid is secreted by the woman's body before ovulation to improve the sperms' chances for survival and of
reaching the ovum. Due to the timing of its secretion, it can be used to interpret the onset of fertility. The complete
absence of cervical fluid is a strong indicator of infertility.
In the cervical canal there are crypts that produce cervical mucus of different types according to levels of
estrogen and progesterone in the woman's system.
Estrogenic or E-type mucus is created when estrogen predominates, usually coinciding with the
increasing levels of the follicular phase of the ovaries, when developing follicles are producing rising levels of
estrogen and the proliferative stage of the endometrial uterine lining. This climaxes at the time when peak
estrogen triggers the surge of Lutenizing Hormone, which triggers ovulation of the predominant follicle. At this
time, the highest levels of estrogen results in the most E-type mucus, which is the type that nurtures and
facilitates sperm survival and fertilizing capacity, with high water content and a more alkaline nature. It is the
egg-white, stretchy, type we want to see for natural fertility. Sperm can live for 3-5 days in this environment.
Gestagenic or G-type mucus is created when progesterone levels are high &/OR estrogen levels are low.
This happens after ovulation, when the spent husk of the predominant follicle left behind develops into the
corpus luteum, which secrete progesterone to make the lining of the uterus suitable for implantation of a
possibly fertilized egg. Progesterone inhibits the response of the cervical crypts to estrogen and reduces the E-
type mucus.
This creates a sticky plug that can block the cervical canal, inhibiting sperm from entering. More sperm aren't
needed at this time. This thick, viscous mucus will not usually be visible at the vulva and is thus named the
dry days when observing the mucus for fertility awareness methods. It is also more acidic and does not feed
the sperm. Sperm will only live for minutes in this environment.
Body temperature rises and falls in a consistent pattern. Ovulation causes your temperature to remain elevated for
about two weeks. FAM looks for this rise to determine when post-ovulation infertility begins.
The cervix is the muscular opening of the uterus. With the approach of ovulation it becomes softer, opens, and raises its
position relative to the uterus. At infertile times it is low, closed and firm. Currently, Ovusoft and FAM do not make use
of this sign directly in calculating fertility, but users may track it for cross-reference purposes.

There are a number of different clues to show where a woman is in her fertility cycle, ie.
which "phase" of fertility she is in. This system utilizes three primary ones: menstruation
(menses), cervical fluid, and waking temperature (also known as basal body temperature or
BBT). The characteristics of the cervix are a fourth sign that some users of FAM rely on to
corroborate the first three.
As an absolute minimum in the practice of fertility awareness, you only need to keep track of two of the
four listed above: menstruation and temperature. Cervical fluid provides an added bonus in that it defines
the onset of fertility, whereas temperature only indicates when ovulation has already taken place, perhaps
too late to be of much use in achieving pregnancy. When used together, however, temperature and
cervical fluid help you identify your fertile period with a high degree of accuracy.
The First Clue: Menstruation

While many people regard menstruation as the start of a new cycle, as does FAM, it is actually the end of
the previous cycle. Why do we say this?
Menstruation is the process of shedding the endometrium (lining of the uterus) that had built up during
the previous menstrual cycle. Therefore, it truly is the end of the previous cycle. Because it is so easy to
identify, however, it has become symbolic of the start of another "period" and is used as such in FAM.
The endometrium is a lining of tissue on the walls of the uterus that builds up before ovulation in
anticipation of the implantation of a fertilized egg. If the egg is not fertilized, it does not implant and
roughly two weeks later the built-up tissue is sloughed off. The uterus will build it up again in the new
cycle in preparation for the next ovulation.
The Second Clue: Cervical Fluid Cervical fluid is an important sign in fertility awareness. The woman's
body begins to secrete estrogen shortly after menstruation, which causes glands around the cervix to
secrete cervical fluid. As ovulation approaches, the amount of estrogen builds, causing the body to secrete
even more fluid. The increased levels of estrogen also make the cervical fluid stretchy and clear.
As the level of estrogen builds, another hormone, called lutein, is released. Lutein causes the ovaries to
release the ovum. The estrogen levels decrease somewhat after ovulation, causing the cervical fluid to dry
up. This drying up process normally starts on or just after the day of ovulation.
Cervical fluid has several purposes in the area of human reproduction. First, it performs a lubricating
function during sexual relations. Secondly, but more importantly, it provides a friendly environment for
the survival of sperm after sexual relations have taken place. Without this environment, sperm would live
no longer than several hours and would be literally stopped dead in their tracks, unable to move, unable

to fertilize the waiting ovum. In the presence of cervical fluid, sperm are provided with both nutrients and
a conduit for movement and may live up to five days in such an environment. Therefore, in addition to
providing a pathway to the ovum, cervical fluid widens the fertility window beyond the daylong life span
of the average ovum and hours-long life span of the average sperm. Sexual relations taking place several
days before ovulation may still result in conception due to the increased viability of the sperm in the
presence of fertile-quality cervical fluid.
Cervical fluid is therefore a positive sign that fertility is increasing and may be used as such in fertility
awareness. For pregnancy achievers, it provides an excellent pre-ovulation indicator, whereas
temperature alone can only predict ovulation after the fact.
Cervical fluid may be observed directly, in which case you might notice the following qualities:
Sticky – A less fertile-type of fluid, not very conducive to supporting either sperm motility or lifespan. This
may correspond to a Moist vaginal sensation.
Creamy – A lotion-like type of fluid, which can support sperm for longer periods than the sticky-quality
type. This may correspond to a Wet vaginal sensation.
Eggwhite – The most fertile quality cervical fluid, it is clear, stretchy, and slippery. This type of cervical
fluid resembles raw eggwhite, hence the descriptive name. This may correspond to a Lubricative vaginal
sensation.
For detailed explanation observing and differentiating between the types of cervical fluid and vaginal sensation
Taking Charge of Your Fertility. Or class by www.Justisse.ca

..

The Third Clue: Waking Temperature

Temperature, or more accurately, waking / basal body temperature, is another one of the body's

measurements that changes in regular cycles. "Basal" body temperature simply means the temperature of
your body at rest.
Your body temperature is not a consistent 98.6° F / 37° C as most people think. These figures are the
body's normal high temperature during waking hours. After going to sleep at night, your body
temperature gradually drops, reaching its lowest point in the early morning. As you get closer to your
waking hours, your metabolism picks up again, raising your body temperature ever so gradually, and the
cycle is repeated. The scale of the drop and rise of body temperature can differ from person to person,
(although it is normally about 0.1° F / 0.05° C) but all people experience it to some extent or another.
When a woman ovulates, the follicle containing the ovum ruptures, releasing the egg and the hormone
progesterone into the body. This hormone has several effects, for our purposes not the least of which is
the raising of the basal body temperature. This increase in temperature is significant and detectable, as it
typically is about 0.2 to 0.4° Fahrenheit / 0.1 to 0.2° Celsius over the course of several days. To detect this
change, you will need a basal thermometer, available from most pharmacies. A standard fever
thermometer is not accurate enough for our purposes here, as even a change of 0.1° F / 0.05° C is
important. Therefore, an important first step in the practice of FAM is to buy a basal
thermometer.
FAM looks for three temperatures that rise at least 0.2° F / 0.1° C above the high of the previous six
temperatures. A "coverline" is drawn 0.1° F / 0.05° C above the highest of these six temperatures and
when three successive temperatures are above this line, a thermal shift is identified and there's a good
chance that ovulation has already occurred. (This is a simplification of the identification of the coverline;
please refer to Taking Charge of Your Fertility or the glossary for more a more detailed explanation of
calculating a coverline and identifying various thermal shift conditions.)
The temperature sign gives us a great, but late, clue that ovulation has occurred and helps to pinpoint the
actual date. That's why it is so important to use cervical fluid in conjunction with temperature in the
practice of Fertility Awareness if pregnancy is your goal -- together they identify when you are fertile and
when ovulation has already occurred.
The Fourth Clue: Characteristics of the Cervix

The opening of the uterus is a thick muscle known as the cervix. As ovulation approaches, the same
hormones that cause cervical fluid to be secreted also cause changes in the position, texture, and opening
of the cervix.
During infertile periods (Phase 1 and 3), the cervix is low, firm and closed (during Phase 3, it is closed
tightly). It is so low that it is fairly easy to reach for observation purposes. As fertility increases, the cervix
rises in position, becomes softer, and starts to open. At peak fertility, the opening of the cervix is about 15

mm wide.
These changes make it easier for sperm to reach the ovum -- if the cervix didn't open, conception wouldn't
take place. If the cervix didn't close tightly after ovulation, the uterus and fertilized egg could become
infected. The cervix has to open somewhat at menstruation to allow the endometrium to be shed.
Its use in fertility awareness is primarily as an additional sign when temperature and cervical fluid
do not define by themselves when post-ovulation infertility has begun.
Position Of Uterus At Different Times Of The Menstrual Cycle - Functional

Changes
If you check your cervix regularly and in the same position you will see that it moves up and down during the cycle. (All
illustrations from Justisse Guide Images, training )





Putting it all Together
Summary: FAM works by determining the date limits for periods of fertility and infertility. Setting the start date of one
phase automatically determines the end date of the previous phase. The start date for Phase 1 low fertility is set based
upon menstruation. Phase 2 fertility is set based upon the presence of cervical fluid or using a formula based upon
shortest historical cycle length. The start of Phase 3 infertility is set based upon temperature changes alone or a
combination of temperature and cervical fluid changes.
Determining the Start of the Pre-ovulatory Low Fertility Phase (Phase 1)

Setting the start date of Phase 1 is easy -- it's the first day of menstruation. Phase 1 is said to be infertile,
but as you get near the end of it, it becomes slightly more fertile. This is due to its closeness to ovulation
and the fact that sexual relations before ovulation that most frequently result in pregnancy. The ovum only
survives about 24 hours on its own, so sexual relations which take place 24 hours after ovulation don't
normally result in conception. However, sexual relations as many as 5 days before ovulation may result in
conception.
For this reason, it is very important to set the start of Phase 2 fertility accurately.
Determining the Start of the Fertile Phase (Phase 2)

If you recall from our discussion of the clues to fertility, cervical fluid is a positive sign of fertility. This
means that the start of the fertile period, Phase 2, is set on the first day ANY cervical fluid appears. This is
because cervical fluid allows sperm to live up to 5 days, which means that ovulation doesn't have to occur
just after sexual relations for a woman to conceive a child. On the other hand, without cervical fluid, sexual
relations do not normally result in conception (we say "normally" because even though it's highly unlikely,
anything is possible!) Therefore, FAM treats the start of fertility, Phase 2, as being the first day cervical fluid

is present.
What if you're not tracking cervical fluid and have decided to use menstruation and basal body
temperature as your only fertility signs? Or what if you normally do use cervical fluid but for whatever
reason, you fail to do so in the current cycle? FAM will treat cycle day 6 as the start of the fertile phase in
such a situation. (Ovusoft, however, will also review your prior cycle history and will allow you to override
cervical fluid observations if your cycle history suggests that you are truly infertile.)
A Note about Cervical Fluid Changes as Ovulation Approaches: Cervical fluid first appears during Phase 2
and changes in quantity, color and consistency as ovulation approaches. The "less fertile" type of cervical
fluid is typically sticky, crumbly or creamy/opaque, the "more fertile" type is like raw eggwhite (wet,
stretchy, slippery, and clear).
Armed with this knowledge, pregnancy achievers can be fairly certain when their chances for conception
are highest. Just after ovulation, the hormone progesterone is released and estrogen levels drop, causing
cervical fluid to begin "drying up" -- it goes from the more fertile to a less fertile type. The first day of this
change, fertility and conception chances are still high. Within a day, the conception chances drop
considerably, so sexual relations are advised through this period to achieve pregnancy.
Determining the Start of the Post-ovulation Infertile Phase (Phase 3)

The start date for Phase 3 infertility can be set based on temperature changes alone, or better yet, based
on a combination of temperature changes and changes in cervical fluid characteristics.
FAM requires there to be a significant upward shift in basal body temperatures for at least three
consecutive days over the previous six days. All temperatures must be undisturbed by late rising, sickness,
physical exertion, etc. This again points to the value of taking your temperature the FIRST thing in the
morning, as there is less chance that these readings will be disturbed.
What determines whether a rise in temperature is significant? FAM uses a number of rules for determining
whether this condition has been met. First, a coverline is drawn 0.1° F (0.05° C) above the highest of the six
pre-shift temperatures. Once 3 or more temperatures are above the coverline, a thermal shift is said to
have taken place.
While it goes beyond the scope of this primer to explain it in detail (Taking Charge of Your Fertility covers it
in great depth), temperature rises are categorized in the following manner:
 Standard Thermal Shift: Three successive days with temperatures above the coverline.

 Slow-rise Thermal Shift: The first temperature in the shift is at the coverline; the remaining
temperatures are above the coverline. Requires four successive days with temperatures above the
coverline.
 Fall-back Thermal Shift: The first temperature is above the coverline, the second dips back to or
below the coverline, followed by three temperatures above the coverline. The first temperature might also
be eliminated using the Rule of Thumb, which would then make this shift mimic the Standard Thermal
Shift.
Once in Phase 3, you are infertile through Phase 1, so you may elect to stop observing your temperature
and cervical fluid symptoms until menstruation starts. Both observations should be resumed in Phase 1
right after days of heavy menstrual flow have subsided.
A Final Note on Cervical Fluid

Some may find the idea of observing their cervical fluid sign to be, well, less than exciting. It does,
however, provide a wealth of information about fertility and has a MAJOR advantage for those that use it:
It more accurately identifies the period of Phase 2 fertility than cycle history or temperature alone. For
those trying to achieve pregnancy, this is invaluable because changes in it represent positive signs of
increasing fertility.
Varying Lengths of Cycles: time from ovulation to menses is stable in stable reproductive years
(less so with menarche and menopausal years)

Photos of an Actual Ovulation!!!

The Follicle (reddish area in photo) will become pale and function as the Corpus Luteum, which produces Progesterone
and Estrogen to maintain a pregnancy until the placenta becomes fully functioning.
To Learn Yourself Or For Clients: Free Course On Charting And Analysis -

Https://Www.Fertilityfriend.Com
See Fertility Cycle Charting Handouts, one for those with a low temperature (may have low
thyroid) and one for those with a regular temperature profile. For use by those charting
clients (or yourself)

WiseWomanhood School & Practice Terra Rafael, CAP
Male Reproductive Anatomy and Fertility concerns
Male Anatomy and Sperm Development
i. fertility in men-development of sperm; examination of shukra
Spermatogenesis (From Wikipedia, the free encyclopedia) http://en.wikipedia.org/wiki/Spermatogenesis for

complete listing
Spermatogenesis is the process by which male primary sperm cells undergo meiosis, and produce a number of
cells termed spermatogonia, from which the primary spermatocytes are derived. Each primary spermatocyte
divides into two secondary spermatocytes, and each secondary spermatocyte into two spermatids or young
spermatozoa. These develop into mature spermatozoa, also known as sperm cells. Thus, the primary
spermatocyte gives rise to two cells, the secondary spermatocytes, and the two secondary spermatocytes by
their subdivision produce four spermatozoa.[1]
Spermatozoa are the mature male gametes in many sexually reproducing organisms. Thus, spermatogenesis is
the male version of gametogenesis. In mammals it occurs in the male testes and epididymis in a stepwise
fashion, and for humans takes approximately 64 days.[2] Spermatogenesis is highly dependent upon optimal
conditions for the process to occur correctly, and is essential for sexual reproduction. DNA methylation and
Terra Rafael, WiseWomanhood@gmail.com, www.wisewomanhood.com Page 1

histone modification have been implicated in the regulation of this process. [3] It starts at puberty and usually
continues uninterrupted until death, although a slight decrease can be discerned in the quantity of produced
sperm with increase in age. The entire process can be broken up into several distinct stages, each
corresponding to a particular type of cell in human:
A mature human Spermatozoon
Purpose
Spermatogenesis produces mature male gametes, commonly called sperm but specifically known as
spermatozoa, which are able to fertilize the counterpart female gamete, the oocyte, during conception to
produce a single-celled individual known as a zygote. This is the cornerstone of sexual reproduction and
involves the two gametes both contributing half the normal set of chromosomes (haploid) to result in a
chromosomally normal (diploid) zygote.
To preserve the number of chromosomes in the offspring – which differs between species – each gamete must
have half the usual number of chromosomes present in other body cells. Otherwise, the offspring will have
twice the normal number of chromosomes, and serious abnormalities may result. In humans, chromosomal
abnormalities arising from incorrect spermatogenesis can result in Down Syndrome, Klinefelter's Syndrome,
and spontaneous abortion.
Location
Spermatogenesis takes place within several structures of the male reproductive system. The initial stages
occur within the testes and progress to the epididymis where the developing gametes mature and are stored
until ejaculation. The seminiferous tubules of the testes are the starting point for the process, where stem
cells adjacent to the inner tubule wall divide in a centripetal direction—beginning at the walls and proceeding
into the innermost part, or lumen—to produce immature sperm. Maturation occurs in the epididymis.
Spermatocytogenesis is the male form of gametocytogenesis and results in the formation of spermatocytes
possessing half the normal complement of genetic material. In spermatocytogenesis, a diploid
spermatogonium which resides in the basal compartment of seminiferous tubules, divides mitotically to
produce two diploid intermediate cells called primary spermatocytes. Each primary spermatocyte then moves
into the adluminal compartment of the seminiferous tubules and duplicates its DNA and subsequently
undergoes meiosis I to produce two haploid secondary spermatocytes, which will later divide once more into
haploid spermatids. This division implicates sources of genetic variation, such as random inclusion of either
parental chromosomes, and chromosomal crossover, to increase the genetic variability of the gamete.
Each cell division from a spermatogonium to a spermatid is incomplete; the cells remain connected to one
another by bridges of cytoplasm to allow synchronous development. It should also be noted that not all
spermatogonia divide to produce spermatocytes, otherwise the supply would run out. Instead, certain types
of spermatogonia divide to produce copies of themselves, thereby ensuring a constant supply of gametogonia
to fuel spermatogenesis.
Stages
Influencing factors
The process of spermatogenesis is highly sensitive to

fluctuations in the environment, particularly hormones and
temperature. Testosterone is required in large local
concentrations to maintain the process, which is achieved via
the binding of testosterone by androgen binding protein
present in the seminiferous tubules. Testosterone is produced
by interstitial cells, also known as Leydig cells, which reside
adjacent to the seminiferous tubules.
Seminiferous epithelium is sensitive to elevated temperature

in humans and some other species, and will be adversely
affected by temperatures as high as normal body temperature.
Consequently, the testes are located outside the body in a sack
of skin called the scrotum. The optimal temperature is
maintained at 2 °C (man) - 8 °C (mouse) below body
temperature. This is achieved by regulation of blood flow[4] and positioning towards and away from the heat
of the body by the cremasteric muscle and the dartos smooth muscle in the scrotum.

Dietary deficiencies (such as vitamins B, E and A), anabolic steroids, metals (cadmium and lead), x-ray
exposure, dioxin, alcohol, and infectious diseases will also adversely affect the rate of spermatogenesis.[citation
needed]
Hormonal control
Hormonal control of spermatogenesis varies among species. In humans the mechanism are not completely
understood, however it is known that initiation of spermatogenesis occurs at puberty due to the interaction of
the hypothalamus, pituitary gland and Leydig cells. If the pituitary gland is removed, spermatogenesis can still
be initiated by follicle stimulating hormone and testosterone.
Follicle stimulating hormone stimulates both the production of androgen binding protein by Sertoli cells, and
the formation of the blood-testis barrier. Androgen binding protein is essential to concentrating testosterone
in levels high enough to initiate and maintain spermatogenesis, which can be 20-50 times higher than the
concentration found in blood. Follicle stimulating hormone may initiate the sequestering of testosterone in
the testes, but once developed only testosterone is required to maintain spermatogenesis. However,
increasing the levels of follicle stimulating hormone will increase the production of spermatozoa by preventing
the apoptosis of type A spermatogonia. The hormone inhibin acts to decrease the levels of follicle stimulating
hormone. Studies from rodent models suggest that gonadotropin hormones (both LH and FSH) support the
process of spermatogenesis by suppressing the proapoptotic signals and therefore promote spermatogenic
cell survival. [5]
The Sertoli cells themselves mediate parts of spermatogenesis through hormone production. They are capable
of producing the hormones estradiol and inhibin. The Leydig cells are also capable of producing estradiol in
addition to their main product testosterone.
Wikipedia http://en.wikipedia.org/wiki/Spermatogenesis 6/27/12
Fertilization Chain Of Events Author: R. Bowen, Colorado State University
Fertilization is more a chain of events than a single, isolated phenomenon. Indeed, interruption of any step in the
chain will almost certainly cause fertilization failure. The chain begins with a group of changes affecting the sperm,
which prepares them for the task ahead.
Successful fertilization requires not only that a sperm and egg fuse, but that not more than one sperm fuses with
the egg. Fertilization by more than one sperm - polyspermy - almost inevitably leads to early embryonic death. At
the end of the chain are links that have evolved to efficiently prevent polyspermy.
In overview, fertilization can be described as the following steps:

Sperm Capacitation Freshly ejaculated sperm are unable or poorly able to fertilize.
Rather, they must first undergo a series of changes known collectively as capacitation.
Capacitation is associated with removal of adherent seminal plasma proteins,
reorganization of plasma membrane lipids and proteins. It also seems to involve an influx
of extracellular calcium, increase in cyclic AMP, and decrease in intracellular pH. The
molecular details of capacitation appear to vary somewhat among species.
Capacitation occurs while sperm reside in the female reproductive tract for a period of
time, as they normally do during gamete transport. The length of time required varies
with species, but usually requires several hours. The sperm of many mammals, including
humans, can also be capacitated by incubation in certain fertilization media.
Sperm that have undergone capacitation are said to become hyperactiviated, and among other things, display
hyperactivated motility. Most importantly however, capacitation appears to destabilize the sperm's membrane to
prepare it for the acrosome reaction, as described below.
Sperm-Zona Pellucida Binding Binding of sperm to the zona pellucida is a receptor-ligand interaction with a
high degree of species specificity. The carbohydrate groups on the zona pellucida glycoproteins function as sperm
receptors. The sperm molecule that binds this receptor is not known with certainty, and indeed, there may be
several proteins that can serve this function.
The Acrosome Reaction Binding of sperm to the zona pellucida is the easy part of fertilization. The sperm then
faces the daunting task of penetrating the zona pellucida to get to the oocyte. Evolution's response to this
challenge is the acrosome - a huge modified lysosome that is packed with zona-digesting enzymes and located
around the anterior part of the sperm's head - just where it is needed.
The acrosome reaction provides the sperm with an enzymatic drill to get through the zona pellucida. The same
zona pellucida protein that serves as a sperm receptor also stimulates a series of events that lead to many areas of
fusion between the plasma membrane and outer acrosomal membrane. Membrane fusion (actually an exocytosis)
and vesiculation expose the acrosomal contents, leading to leakage of acrosomal enzymes from the sperm's head.
As the acrosome reaction progresses and the sperm passes through the zona
pellucida, more and more of the plasma membrane and acrosomal contents are lost.
By the time the sperm traverses the zona pellucida, the entire anterior surface of its
head, down to the inner acrosomal membrane, is denuded. The animation to the right
depicts the acrosome reaction, with acrosomal enzymes colored red.
Sperm that lose their acrosomes before encountering the oocyte are unable to bind to the zona pellucida and
thereby unable to fertilize. Assessment of acrosomal integrity of ejaculated sperm is commonly used in semen
analysis.
Penetration of the Zona Pellucida The constant propulsive force from the sperm's flagellating tail, in
combination with acrosomal enzymes, allow the sperm to create a tract through the zona pellucida. These two
factors - motility and zona-digesting enzymes- allow the sperm to traverse the zona pellucida. Some investigators
believe that sperm motility is of overriding importance to zona penetration, allowing the knife-shaped mammalian
sperm to basically cut its way through the zona pellucida.

Sperm-Oocyte Binding Once a sperm penetrates the zona pellucida, it binds to and fuses with the plasma
membrane of the oocyte. Binding occurs at the posterior (post-acrosomal) region of the sperm head.
The molecular nature of sperm-oocyte binding is not completely resolved. A leading candidate in some species is a
dimeric sperm glycoprotein called fertilin, which binds to a protein in the oocyte plasma membrane and may also
induce fusion. Interestingly, humans and apes have inactivating mutations in the gene encoding one of the
subunits of fertilin, suggesting that they use a different molecule to bind oocytes.
Egg Activation and the Cortical Reaction Prior to fertilization, the egg is in a quiescent state, arrested in
metaphase of the second meiotic division. Upon binding of a sperm, the egg rapidly undergoes a number of
metabolic and physical changes that collectively are called egg activation. Prominent effects include a rise in the
intracellular concentration of calcium, completion of the second meiotic division and the so-called cortical
reaction.
The cortical reaction refers to a massive exocytosis of cortical granules seen shortly after sperm-oocyte fusion.
Cortical granules contain a mixture of enzymes, including several proteases, which diffuse into the zona pellucida
following exocytosis from the egg. These proteases alter the structure of the zona pellucida, inducing what is
known as the zona reaction. Components of cortical granules may also interact with the oocyte plasma
membrane.
The Zona Reaction The zona reaction refers to an alteration in the structure of the zona pellucida catalyzed by
proteases from cortical granules. The critical importance of the zona reaction is that it represents the major block
to polyspermy in most mammals. This effect is the result of two measurable changes induced in the zona pellucida:
1. The zona pellucida hardens. Crudely put, this is analogous to the setting of
concrete. Runner-up sperm that have not finished traversing the zona pellucida
by the time the hardening occurs are stopped in their tracks.
2. Sperm receptors in the zona pellucida are destroyed. Therefore, any sperm that
have not yet bound to the zona pellucida will no longer be able to bind, let
alone fertilize the egg.
The loss of sperm receptors can be demonstrated by mixing sperm with both
unfertilized oocytes (which have not yet undergone the zona reaction) and two-cell embryos (which have
previously undergone cortical and zona reactions). In this experiment, sperm attach avidly to the zona pellucida of
oocytes, but fail to bind to the two-cell embryos.
Post-fertilization Events Following fusion of the fertilizing sperm with the

oocyte, the sperm head is incorporated into the egg cytoplasm. The nuclear
envelope of the sperm disperses, and the chromatin rapidly loosens from its
tightly packed state in a process called decondensation. In vertebrates, other
sperm components, including mitochondria, are degraded rather than
incorporated into the embryo.
Chromatin from both the sperm and egg are soon encapsulated in a nuclear
membrane, forming pronuclei. The image to the right shows a one-cell rabbit
embryo shortly after fertilization - this embryo was fertilized by two sperm,
leading to formation of three pronuclei, and would likely die within a few

days. Pass your mouse cursor over the image to identify pronuclei.
Each pronucleus contains a haploid genome. They migrate together, their membranes break down, and the two
genomes condense into chromosomes, thereby reconstituting a diploid organism.
Determining Healthy Male Shukra : semen= suspension liquid from the prostate, cowpers gland, etc. which
contains sperm
• weight of testicles = reproductive tissues producing sperm

• changes in testicles = hydrocele, growths, etc
• cramerasteric reflex (touch glans, penis retracts)
• sustains erection
• normal urine flow (indicates lack of prostate swelling or growth)
• no infective agents – gonorrhea, syphilis, herpes, other
• -seminal quantity = 1/8 anjali , about 2-4 ml/ emission;
o 100-200 million sperm; whitish gray color is normal for shukra
o -sweet taste, esp. for K person (= fructose); sour for VP person (=citric acid); if pungent=secondary infection
o -consistency = viscous, unctuous (due to lipids); slimy (due to prostatic secretion)
o -painless - yields bliss w/ emission; no burning
o -coagulates within 10 min ( = fibrin content due to K dosha)
• optimal shukra= luster in the eyes, good growth of hair, well formed sexual organs, attractive body, charm of
personality, capacity for love, empathy & compassion
• excess shukra=> excess semen, passes semen in dreams, excessive sexual desire, excess reproductive fluid, stones
in semen, swollen prostate, perverted desire of sex, creates fatigue
• deficient shukra=>lack of vigor, lack of sexual desire, sterility, impotence, dryness of the mouth, lassitude,
weariness, lower back pain, difficulty & slowness in ejaculation and blood in the semen, scrotum empty or cold, pain
in penis and testes, afraid of opposite sex (absence of ojas), premature ejaculation
Shukravaha srotas: Channels supplying male reproductive tissue, produce ojas and for emotional release: origin
testes, nipple; passage=vas deferens, epididymus, prostate, urethra, urinogenital tract; Opening= urethral opening
where semen & ovum are produced. Also : prostate in men & sexual secretions in women.
• Close connection between ojas and reproductive for men –
o each ejaculation can deplete ojas;
o men are easily addicted to ejaculation;
o masturbation & gay sex are more depleting – not restored by the feminine energy
o in general : one ejaculation/month for men is healthy (young men 1/week) vary with doshas

• Seven dhatus nourished one level after another - 35 days to get to reproductive+ (5 days per dhatu)
• Rasa =>Rakta=>Mamsa=>Medha=>Asthi=>Majja=>Shukra/Artava=> OJAS (immune)
• Milk, almonds, Hummus, Ashwaganda go directly to nourish reproductive tissues
• ***Poor diet , poor digestion then rasa out then everything else will be off : MUST care
for the whole body, as well as focus on reproductive to have a healthy reproductive
system.
Male Fertility Defects and Ayurvedic Treatment -Charaka Samhita – chikitsashanam xxx:
126
“The man also should be evacuated with five measures (Terra: Pancha Karma)and after examining his semen
involvement of dosha should be known according to color and the derangement should be treated with proper
remedy.”
Semen unctuous, viscous, slimy, sweet, non-burning and white like rock crystal should be taken as pure (normal).
(245)
The defective semen are frothy, thin, rough, of abnormal color, foetid, slimy, combined with other dhatus and
precipitant. Charaka continued
• Semen affected by vata = frothy, thin, rough and ejaculated with difficulty and in little quantity. It has no
potency for fertilization.
• Semen affected by pitta is bluish or yellow, very hot, foetid and is ejaculated with burning sensation.
• Semen obstructed in its passage by kapha = exceedingly slimy.
• Due to suppression of urges , semen obstructed in its passage by vata = -------------
Treatment of defective sperm per Charaka

When semen becomes defective, it should be treated with aphrodisiac formulations which are easy to use and
beneficial, the formulations alleviating raktapitta and those useful in female genital disorders.
Jivaniya ghrta, chyvan prasha and the use of shilajatu remove the defect of semen.
• In semen affected by vata –unctuous enemas are advisable.

• In paittika disorders – rasayana formulations mentioned in chapter on “abhyamalakiya (ci1.1) are commended.
• Kapha disorders – rasayana formulation of pippali, amrta and loha; Triphala and bhallataka (bibhitaki)
• Semen accompanied by other dhatus, after examinations, should be treated properly for dosha as well as dhatu
concerned, according to morbidity.
• Semen defects – ghee, milk, meat soup, sali rice, barley, wheat and shastika rice water particularly as enema

Impotency – Charaka continued ( 154-190)
Causes of impotency due to loss of seed: due to intake of cold, rough, little, mixed, incompatible and uncooked food;
grief, anxiety, fear and terror, indulgence in women, exorcism, suspicion, deficiency of rasa etc (dhatus), imbalance of
vata etc. (doshas), fasting, exertion, ignorance of the taste for women, faulty application of panchakarma – the person
becomes pale, too weak, of low vitality, with little erection to women, affected with cardiac disorder, anemia, bronchial
asthma, jaundice, exhaustion, vomiting, diarrhea, colic, cough and fever .
Causes of impotency due to loss penile strength: due to intake of excessively sour, salty, alkaline, incompatible and
unsuitable food; drinking too much water, irregular meals, intake of floury and heavy preparations, regular use of curd,
milk, and meat of marshy animals, reduction from illness, coitus with female child and in non-vagina; cohabitation
lustfully and ignorantly with woman having chronic illness with foul odor, excessive discharge an defective genital track;
intercourse with quadrupeds; injury of phallus; non-washing of penis, wounds in penis by sharp instrument, teeth or
nails or its pressing or striking with wooden stick; excessive use of awny insects (in order to elongate the organ) and
holding back the semen. Characterized by the following symptoms – swelling, pain and redness in penis; appearance of
acute boils, inflammation in penis, abnormal growth therein, appearance of ulcers with discharge like rice water or
blackish or reddish in color, ring-like hardness in circumference of the penis, fever, thirst, giddiness, fainting, vomiting,
red, black, blue or violet discharge, burn-like intense sensation with pain in pelvis, testicles, suture and groin; sometimes
slimy or pale discharge, mild swelling with feeling of wetness and little discharge, delayed inflammation and quick
recovery; appearance of maggots, moisture, foul odor, necrosis of gland, penis and testicles .
Causes of impotency due to senility – semen is often diminished in too old persons particularly due to deficiency of rasa
etc (dhatus), not using aphrodisiacs, gradual decay of strength, energy and sensory as well as motor organs,
deterioration in life-span, want of nutrition, physical exertion and mental exhaustion. Consequently the person has
wasted dhatus, debilitated, devoid of normal complexion, with poor expression and falls prey to disease shortly.
Causes of impotency due to deficiency of semen – caused due to excessive mental work, grief, anger, fear, envy,
curiosity, intoxication and agitation; regular use of rough diet and drugs by the emaciated one; fasting by the debilitated
one and intake of little food--rasa, the chief of the dhatus, located in the heart, is diminished quickly resulting in
deficiency of other dhatus, beginning with blood and ending with semen. Of them semen is the excellent resort. Or if
one indulges in sexual intercourse due to over-exhilaration of mind, his semen is diminished and he is reduced.
Consequently he falls prey to some severe disease or even death. Hence, One desirous of health should particularly
protect the semen.
General Treatment of impotence - One knowing drugs and time, should apply enemas, ghee extracted from
milk, aphrodisiac and rasayana formulations in the treatment of impotency caused by excessive coitus and imbalance of
doshas while considering the strength of body, morbidity and agni.
• In that caused by curses, spiritual treatment should be given.

• First the patient should be uncted and fomented and then given unctuous purgative. After giving him diet, he
should be administered with non-unctuous enema and then unctuous enema. Thereafter non-unctuous enema
prepared with the formulation of palasa, eranda and mustadi then:
• Impotency due to loss of semen - the aphrodisiac formulations mentioned earlier should be given.
• In case of loss of penile strength- local anointment, sprinkling or blood-letting should be done. The patient
should take uncting substance, then unctuous purgative, unctuous enema and thereafter non-unctuous enema.
( besides the overall treatment of wound should be applied)
• Impotency due to senility and deficiency of semen – given proper unctuous evacuation after unction and
fomentation. Ghee, aphrodisiac and rasayana formulations and sustain enemas are the remedy for both types.
Obstructive problems
A blockage in a sperm-carrying tubes has many potential causes. The most common are outlined below.
• Tension of the groin area – blocking blood flow to the generative organs and penis, not blocking the sperm
carrying tubes themselves but healthy circulation (also important in erectile dysfunction).
• Groin surgery (including hernia repair and fixation of undescended testicles).
• Trauma to the scrotum sack covering the testicles (even fairly minor sporting injuries).
• Infection (particularly chlamydia, gonorrhoea and tuberculosis).
• Previous vasectomy (a form of contraception that involves tying the sperm-carrying tubes).
Some men have congenital (present at birth) absence of the vas deferens on one or both sides. The vas deferens
is the tube that conducts the testicular component of semen to the urethra, which then carries semen through the
penis to the outside world. About 10 per cent of men with an obstructive cause for their infertility will have this
problem. The seminal vesicles (where other semen components are made) are often absent too.
Another rare obstructive cause is Berry-Perkins-Young syndrome, in which sufferers have a chronic chest
disease (bronchiectasis), chronic sinusitis and obstructive infertility.
Ayurvedic Treatment: to remove blockages per condition of shukra – treat any infection; soothe trauma of the
scrotum; use castor oil packs and massage of the groin to reduce scar tissue from surgeries; groin massage along
with general massage to remove tension of the groin area and allow good blood circulation.
Testicular injury and disease
• A blow to the testicles, which may occur in sport or during a fight, can cause swelling of the testicles,
or bleeding in or around them. This may, in some cases, cause the blood supply to the testicles to fail,
resulting in permanent damage to the sperm production mechanism.
• Torsion of the testicles (twisting of a testicle on its cord) can have a similar effect if it is not treated
very quickly with surgery.

• Mumps is the best-known cause, but is not the only one. Mumps virus can cause inflammation of the
testicles (orchitis, which usually appears as painful swelling of the testicles) and failure of sperm
production. Mumps will only affect fertility if it causes orchitis and, even then, only rarely.
• Undescended testicles (cryptorchidism) are another common cause of failure of sperm production.
Male infants and children are routinely examined to identify this problem, as future fertility can only be
preserved if surgical treatment to fix the testicles in the scrotum is performed in early childhood. Even
surgery in infancy does not guarantee future fertility, as studies have shown increased oxidative stress in
sperm from these men.
Varicocele
A varicocele is a dilation of the testicular veins in the spermatic cord that leads from the testicles to the
abdomen. The role of this condition in causing infertility is uncertain and highly controversial. Varicoceles
occur in 15 to 20 per cent of fertile men and 30 to 40 per cent of men with fertility problems. They can occur on
either or both sides, but are far more common on the left.
They are best identified when the man is standing up and are often described as feeling like 'a bag of worms'.
Experts suggest that the varicocele either heats up the testicles or impairs their blood supply resulting in a build-
up of oxidative stress, thus allowing free radical damage of sperm. The co-existence of other risk factors, such
as smoking, with varicocele seems to have a greater effect on the risk of infertility, multiplying free radical
damage.
Ayurvedic Treatment: Treat vessels and Rakta; ensure good circulation
Problems with erection and ejaculation
Problems with sex are the principal cause of infertility in about 5% of couples. This can be due to:
• erectile dysfunction (inability to attain or maintain an erection adequate for intercourse)

• premature ejaculation
• failure to ejaculate
• inability to achieve vaginal penetration for other reasons.
Ayurvedic Treatment: See section from Charaka above; Herbs for ED; massage techniques for circulation to penis;
treatment for general debility
Hormonal problems
Testosterone deficiency can reduce fertility and may be caused by problems with testicular testosterone
production, or problems with the pituitary gland or hypothalamus in the brain, which control testosterone
production.

Overproduction of prolactin (hyperprolactinaemia), a hormone produced by the pituitary gland, may also reduce
fertility.
Ayurvedic Treatment: Herbs for fertility; massage techniques to circulation to testicles; treatment for general
balance
General medical disorders that reduce fertility
There are several conditions that may reduce fertility:
• Fever: influenza (flu), pneumonia, or even a severe cold can cause a high fever, which will adversely affect sperm
production and quality. These changes usually recover over a few weeks.
• Diabetes: in the longer term, diabetes can cause problems with erection and ejaculation through causing
damage to the function of the 'automatic nervous system'.
• High blood pressure: hypertension (high blood pressure) can cause problems with erection, either directly or as
a side effect of medication.
• Coronary artery disease: coronary artery disease can cause problems with erection. This could be due to
generalised hardening of the arteries, in the penis as well as the heart, or to drugs used in the treatment of
heart problems.
• Neurological disorders: multiple sclerosis, stroke, and spinal cord injury and disease can all cause problems with
erection and ejaculation.
• Kidney disease: chronic renal failure, which results in a build- up of waste products in the body, can adversely
affect sperm quality and fertility. It can also cause erection problems.
• Cancer: cancers that affect the genital tract or endocrine (hormone-producing) systems may directly reduce
fertility. Otherwise, drugs and radiation used to treat cancer may severely reduce sperm production or even
stop it altogether. Stress (see below) may also have an effect.
• Alcoholism: alcohol is toxic to sperm and overuse of alcohol can reduce sperm quality and fertility.
• Stress: stress causes several hormonal changes in the body that can affect fertility. Stress can have many causes,
including anxiety over fertility problems.
Other factors contributing to sub-optimal fertility in men

• Environmental toxins: phalates and pesticides, as well as heavy metals all can reduce fertility due to oxidative
stress (free radical damage)
• Poor diet: lack of anti-oxidants in the diet leaves sperm open to damage by free radicals, which can be reduced
by the action of those anti-oxidants – Vitamins C and E. Folate (taken along with other B vitamins) protects the
DNA from being damaged by free radicals.
• Over-exercise: again oxidative damage to sperm is increased by too much aerobic exercise, which increases free
radicals
• Obesity: excess fat tissue increases free radicals. Excess heat of testes may reduce sperm production
Adapted and amended from : http://www.netdoctor.co.uk/menshealth/facts/malefertility.htm

The oxidative stress balance chart - ROS= reactive oxygen species
The following chart illustrates how various factors cause oxidative stress which damages the sperm DNA resulting in
infertility and miscarriage AND/OR Damage the sperm membrane, decreasing motility and ability to fuse with an
oocyte.


Treatment of low sperm count, damaged sperm, immobile sperm
Sperm Enhancement with Self Care
a. Ayurvedic consultation – for an individualized, holistic approach, possibly including Cleansing & Rejuvenating
b. Foods to Nourish All Seven Dhatus (Bringhana)- according to doshic needs

Fresh, organic fruits and vegetables
Whole grains
Dairy proteins, including milk, lassi, and panir
Mung dhal
Soaked almonds or soaked walnuts
Sweet, juicy fruits such as mangoes, peaches, plums, and pears
Dried fruits such as dates, figs, and raisins
Stewed apple for breakfast
If your digestion is strong, eat urad cooked with equal parts turmeric, cumin, coriander, and fennel.
A banana cooked in ghee, cinnamon and cardamom is a tasty and wholesome dessert for people with strong
digestion
c. Foods to Enhance the Reproductive Tissue (Vrishya)
• asparagus
broccoli
milk
milk-date shake
milk-mango shake
rice pudding

• spices such as ajwain powder, cumin (which purifies the uterus in women and the genitourinary tract in men),
turmeric (to improve the interaction between hormones and targeted tissues), and black cumin.
In general, it's important to eat a wide variety of foods in order to receive all the essential nutrients. "Keep
trying new vegetables and fruits, and rotate your menus to make sure you're not eating the same thing day after
day," advises Vaidya Mishra.
d. Specialized Treatments For Healthy Sperm
-Herbal Treatment: Herbalized milk:1/3 tsp bala ; 1/3 tsp vidari; & 1/3 tsp ashwaganda boiled in 1 cup of milk -
take at bedtime (milk also enhances sperm/ shukra)
-Foods for male fertility – balance doshas with food and :
o folic acid Findings from a recent study associate low sperm counts in healthy men with reduced levels
of folate.
Leading Food Sources of folic acid: Asparagus, Beets, Broccoli, Spinach, Avocados, Brussels sprouts, Bok
choy, Cabbage, Savoy, Turkey, Beans, dried, Chick-peas, Soybeans, Lentils, Oranges, Peas, fresh
o lycopene Scientists believe this carotenoid may improve sperm count and motility, particularly in men
with depressed levels of lycopene. Leading Food Sources of lycopene: Tomatoes, Grapefruit, pink, Guava
o vitamin C This antioxidant may improve sperm quality by defending against oxidative damage to sperm
membranes. Low levels of vitamin C are thought to contribute to infertility.
Leading Food Sources of vitamin C: Cabbage, red, Kiwi fruit, Strawberries, Potatoes, Oranges, Tangerines
& other mandarins, Peppers, bell, red Pineapple
o vitamin E In addition to protecting sperm membranes against harmful free radical damage,
experimental research suggests this vitamin may enhance a sperm’s ability to fertilize an egg. Leading
Food Sources of vitamin E: : Acorn squash Broccoli, Avocados, Peanuts, Brazil nuts, Mangoes, Almonds,
Sunflower seeds
o zinc Important for Hormone metabolism, sperm formation, and sperm motility, zinc may also foster
improved sperm quality. Leading Food Sources of zinc: Barley, Lamb, Turkey, Oysters, Crab, Wheat, Beef,
Chicken , Pumpkin seeds
e. Chanting Sanskrit – for organs: testicles= Bum
f. Marma points: for testes, testicles, spermatic cord to help sperm development (handouts following)
g. Herbs for Shukravahasrotas

o Avoid for fertility: Neem, vidanga, aloe (esp. long-term)
o Trifala – reduces ama
o Ashwaganda V-P+K- spermatogenesis, testosterone precursors
o Bala - dhatu strengthener

o Brahmi- stress and circulation
o Eggs - protein for hormones and tissues
o Gokshur increases semen production
o Guggulu VK-P+ aphrodisiac
o Kapikacchu V-P+ K- aphrodisiac, increases ojas
o Licorice spermatogenesis
o Lotus VP-K+ for impotence, spermatorrhea, excess energy
o Nutmeg VK- P+ premature ejaculation
o Pippili with fennel – promotes spermatogenesis
o Rose P- spermatogenesis
o Shatavari VP- impotence, sexual debility, increases fertility
o Shilajit VK-P+ helps libido, genitourinary tract
o Vidari VP-K+ increases fertility, tx impotence & hormone deficiency, enlarged prostate
o Gokshuradi guggulu mild aphrodisiac
o Saffron
o Amalaki - Antioxidant, repair heads of sperm
o Punanarva - for obstructions
o Liver herbs - tikta - hormone balancing
o Damiana - libido
o Haridara - Tumeric - rasayana, blood purifier, blood thinner - increase circulation
Herbs for Infertility, Low Sperm Count – Western and Ayurvedic

PK-
o Eupatorium prup.
o Taraacum
o Urtica
o Verbena
KV-
o Allium
o Capsicum
o Semecarpus
o Withania
o Zanthooxyllum
VPK=
o Eclipta
o Glycyhrriza

o Mucuna
o Panax
o Sida
o Tribulus
PV-
o Asparagus spp.
o Avena
o Dioscorea
o Polygonum multi.
o Pueraria
o Serenoa
K-
o Turnera
Herbs for Impotence, Erectile Dysfunction – Ayurvedic and Western

PK-
o Eupatorium
o Nelumbo
KV-
o Allium
o Capsicum
o Cinnamomum
o Ferula
o Myristica
o Plumbago
o Trigonella
o Withania
o Zingiber
VPK=
o Artemisia vulg.
o Chamaelirium
o Crocus

o Eugenia
o Ginkgo
o Mucuna
o Psoralea
o Rhodiola
o Rosa
o Tinospora
o Tribulus
o Valeriana wallich
PV-
o Asparagus racemosus
o Avena
o Polygonatum multi.
o Polygonum multi.
o Serenoa
K-
o Turnera





h. Avoid medications which might affect sperm ( at least 60 days before conception planned)-
Medications effecting sperm quality & fertility

October 17, 2011Carole 4 Comments »
One of the routine questions that patients get asked when they submit a semen sample for analysis is “Have you taken any
medications in the last 60 days?” The 60 days is relevant because it takes around 60-70 days for a sperm cell to be produced and
so exposures that occurred two months earlier may effect your semen quality today.
Each sperm arises from a spermatogenic stem cell which produces a group of sperm that go through a set program of cellular
development to produce the final sperm cell with its distinctive shape and fertilizing ability. Since some new sperm are started on
their two month journey every day, the testicle is filled with sperm at various stages of development. Normally, only mature
sperm cells end up in the ejaculate in about 70 days. For those of you who are interested in learning more about the genetic and
cellular transformation sperm cells undergo during their two months in the testicular production line, you will find a description
of spermatogenesis (cellular division and replication) and spermiogenesis (maturation and structural remodeling of sperm cells
from round cells to a cell specialized for fertilization) from this link.
During this long production period, the medications men take may have a negative effect on sperm quality. The University of
Iowa Urology Department website has an informative page listing some of the medications that have been shown to cause
problems
Anabolic steroids are testosterone and other synthetically produced variants of testosterone which are most often abused by body
builders and other athletes who want to increase muscle mass and sports performance dramatically. Anabolic steroid abuse is
something that most of us have heard about but you may not be aware that testosterone prescribed for you may be the culprit in a
poor semen analysis result. According to my andrology list-serve discussion, more men are being given prescription testosterone
supplements by their primary doctor because they are diagnosed with low testosterone levels and are complaining of erectile
dysfunction, low libido and low energy. Not all primary care doctors are aware of either the effect of these testosterone
supplements on sperm quantity and quality or they don’t realize that their patient is actively trying to conceive.
Urologists who specialize in infertility treatments can use other drugs instead of testosterone such as clomiphene citrate (brand
name Clomid), aromatase inhibitors that block the formation of estradiol from androgens and hCG (a hormone with LH-like
activity to stimulate the steroid sensitive cells in the brain and testes) to correct low levels of testosterone without damaging
sperm production. The good news is that for most men when testosterone supplementation is discontinued, sperm production can
recover although it will take 4-6 months so advance planning for fertility is required. Unfortunately, it is not always reversible so
it is important to let your primary care doctor know that you are concerned about protecting your fertility.
Antibiotics including Gentamycin, Erythromycin, Tetracycline and Nitrofurantoin have been implicated in reducing sperm
quality and quantity by several mechanisms. Nitrofurantoin, erythromycin and gentamycin have direct toxic effects on the
testicular cells, killing the cells that produce sperm or regulate the production of sperm. Nitrofurantoin also has been shown to
interefere with the normal hormonal signalling between the testis and the brain ( the hypothalamic-pituitary-gonadal (HPG) axis).
Tetracylcines have been shown to negatively effect the fertilizing ability of sperm. Be sure to ask your doctor about the potential
effects of using any antibiotic, especially if it will be prescribed for long term use, on fertility.
Antihypertensives used to control high blood pressure can also negatively affect fertility. Spironolactone affects the
hypothalamic-pituitary-gonadal (HPG) axis). Calcium channel blockers have been shown to block fertilization by interfering with
calcium sensitive receptors on sperm cells. Beta-blockers interfere with fertility by decreasing libido and negatively affecting
sexual function, instead of by directly affecting sperm quality. Alpha-adrenergic blockers and thiazide diuretics can cause erectile
dysfunction. When your doctor prescribes antihypertensives, ask about any known reproductive side effects.
Mark Sigman, MD , Associate Professor of Surgery at Brown Medical School has summarized the effects of a large number of
medications on sperm quality in his paper, Medications that impair male fertility, published in Vol. 5, No. 2 , May 2007 of

Sexuality, Reproduction and Menopause. I have copied his table summary below, but you should check out his entire on-line
article (also available as a downloadable pdf which you can print and take with you to the doctor’s office).
Agents Proposed to Adversely Affect Male Fertility
Medication Gonadotoxic Altered HPG Axis Decreased Libido Erectile Dysfunction Fertilization Potential
Recreational/Illicit drugs
Alcohol + + + + -
Cigarettes + - - + -
Marijuana + + - - -
Opiates - + + - -
Cocaine + - - + -
Antihypertensives
Thiazide diuretics - - - + -
Spironolactone - + + + -
Beta-blockers - - + + -
Calcium channel blockers - - - - +
Alpha-adrenergic blockers - - - + -
Psychotherapeutic agents
Antipsychotics - + + + -
Tricyclic antidepressants - + + + -
MAOIs - - - + -
Phenothiazines - + - - -
Lithium - - + + -
Chemotherapeutic agents
Alkylating agents + - - - -
Antimetabolites + - - - -
Vinca alkaloids + - - - -
Hormones
Anabolic steroids - + - + -
Testosterone - + - + -
Antiandrogens - + + - -
Progesterone derivatives - + + + -
Estrogens - + + + -
Antibiotics
Nitrofurantoin + + - - -
Erythromycin + - - - -

Tetracyclines - - - - +
Gentamycin + - - - -
Miscellaneous medications
Cimetidine - + - - -
Cyclosporine - + - - -
Colchicine - - - - +
Allopurinol - - - - +
Sulfasalazine + + - - -
HPG, hypothalamic-pituitary-gonadal; MAOIs, monoamine oxidase inhibitors.
Modified from Nudell DM, et al. Urol Clin North Am. 2002;29:965-973.
I have focused on prescription medications for this post, but you should be aware that other drugs associated with infertility
include: alcohol, tobacco, excessive caffeine, marijuana, heroin, and methadone. Even vitamin supplements or other non-
prescription medications have the potential to cause problems with fertility so it is really important to disclose everything you are
taking or using with your doctor to be sure that you are not sabotaging your own fertility without realizing it.
© 2011, Carole. All rights reserved.
Posted on October 17, 2011 at 9:33 am

http://fertilitylabinsider.com/2011/10/medications-that-can-impair-sperm-quality-and-fertility/
http://fertilitylabinsider.com/2011/10/medications-that-can-impair-sperm-quality-and-fertility/trackback/
Categorised under : Fertility Preservation , Navigating Treatment , Repro Bio 101
Tagged with : medications and fertility , medications and semen
1. Rao MV. Effects of alcoholic extract of Terminalia bellirica fruit extract on male reproductive functions. Arch Biol (Bruxelles)
1989;100:37-46.
2. Singh A, Singh SK. Evaluation of antifertility potential of Brahmi in male mouse. Contraception 2009;79:71-9.
3. Ahmed M, Khan MY, Khan AA. Effects of Ocimum sanctum (Tulsi) on the reproductive system: An updated review. Biomed Res
2002;13:63-7.
4. Vohora SB, Garg SK, Chaudhury RR. Antifertility screening of plants. 3. Effect of six indigenous plants on early pregnancy in
albino rats. Indian J Med Res 1969;57:893-9.
5. Kasinathan S, Ramakrishnan S, Basu SL. Antifertility effect of Ocimum sanctum L. Indian J Exp Biol 1972;10:23-5.
6. Akbarsha MA, Palanisamy M, Murugaian P, Lakshmi Latha PN. Ursolic acid generates symplasts in rat spermatogenic clones.
Phytother Res 1998;12:32-6.
7. Kantak NM, Gogate MG. Effect of short term administration of Tulsi (Ocimum sanctum Linn.) on reproductive behaviour of adult
male rats. Indian J Physiol Pharmacol 1992;36:109-11.
8. Organisation for Economic Co-operation and Development (OECD), OECD guideline for testing of chemicals: Guideline 420,
Acute Oral Toxicity - Fixed Dose Procedure, OECD, Paris, France, 2001.

i. Flower essences page 36 ACY
j. Turning off stress – why important & how to do it: Stress hormones adversely influence the hormones
needed for healthy reproduction. Sometimes we had past traumas and we learned habits of hyper-vigilance to
protect ourselves, using our adrenal glands to ready us for fight or flight. Learning new patterns to decrease
now unneeded hypervigilance allows for better functioning of the reproductive tissues. See handout below
for one way to help.
Breathing to Relieve Stress

If you are habitually excitable, anxious, or just speeding around in a Type A manner you are acting as though a tiger is
chasing you all the time. By using your breath in a conscious way you can turn off your adrenal glands and move out of
fight-or-flight and into the relaxed mode that allows for good digestion, tuned in sex, and a healthier life in general.
Blood pressure can be reduced. Not to mention the mental pressure.
Daily practice- Abdominal Breathing:

Lie on your back, with knees bent up and feet on the floor to relax your lower belly. Gently place one hand on your belly
and one hand on your chest to help you gauge where your breath is going. Just breath naturally in this position for a few
breaths, becoming aware of the speed, depth, and location of your normal breath.
Now, breathing through your nose, take a DEEP, slow breath in that fills up your belly like a balloon. The hand on your
belly should go up first, then filling the lungs all the way up to the top, your chest hand will go up too.
When it’s time to exhale gently and slowly(don’t hold your breath here) letting the air out of your chest first, feeling that
hand sink down as it empties and then, the belly hand goes down at the end of the full exhale.
Don’t force the breath, so much as open up to it coming in and then let the natural force of the air let it move itself back
out, in its own time. If you force the breath out you may hyperventilate and feel dizzy or tingling in the fingers. ( If that
happens, cup your hands around your nose and mouth and rebreathe your air to bring balance back to your O2/CO2
levels.)
Continue the gentle, deep breathing for about five minutes—or longer if you want.
Throughout the day:

Whenever you start to notice you’re “revving up” , take a short breathing break. You don’t have to lie down, just do it
sitting or standing upright. Take at least 3 deep slow gentle breaths—you’ll turn down the adrenals and relax.
More helps:
Another breath useful to waylay anxiety or help go to sleep is from Henry Emmons, The Chemistry of Joy, pp 97,98
Calming Breath:

• Slowly breathe in through your nose. ex. count to 4 (suit the counts to your personal comfort zone)
• Hold your breath for a few seconds. ex. count to 2
• Breathe out your mouth, even more slowly than you inhaled. ex.count to 7
Alternate Nostril Breathing – to balance the solar/lunar, langhana/brmhana energies in the prana, mind, and rasa.
YOU DON”T HAVE TO BE TENSE TO ACCOMPLISH THINGS!!! Affirm: “When I’m relaxed I accomplish more.” If you find
that when you relax that you feel exhausted – you probably are! You may need to take more rest for awhile to allow
your body to recover from being whipped to a frenzy. You need rejuvenation.
Maya Abdominal Therapy can be helpful in relaxing the upper and lower abdomen and making it easier to take deep
breaths. Other helps to turning off the adrenals can be Rescue Remedy or herbs that Terra can recommend. Adrenal
health is important for overall health, hormonal balance, and healthy menopause. Rejuvenate now & maintain your
health.
Environmental toxins and radiation
Several media reports have highlighted research studies showing that sperm counts are falling and that male
fertility is declining, possibly because of environmental pollution. A similar number of studies have shown no
change whatsoever, but these do not make such good headlines and often fail to be reported in the media.
Is male fertility in decline?
Because evidence exists both one way and the other, the answer must be 'maybe'! One thing is certain, and that
is that many more environmental toxins that might affect fertility exist now than 50 years ago.
Table 3: Environmental toxins that may affect fertility.

Potential toxin Origin Effect
Alkylphenols Industrial and domestic detergents Hormonal disrupter
Lacquers to coat foods/ dental treatmentsLacquers to coat foods; dental treatments Hormonal disrupter
Dioxins Paper production; transformer disposal Hormonal disrupter
Organochlorine pesticides
Lindane used on cereals, soft fruits, cabbageHormonal disrupter
(Lindane, DDT, etc)
Hormonal disrupter, testicular
Phthalates Some soya products
toxin
Phyto-oestrogen
Some soya products Hormonal disrupter
(found in certain types of plant products)
Vinclozolin Hormonal disrupter, testicular toxin Hormonal disrupter

Disclaimer
Nothing on the Enhancing Fertility, Pregnancy, Birth and Postpartum with Ayurveda website which you will be given access to, should be
construed to constitute medical advice, diagnosis, treatment or prescribing, or a substitute for such activity. The sole purpose of this
website is to provide information about the complementary and alternative medicine modalities of Ayurvedic Perinatal Care. The
information contained herein is not intended for use in the diagnosis, prevention or cure of any disease. If you have any serious, acute or
chronic health concern, please consult a licensed health professional who can fully assess your medical needs.
The entire contents of the Terra Rafael online courses are based upon the opinions of Terra Rafael, Ayurveda Practitioner and retired
midwife; they do not necessarily represent the views of the staff of Sacred Window of its associates and staff. Furthermore, they are not
intended to replace a one-on-one relationship with a qualified health care professional, and they are not intended as medical advice.
They are intended as a sharing of knowledge and information from the training, education and experience of Terra Rafael. Sacred
Window and its staff encourage you to make your own health care decisions based upon your research and in partnership with qualified
health care professionals.
Terra Rafael and other Mentors you may hire through Sacred Window to support you in study are not medical doctors or licensed health
care practitioners or providers. They do not provide medical advice, diagnosis, treatment or prescribing, or a substitute for such activity,
though they may give you information that may support natural healing. Sacred Window and its staff make no promise of benefit, claim
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altering or discontinuing any current medications, treatment or care, or starting any diet, exercise or supplementation program, or if you
have or suspect you may have a health condition that requires medical attention.

WiseWomanhood Practice & School Terra Rafael, CAP
Class 6: Women’s Health, Yoga Veda Institute

Female Fertility Concerns
Repeat: Disorders of female genital tract -Charaka Samhita Ch 30- “The track affected with
these defects does not hold the semen and as such the woman does not conceive and gets inflicted with various
disorders.”
1. Vatika constitution following vata-aggravating diet & practices- pain, stiffness, feeling of ants crawling,
hardness & numbness of vagina, exhaustion & other vatika disorders. Menstrual discharge appears with
sound, painful, frothy, thin & rough. [Treatment: vata calming with diet, lifestyle, herbs]
2. Paittika – due to excess pungent, sour, salty, alkaline things. Burning sensation, inflammation, fever & heat;
menstrual flow blue, yellow or black and excessive, hot discharge with “cadaverous smell” [Treatment: pitta
calming with diet, lifestyle, herbs, including pitta soothing herbs that target the uterus-- Musta and
Hibiscus.
3. Kapha aggravated. Slimy, cold, itching, with mild pain and pale with menstrual flow pale and slimy.
[Treatment: kapha calming with diet, lifestyle, herbs]
4. All three doshas vitiated in genital tract; burning sensation, pain and white slimy discharge. [ch s 30/9-15]
5. Aggravated rakta-pitta – blood overflows from genital tract, even after conception. sasrja yoni [pitta
calming including Ashoka, pitta soothing herbs that target the uterus-- Musta and Hibiscus. as
indicated]
6. Pitta in genital tract & uterus –affects blood- arajaska – produces leanness & abnormal complexion [16-17]
Amenorrhea ( heavy bleeding leads to anemia leads to weakness, paleness and amenorrhea
7. Organisms arise in genital tract, cause itching – acarana- by which women have frequent desires for man
{18]
8. Vayu due to excessive coitus – swelling, numbness & pain in genitals- aticarana [19] [educate re: problems
of excessive coitus, calm vata in pelvis – with soaks/steams]
9. Sexual intercourse in a too premature woman – vayu – pain in back, waist, thighs and groins -prakcarana
[20] [prevent when possible through education; treat with warmth and oil massage; poss basti]
10. Kapha aggravation during pregnancy then suppresses urge to vomit, vitiated vayu carries kapha to the
genital tract – pale fluid w piercing pain or white mucus - upapluta [21-22] [ gentle treatment if pregnant!]

11. Pitta woman suppresses sneeze & belch during coitus, vayu combines w pitta in genital tract – genital s
swollen, tender, painful & menstrual flow is blue & yellow. pain in pelvis, groins & back – paripluta [23-
24][educate; treat vata and pitta- pitta soothing herbs that target the uterus-- Musta and Hibiscus.]
12. Natural urges suppressed, vayu takes an upward course in genitals – menstrual blood painful due to
upward tendency (instant relief after discharge of blood.) udavartini [25-26] [educate; treat apana vayu
with dashamula, ashwini mudra]
13. Untimely straining during labor leads to vayu obstructed by the baby, combines w kapha & rakta produces
prolapsed which obstructs the passage of menstrual flow – karnini [27] [Educate birth attendants when
possible; replacement of uterus – treat apana & various techniques in protocol]
14. Vayu morbidity in sonata (menses or ovum) destroys the fetus formed over & over due to roughness –
putraghni [Educate to avoid; Treat vata in artava – diet, herbs, soak/steams]
15. Overeating before sexual intercourse and lying in faulty postures- vayu with food curves the opening of
vagina along w vata distress in bones & muscles. Vagina becomes exceedingly painful & intolerant to coitus.
antarmukhi [29-30] [educate; vata reduction]
16. Female fetus if vayu due to roughness affects the genital tract , makes it minute opening – maternal defect
– sucimukhi [31] [ Educate mothers about need for pregnancy balance; may need surgery]
17. Suppressing natural urges during coitus – vitiated vayu causes painful retention of feces & urine & dryness
of vaginal opening. shushka yoni [32] [educate; treat vata, apana vayu]
18. Semen having entered the uterus comes out after six or seven days, w or without pain – vamini [33][?]
19. genetic defect, female fetus – vayu destroys the ovary – woman averse to males and devoid of breasts.
incurable – shandhi [34]
20. Abnormal postures during coitus on uncomfortable bed – vayu vitiated dilates the opening of the uterus
and genital tract. Tract becomes unclosed opening, painful and with rough & frothy menstrual discharge.
Also growth of flesh w painful joints & groin. maha-yoni {35-36] [educate to prevent; treat vayu with herbs,
steam/soaks; ashwini mudra/vaginal squeezes to tone]
Formulas in Charaka Samhita (vi. 8. 49-125): not all herbs known or available widely
To help conception by destroying diseases caused by vata and pitta: Ghee and oil mixed 2.56 kg cooked with decoction
of bala 20.48 litres with the pastes of salaparni, Vidari (payasya,) jivanti, vira, rsabhaka, jivaka, stravani, pippali
mudgaparni, piluparni, masaparni, sarkara, kstrakakoli and kakanasa, along with four times milk. Use according to
strength.
To alleviate vata of female genital track and help conception: Ghee 640 gm cooked with kasmarya, tripala, draksha,
kasamarda, parusaka, Punanarva, haridra, daruharidra, kakanasa, sahacara, shatavari and guduchi.

Alleviate pain in genital track, sides, heart disease, gulma and piles: Pippali, upakuncka, jiraka, vrsaka, rock salt, vaca,
yavakshara, ajamoda, sarkara and citraka should be pounded and fried with ghee. It should be administered with clear
wine.
Pain: milk boiled with rasna, gokshura, and vrshaka taken. The part should be sprinkled over with decoction of Guduchi,
Triphala, and danti.
To relieve pain: oil cooked with paste of rock salt, tagara, kushtha, brhati(Dashmula) and devadaru in equal quantity. Put
into vagina.
For vaginal track to patient of vatika type – tampon with this oil, sprinkle, massage: oil 640 gm cooked with the paste of
Guduchi, jati, rasna (pluchea lanceolata), bala, madhuka (? Centella asiatica), citraka, kantakari, devadaru (cedrus
deodara) and yuthika each 10 gm, along with cow’s urine and milk each in double quantity (1.28 litres each)
For Vaitika type : put in warm paset of himsra after massage
For Paittika type: put in paste of panchvalkala
For Kaphaja type: use drugs of shyamadi group in vagina after massage
Paittika type of genital disorders – cold and pitta-alleviating sprinkling, massage & tamponing should be done along w/
ghrta for unction.
Brhat Shatavari ghrta – alleviates derangements of female genital track, menses, semen and is aphrodisiac and provides
male progeny – 16 g of shatavari root crushed. With its juice and equal quantity of milk, 2.56 kg ghee should be cooked
with the paste of vitalser drugs, shatavari, grapes, parusaka, and priyala and two types of madhuka (terrestrial and
aquatic) each 10 gm. When prepared and cooled add honey and pippali (each 320 gm and sugar 400 gm. Should be
taken in doses of 10 gm.
Help conception and remedy for the paittika disorders of female genital track – ghee processed with vitaliser drugs.
((verses 63-69)
For Kapha in genital track – apply cleansing suppository made of cloth impregnanted profusely with hog’s bile
Cleansing of genital track – suppository the size of index finger – made of pippali, marica, masa, satahva, kustha and
rock salt put into vagina. (70-72)
To remove discharge from vagina – decoction of Triphala mixed with buttermilk, cows urine and shukta (73-83)
Raktayoni – administer hemostatic drug according to dosha after observing its association by the color of the blood
discharged.
Vatika Asrgdara –powder of sesamum, curd, ghee, treacle and lard – all mixed with honey should be taken. Or curd
mixed with sugar, honey, madhuyasthi and sunthi.

Paittika Asrgdara – payasya, utpala, lotus root and rhizome, kaliyaka, musta mixed with milk, sugar and honey should be
taken.
Pshyanuga Churna – patha, seed-pulp of jambu and mango, shaileya, rasanjana, ambashtha, exudation of shalmal
(mocarasa), lajjalu, bark of tuaja, bahlika, ativisha, bilva, musta, lodhra, gairika, aralu, marica, sunthi, mrdvika, red
sandal, katphala, indrayava, ananta, dhataki, madhuka and arjuna – all collected in pushya constellation in equal
quantity – make into a fine powder, taken with hone followed by rice water. Useful for piles, diarrhea and bloody stools.
Destroys diseases of children caused by doshas or extraneous factor. I forcibly removed defects of genital track, menses
and discharges as white, blue, yellow, blackish and reddish. ( 90-95)
Raktayoni, arajaska (amenorrhea) & putraghni------ghrta prepared with decoction of kashmarya and kutaja as vaginal
douche
Amenorrhea (arajaska) – blood of antelope, goat and sheep mixed with curd, sour fruit and ghee or milk processed with
vitaliser drugs.
For disorders of kapha and vata and karnini, acarana, shuskayoni, and prakcarana – Oil processed with vitaliser drugs
given as vaginal douche
Cleanser of channels and alleviation of itching, moisture & smelling - powder of yeast with honey on a piece of flax
Prakcarana and aticarana – non-unctuous enema with vata-alleviating oils cooked hundred times as well as fomented
with vata alleviating drugs. Give her uncting substances, unctuous food and poultices.
Vamini and upapluta types disorder – manage patient with unction, fomentation, etc followed by applications of
unctuous tampon. Thereafter she should be saturated.
Vipluta yonivyapad – unctuous tampon prepared w decoction of bark of shallaki, jingini, jambu and dhava and panca
valkala
Karnini yoni – suppository made of kustha, pippali, arka, Triphala and rock salt pounded with goat’s urine applied into
vagina. Also- kapha alleviating measures are useful.
Udavarta yoni and allied vatika disorders; also mahayoni and srasta yoni – unction with trivrt (ghee, oil and fat),
fomentation, meat soup of domestic and marshy animals, and enema with milk boilded with dashamula are efficacious.
Unctuous enema and vaginal douche should also be give nwth traivrta (ghee, oil and fat).
Srasta yoni (displaced genital track) – massage w ghee and after fomentation with milk should be placed inside and
bandaged , putting bolus of vesavara till the time of urination.
***“WHATEVER REMEDY IS SAID FOR VATIKA DISORDERS, SHOULD BE APPLIED IN ALL DISORDERS OF FEMALE
GENITAL TRACK, PARTICULARLY IN MAHAYONI. THE GENITAL TRACK OF WOMEN DOES NOT GET AFFECTED WITHOUT
VATA. HENCE ONE SHOULD PACIFY IT FIRST AND THEN TREAT OTHER DOSHA.”***

Excessive pale (whitish) discharge – paste of rohitaka root with water OR paste of amalaki seeds with sugar and honey
OR lick powder or juice of amalaki with honey
Remove sliminess and make genital track clean – powder of kasisa, Triphala, saurastri, lajjalu amra seeds and dhataki,
mixed with honey
Stiff and hard genital track – softening measures such as putting local application of vesavara, payasa or krsara.
“THUS WHEN THE GENITAL TRACK IS NORMALIZED, THE WOMEN CONCEIVE IF THE SEED IS NORMAL AND UNDAMAGED
AND THE CONSCIOUSNESS HAS MOVED IN.”
Vaginal Infections
Questions about her vaginal discharge can screen for any emerging problems:
-amount of discharge (especially changes)
-color, normal: white or slate gray or clear (does she know her normal cervical fluids)
Trichomonas (Trich): gray or greenish
Bacterial Vaginosis (BV): gray and frothy
Yeast: white or slate
Cervicitis: clear or yellow.
Gonorrhea: may be yellow – don’t ignore
-If off color, is it frothy? yes for 10% trich 7% BV
-Odor- yes for trich and BV, may be some with yeast.
-Burning: with trich, yeast, herpes
-Itching: with trich, yeast
-Painful urination: trich, yeast, herpes
-Painful intercourse: trich, yeast, herpes
-When checking to differentiate normal ph :3.8-4.2, although higher in pregnancy, like 4.5. ph of trich is
5-7, BV is 5-6
-On speculum exam:
Trich-yellowish, frothy, bubbly with strawberry flecks on the cervix due to
inflammation.
Yeast- cervix is red and inflamed with white patches that come off easily., curd-
like or stringy. If the white patches don't scrape off, refer to physician for possible
cervical cancer.
Chlamydia- thick, yellow, pus-like.
Herpes- ulcerated weeping, gooey white stuff. If there is a lesion present, culture
it, if no lesion, culture the discharge.
-Whiff Test: 1 drop of KOH (potassium hydroxide) onto sample of discharge, if it smells like rotten fish=
gardnerella.

Consider your scope of practice in treating vaginal infections. Continuing or repeated

infections can cause deeper disease of female reproduction. Be sure she’s treated, especially
before conceiving. Treating vaginal infections is more complicated while preserving the
pregnancy and also they may have detrimental effects (more in Pregnancy classes).
Treatments:
Check pulses/ symptoms to determine doshic artava imbalances as well as symptoms to determine best
choice of treatments.
YEAST - what women often say they have, though it may be something else. It can be
more Kapha – white and curdy more Pitta – curds but may be yellowish and more acidic/burning
Treatment
Yeast is commonly found in the digestive tract, including the mouth and rectum, therefore to prevent
recurrent infections careful hygiene is important, as well as balancing the microbiome of the yoni. Kapha ama
will feed yeast and women often have high Kapha or eat a kaphagenic diet – be sure to balance systemically
too:
• Wiping front to back,

• Using condoms for oral or anal intercourse,
• Eat yogurt or acidophilus/avoid sugar, fruit juice, and flour products to keep yeasts in body
under control,
• Frequent handwashing with a nailbrush to keep yeast on hands under control,
• Wash underwear and bedlinens in hot water and bleach in extreme cases. Also towels,
bathmats, toilet seats can be disinfected with betadine.
• Treat male partner concurrently – using above plus penis soaks with treatment chosen from
below. Sexual relations not only passes back and forth between partners, but also breaks up
colonies and spreads furth in the yoni. Having a new sexual partner can take 6 months – year to
adjust to each other’s flora, also leading to UTI’s.
Determine by symptoms and pulse if Vata, Pitta or Kapha excess and treat diet and symptoms accordingly.
• GENERAL VAGINAL DOUCHE – Licorice powder (balances PK, anti-cancer) =2 tablesp Trifala (restores flora,
heals)= 1 tablesp Tumeric (anti-infective)= 2 teasp [Optional teaspoon Sesame oil to reduce V when
needed] 1 pint pure, heated tea water (no chlorine, etc). Steep 10 minutes, strain, body temperature then,
suck up into a large bulb syringe. Lubricate tip w/ sesame or castor oil. Douche gently . For various needs can

add other herbs to mix. After successful treatment course use probiotic insertion to rebuild healthy
microbiome.
• vinegar/water douche daily, followed by acidophilus insert (2 pills or capsules near the cervix),
• boric acid tablets (2 inserted into vagina), followed by acidophilus insert (2 pills or capsules near the
cervix)
• "yeast guard" homeopathic vaginal insert per directions,
• a small peeled unnicked clove of garlic inserted into vagina each night for.
• Neem essential oil in body temp water for gentle douching daily. Continue for 3 days after symptoms
gone.
• Sitz bath per Maya Tiwari – for Venereal warts, syphilis, gonorrhea, HIV/AIDS, candida, yeast infections
Sarsaparilla, Triphala & Safflower Bath Decoction
• 1 gallon water
• 2 tablespoons sarsaparilla powder
• 2 tablespoons triphala powder
• 2 tablespoons safflower threads
• ¼ cup aloe vera gel
Bring water to boil. Add herbal powders and threads to water and bring to a boil. Lower heat and simmer for 5
minutes. While boiling prepare sita bath. Remove from heat and strain. Add aloe vera get into the warm
decoction and pour into bath. (p.158 Women’s Power to Heal by Maya Tiwari)
Medical Treatment: Nystatin, gynelotrimin ( rec. as most effective by gyn.)
TRICH & BACTERIAL VAGINOSIS (BV):

• Internal formula: Trikatu 1 part; Punanarva 5 p; Manjistha 2 parts; Chitrak 1part – take ½ tsp 3x day
before meals if possible with water
• Consider a Pitta soothing diet, if suits other aspects of patient.
• Usnea infusion douches and internally ; also, can add it to the General Vaginal Douche above.

• insert 1 clove of fresh peeled unnicked garlic into vagina overnight change every 12 hours for 7-10
days, insert 2 acidophious tablets in between doses of garlic. Garlic oil capsules can also be used in
same dosage as cloves,
• insert 1- 1,000 mg time-release capsule of Vitamin C at bedtime and follow with acidophilus insert in
early morning.
• Be sure to treat sexual partner to prevent reinfection and use condom if sexual intercourse desired
during treatment time.
• Natural remedies for men: 1 part goldenseal, 1 part myrrh, 1 part echinacea in a capsule or roll them in
a bit of honey to make pills (pea sized). take 8 pills or capsules daily for 3 weeks. Also genital soaks-
use herbs for General Vaginal Douche with Usnea
• Trich can survive in wet sponges several hours and in urine 24 or more hours. Drink 8 0z. cranberry
juice a day to keep trich and bacteria from growing in urine.
Naturopathic All Purpose Vaginal Douche: In 2 cups liquid, add goldenseal, betadine, boric acid, and
echinacea. retain in vagina for 20 minutes, follow with acidophilus insert, repeat for 7 days.
From Dr Barbara Shears, ND
Viral conditions : HPV and Genital Herpes –
Treatment
Internal formula: Kaishore guggulu 2 p ; Shankabhasma 1 p; Pitta soothing herbs like Shatavari, Shankapushpi;
antiviral herbs like turmeric, haritaki
HUMAN PAPILLOMA VIRUS (HPV) found on pap exam – not all strains of HPV cause cancer. They
can come and go, just as bad pap smears can. Some strains also cause large clumps of venereal warts on
external genitals. Must avoid infecting baby during childbirth. Have regular pap smears to make sure cancer
doesn’t develop.
Treatment of HPV
• Put Neem Essential Oil on cervix or on genital warts nightly for a week and after having intercourse
with possible male carrier.
• Use General purpose douche (above) – follow with licorice ghee topically
• See the Sitz bath under the Yeast section above

GENITAL HERPES -- worrisome for conception/pregnancy; viral infection that goes dormant/then active.
Pulse: rasa /rakta pulses w/ pitta spike can mean shedding herpes virus w/out lesion visible
Treatment
Internal formula from Dr. Vasant Lad for active or inactive; ok for use in pregnancy: The dormant virus is killed
by the oral herbs; swab heals active virus –this formula is for pregnancy specifically
▪ abrak bhasma 200 mg

▪ moti bhasma` 200 mg
▪ kama dhudha 200 mg (anti inflammatory)
▪ gulwel sattwa 400 mg
take 1/2 tsp orally 2-3x daily depending on severity
Also swab sores w/ sterilized water & tikta ghrta 2x day morning & evening Do this treatment for 3
months
Geranium essential oil topically
Bala Tea for Genital Herpes - per Maya Tiwari – two servings = daily
• 3 cups water
• ½ tsp bala powder
• ½ tsp lemongrass powder
• ½ tsp sarsaparilla powder
• ½ tsp licorice powder
• 1 teaspoon aloe vera gel
Bring water to boil. Add powders and remove from heat. Cover and let simmer for 15 min. Drain with a cotton
strainer, stir in aloe vera gel and drink warm. Take once after breakfast and again after lunch for duration of
outbreak.

Aromatherapy: Use with local wash, bidet or sitz bath

Bergamot-reduces inflammation and swelling,
Teatree Oil-promotes healing and reduces spread of infection,anti-fungal
Lavendar- infection and swelling.
Neem: anti-bacterial, anti-fungal
*******Refer for infections which just don't go away, they could be an underlying cause in
body which needs to be treated such as blood sugar problems, HIV, candida.
“Trying” For Pregnancy At The Wrong Time – More on Fertility Awareness

Many women don’t know that they can only get pregnant in a certain window of time during each cycle. Teaching clients
how the fertility cycle works and about using the tools of Basal Body Temperature charting and checking fertile mucus
puts the power of controlling her fertility into the woman’s own hands.
The following excerpt is from the website www.tcoyof.com . for full information read the book: Taking Charge of Your
Own Fertility by Toni Wechsler (a good reference) OR take free study course from www.fertilityfriend.com
The Clues to Fertility

Summary: Menstruation, cervical fluid, and waking temperature are the primary clues to determining fertility. Cervix position and
texture is used as a means of corroborating the temperature and cervical fluid signs.Menstruation, or menses, marks the beginning
of a new cycle and its onset is a positive sign of the pre-ovulation low fertility phase ("Phase 1"). In many cases, FAM relies on the
accurate recording of the menstruation start date to properly compute the arrival of the pre-ovulatory fertile phase "Phase 2").
Cervical fluid is secreted by the woman's body before ovulation to improve the sperms' chances for survival and of reaching the
ovum. Due to the timing of its secretion, it can be used to interpret the onset of fertility. The complete absence of cervical fluid is a
strong indicator of infertility.
Body temperature rises and falls in a consistent pattern. Ovulation causes your temperature to remain elevated for about two
weeks. FAM looks for this rise to determine when post-ovulation infertility begins.
The cervix is the muscular opening of the uterus. With the approach of ovulation it becomes softer, opens, and raises its position
relative to the uterus. At infertile times it is low, closed and firm. Currently, Ovusoft and FAM do not make use of this sign directly in
calculating fertility, but users may track it for cross-reference purposes.
There are a number of different clues to show where a woman is in her fertility cycle, ie. which
"phase" of fertility she is in. Ovusoft utilizes three primary ones: menstruation (menses), cervical
fluid, and waking temperature (also known as basal body temperature or BBT). The characteristics of
the cervix are a fourth sign that some users of FAM rely on to corroborate the first three. (Ovusoft
permits you to track the characteristics of the cervix, but it is informational only and not used in any
calculations.)
As an absolute minimum in the practice of fertility awareness, you only need to keep track of two of the four listed
above: menstruation and temperature. Cervical fluid provides an added bonus in that it defines the onset of fertility,
whereas temperature only indicates when ovulation has already taken place, perhaps too late to be of much use in
achieving pregnancy. When used together, however, temperature and cervical fluid help you identify your fertile
period with a high degree of accuracy.
The First Clue: Menstruation

While many people regard menstruation as the start of a new cycle, as does FAM, it is actually the end of the
previous cycle. Why do we say this?
Menstruation is the process of shedding the endometrium (lining of the uterus) that had built up during the previous
menstrual cycle. Therefore, it truly is the end of the previous cycle. Because it is so easy to identify, however, it has
become symbolic of the start of another "period" and is used as such in Ovusoft and FAM, as well.
The endometrium is a lining of tissue on the walls of the uterus that builds up before ovulation in anticipation of the
implantation of a fertilized egg. If the egg is not fertilized, it does not implant and roughly two weeks later the built-
up tissue is sloughed off. The uterus will build it up again in the new cycle in preparation for the next ovulation.

The Second Clue: Cervical Fluid

Cervical fluid is an important sign in fertility awareness. The woman's body begins to secrete estrogen shortly after
menstruation, which causes glands around the cervix to secrete cervical fluid. As ovulation approaches, the amount
of estrogen builds, causing the body to secrete even more fluid. The increased levels of estrogen also make the
cervical fluid stretchy and clear.
As the level of estrogen builds, another hormone, called lutein, is released. Lutein causes the ovaries to release the
ovum. The estrogen levels decrease somewhat after ovulation, causing the cervical fluid to dry up. This drying up
process normally starts on or just after the day of ovulation.
Cervical fluid has several purposes in the area of human reproduction. First, it performs a lubricating function during
sexual relations. Secondly, but more importantly, it provides a friendly environment for the survival of sperm after
sexual relations have taken place. Without this environment, sperm would live no longer than several hours and
would be literally stopped dead in their tracks, unable to move, unable to fertilize the waiting ovum. In the presence
of cervical fluid, sperm are provided with both nutrients and a conduit for movement and may live up to five days in
such an environment. Therefore, in addition to providing a pathway to the ovum, cervical fluid widens the fertility
window beyond the daylong life span of the average ovum and hours-long life span of the average sperm. Sexual
relations taking place several days before ovulation may still result in conception due to the increased viability of the
sperm in the presence of fertile-quality cervical fluid.
Cervical fluid is therefore a positive sign that fertility is increasing and may be used as such in fertility awareness. For
pregnancy achievers, it provides an excellent pre-ovulation indicator, whereas temperature alone can only predict
ovulation after the fact.
Cervical fluid may be observed directly, in which case you might notice the following qualities:
Sticky – A less fertile-type of fluid, not very conducive to supporting either sperm motility or lifespan. This may
correspond to a Moist vaginal sensation.
Creamy – A lotion-like type of fluid, which can support sperm for longer periods than the sticky-quality type. This
may correspond to a Wet vaginal sensation.
Eggwhite – The most fertile quality cervical fluid, it is clear, stretchy, and slippery. This type of cervical fluid
resembles raw eggwhite, hence the descriptive name. This may correspond to a Lubricative vaginal sensation.
For detailed explanation observing and differentiating between the types of cervical fluid and vaginal sensation Taking Charge of Your Fertility.

..


The Third Clue: Waking Temperature

Temperature, or more accurately, waking / basal body temperature, is another one of the body's measurements
that changes in regular cycles. "Basal" body temperature simply means the temperature of your body at rest.
Your body temperature is not a consistent 98.6° F / 37° C as most people think. These figures are the body's normal
high temperature during waking hours. After going to sleep at night, your body temperature gradually drops,
reaching its lowest point in the early morning. As you get closer to your waking hours, your metabolism picks up
again, raising your body temperature ever so gradually, and the cycle is repeated. The scale of the drop and rise of
body temperature can differ from person to person, (although it is normally about 0.1° F / 0.05° C) but all people
experience it to some extent or another.
When a woman ovulates, the follicle containing the ovum ruptures, releasing the egg and the hormone progesterone
into the body. This hormone has several effects, for our purposes not the least of which is the raising of the basal
body temperature. This increase in temperature is significant and detectable, as it typically is about 0.2 to 0.4°
Fahrenheit / 0.1 to 0.2° Celsius over the course of several days. To detect this change, you will need a basal
thermometer, available from most pharmacies. A standard fever thermometer is not accurate enough for our
purposes here, as even a change of 0.1° F / 0.05° C is important. Therefore, an important first step in the practice of
FAM is to buy a basal thermometer.
FAM looks for three temperatures that rise at least 0.2° F / 0.1° C above the high of the previous six temperatures. A
"coverline" is drawn 0.1° F / 0.05° C above the highest of these six temperatures and when three successive
temperatures are above this line, a thermal shift is identified and there's a good chance that ovulation has already
occurred. (This is a simplification of the identification of the coverline; please refer to Taking Charge of Your Fertility
or the glossary for more a more detailed explanation of calculating a coverline and identifying various thermal shift
conditions.)
The temperature sign gives us a great, but late, clue that ovulation has occurred and helps to pinpoint the actual
date. That's why it is so important to use cervical fluid in conjunction with temperature in the practice of Fertility
Awareness if pregnancy is your goal -- together they identify when you are fertile and when ovulation has already
occurred.
The Fourth Clue: Characteristics of the Cervix

The opening of the uterus is a thick muscle known as the cervix. As ovulation approaches, the same hormones that
cause cervical fluid to be secreted also cause changes in the position, texture, and opening of the cervix.
During infertile periods (Phase 1 and 3), the cervix is low, firm and closed (during Phase 3, it is closed tightly). It is so
low that it is fairly easy to reach for observation purposes. As fertility increases, the cervix rises in position, becomes
softer, and starts to open. At peak fertility, the opening of the cervix is about 15 mm wide.
These changes make it easier for sperm to reach the ovum -- if the cervix didn't open, conception wouldn't take
place. If the cervix didn't close tightly after ovulation, the uterus and fertilized egg could become infected. The cervix
has to open somewhat at menstruation to allow the endometrium to be shed.

Its use in fertility awareness is primarily as an additional sign when temperature and cervical fluid do not
define by themselves when post-ovulation infertility has begun.
Putting it all Together
Summary: FAM works by determining the date limits for periods of fertility and infertility. Setting the start date of one phase
automatically determines the end date of the previous phase. The start date for Phase 1 low fertility is set based upon menstruation.
Phase 2 fertility is set based upon the presence of cervical fluid or using a formula based upon shortest historical cycle length. The
start of Phase 3 infertility is set based upon temperature changes alone or a combination of temperature and cervical fluid changes.
Determining the Start of the Pre-ovulatory Low Fertility Phase (Phase 1)

Setting the start date of Phase 1 is easy -- it's the first day of menstruation. Phase 1 is said to be infertile, but as you
get near the end of it, it becomes slightly more fertile. This is due to its closeness to ovulation and the fact that
sexual relations before ovulation that most frequently result in pregnancy. The ovum only survives about 24 hours
on its own, so sexual relations which take place 24 hours after ovulation don't normally result in conception.
However, sexual relations as many as 5 days before ovulation may result in conception.
For this reason, it is very important to set the start of Phase 2 fertility accurately.
Determining the Start of the Fertile Phase (Phase 2)

If you recall from our discussion of the clues to fertility, cervical fluid is a positive sign of fertility. This means that the
start of the fertile period, Phase 2, is set on the first day ANY cervical fluid appears. This is because cervical fluid
allows sperm to live up to 5 days, which means that ovulation doesn't have to occur just after sexual relations for a
woman to conceive a child. On the other hand, without cervical fluid, sexual relations do not normally result in
conception (we say "normally" because even though it's highly unlikely, anything is possible!) Therefore, FAM treats
the start of fertility, Phase 2, as being the first day cervical fluid is present.

What if you're not tracking cervical fluid and have decided to use menstruation and basal body temperature as your
only fertility signs? Or what if you normally do use cervical fluid but for whatever reason, you fail to do so in the
current cycle? FAM will treat cycle day 6 as the start of the fertile phase in such a situation. (Ovusoft, however, will
also review your prior cycle history and will allow you to override cervical fluid observations if your cycle history
suggests that you are truly infertile.)
A Note about Cervical Fluid Changes as Ovulation Approaches: Cervical fluid first appears during Phase 2 and
changes in quantity, color and consistency as ovulation approaches. The "less fertile" type of cervical fluid is typically
sticky, crumbly or creamy/opaque, the "more fertile" type is like raw eggwhite (wet, stretchy, slippery, and clear).
Armed with this knowledge, pregnancy achievers can be fairly certain when their chances for conception are
highest. Just after ovulation, the hormone progesterone is released and estrogen levels drop, causing cervical fluid
to begin "drying up" -- it goes from the more fertile to a less fertile type. The first day of this change, fertility and
conception chances are still high. Within a day, the conception chances drop considerably, so sexual relations are
advised through this period to achieve pregnancy.
Determining the Start of the Post-ovulation Infertile Phase (Phase 3)

The start date for Phase 3 infertility can be set based on temperature changes alone, or better yet, based on a
combination of temperature changes and changes in cervical fluid characteristics.
FAM requires there to be a significant upward shift in basal body temperatures for at least three consecutive days
over the previous six days. All temperatures must be undisturbed by late rising, sickness, physical exertion, etc. This
again points to the value of taking your temperature the FIRST thing in the morning, as there is less chance that
these readings will be disturbed.
What determines whether a rise in temperature is significant? FAM uses a number of rules for determining whether
this condition has been met. First, a coverline is drawn 0.1° F (0.05° C) above the highest of the six pre-shift
temperatures. Once 3 or more temperatures are above the coverline, a thermal shift is said to have taken place.
While it goes beyond the scope of this primer to explain it in detail (Taking Charge of Your Fertility covers it in great
depth), temperature rises are categorized in the following manner:
• Standard Thermal Shift: Three successive days with temperatures above the coverline.
• Slow-rise Thermal Shift: The first temperature in the shift is at the coverline; the remaining temperatures
are above the coverline. Requires four successive days with temperatures above the coverline.
• Fall-back Thermal Shift: The first temperature is above the coverline, the second dips back to or below the
coverline, followed by three temperatures above the coverline. The first temperature might also be eliminated using
the Rule of Thumb, which would then make this shift mimic the Standard Thermal Shift.

Once in Phase 3, you are infertile through Phase 1, so you may elect to stop observing your temperature and cervical
fluid symptoms until menstruation starts. Both observations should be resumed in Phase 1 right after days of heavy
menstrual flow have subsided.
A Final Note on Cervical Fluid

Some may find the idea of observing their cervical fluid sign to be, well, less than exciting. It does, however, provide
a wealth of information about fertility and has a MAJOR advantage for those that use it: It more accurately identifies
the period of Phase 2 fertility than cycle history or temperature alone. For those trying to achieve pregnancy, this is
invaluable because changes in it represent positive signs of increasing fertility.
Systemic Hormonal Imbalances

Two main systemic hormonal imbalances affect female fertility--hypothyroidism and polycystic ovarian
syndrome (PCOS). When the thyroid is under functioning, fertility may be lowered. Punarnava, Chitrak and
Guduchi support optimal thyroid function, as does shilajit. Trim Support, containing most of the above herbs,
not only helps with obesity-related fertility issues but also helps optimize thyroid function. Blood test
standards may not be sufficiently sensitive for fertility issues. If you suspect hypothyroid - check the thyroid
pulse to check for doshas there AND the BBT - if it isa flat or low level consistently, then treat for
hypothyroidism with herbs above, added seaweed in diet, marma point for the thyroid ( Kanthanadi - (where
they do tracheostomy-in suprasternal notch; you can feel the trachea- for hypothyroidism use Hena, ginger or
vacha oil clockwise (as if the clock is on the area facing outward) for this Kapha disorder ) and the bija mantra
HRIM (like “him” with an r in it). Check for hypothyroid: thyroid pulse on throat, painted iodine absorption and
basal body temperature check – ASK TERRA TO SHOW YOU THESE IN CLASS
PCOS is a complex topic meriting an article in its own right. Briefly, it is a form of Kapha Syndrome
characterised by multiple small cysts on the ovaries, abdominal obesity, androgenic features such as hirsuitism
(excess facial and body hair growth) and acne, insulin resistance, irregular menstruation and anovulation.
PCOS is a leading cause of female infertility. (12) Ayurvedic management includes a kapha soothing diet rich in
phyto-nutrients, a good kapha pacifying yoga program, and herbal regimens to support weight loss, blood
sugar balance and female hormonal balance. Punarnava is a key herb for managing kapha, Shardunika and
Turmeric help regulate blood glucose and Vidari supports hormonal balance. A combination of Trim Support,
to reduce visceral adipose tissue, Sweet Ease, to help balance blood sugar, and Women's Support to
normalize hormonal balance will be of great v To increase progesterone - from amended from article by Alakananda
Ma.
Infertility due to Stress:
Stress alters the whole body physiology. When stress hormones are activated, reproductive (and digestive)
functions are placed on a very low priority while muscle readiness is prioritized for fight or flight. When stress
is long-term, fertility is impacted. Looking at the balance of brmhana/langhana (yin/yang), relaxation must
amp up as much as stress does.
• Seek to reduce stress through:

• Moderate, non-competitive exercise;
• Flower essences p 45 Ayur for the Childbearing Years;
• Breathing techniques as indicated in the Pranayama section, especially Alternate Nostril Breathing,
which specifically helps balance brmhana/langhana;
• Singing - which opens up the breathing and can calm the mind; Humming is also calming
• Herbs such as brahmi & Shankapushpi (to strengthen the nervous system), nutmeg (mild sedative), and
Ashwaganda (stress mediating) - chosen to suit the doshic needs of the individual.
AGING & Conception: Other systemic hormonal balance issues come up when a woman begins entering
menopause. Fertility is at a peak in the late 20. The number of oocytes is originally 500,000, reducing to about 100,000
at age 30 and less than 10,000 after age 50. Around 30 yrs old the FSH increases to try get the ovarian follicles to
respond more and it continues to gradually increase until 2-3 yrs after menopause. The ovaries meanwhile become
more resistant to FSH stimulation. Estrogen production is reduced with less follicles creating it, leading to anovulatory
cycles. LH target cells decline so that LH levels raise sharply around age 35-40, increasing even dramatically until about
2-3 years after menopause (and reduce less than 20-30 yrs after menopause)
At the same time pelvic blood flow becomes five times LESS than at it peak. Pelvic blood flow is an important aspect of
fertility evaluation - this part can be improved by Maya Abdominal Therapy, acupuncture, stress reduction, and herbs
that increase blood flow in the body.
Thyroid function also often decreases by the 40s which reduces fertility.
High serum FSH/LH ratio (1.9-3.8) is a useful indication of menopause.

Pregnancy After 35
from MARCH OF DIMES
Many women now start a family when they are in their mid-30s or older.
Today, 1 in 5 women in the United States has her first child after age 35 (1).
The good news is that most have healthy pregnancies and healthy babies.
However, studies show that women in their mid-to-late 30s and 40s may face
some special pregnancy risks. Women should be aware of these risks so they
can make informed decisions about their pregnancies, including when to
become pregnant.
Does age affect fertility?
Women usually have some decrease in fertility starting in their early 30s. It often takes a woman in
her mid-30s or older longer to conceive than a younger woman. Men also may have some decrease
in fertility starting in their late 30s (2).
Women over age 35 may be less fertile than younger women because they tend to ovulate (release
an egg from the ovaries) less frequently. Certain health conditions that are more common in this
age group also may interfere with conception. These include (3):
• Endometriosis (a condition in which tissue attaches to the ovaries or fallopian tubes)

• Blocked fallopian tubes (sometimes resulting from past infections)
• Fibroids (non-cancerous growths in the uterus)
A woman over age 35 should consult her health care provider if she has not conceived after 6
months of trying. Studies suggest that about one-third of women between 35 and 39 and about half
of those over age 40 have fertility problems (4). Many fertility problems can be treated successfully.
While women over age 35 may have more difficulty conceiving, they also have a greater chance of
having twins (5). The chances of having twins increases naturally with age. Women over 35 also are
more likely to undergo fertility treatment, which also increases the chance of twins (as well as
triplets and other multiples).
Are women over age 35 at increased risk of having a baby with a birth defect?
A woman’s risk of having a baby with certain birth defects involving chromosomes (the structures in
cells that contain genes) increases with age. Down syndrome is the most common chromosomal

birth defect. Affected children have varying degrees of mental retardation and physical birth
defects. A woman’s risk of having a baby with Down syndrome is (1):
• At age 25, 1 in 1,250

• At age 30, 1 in 1,000
• At age 35, 1 in 400
• At age 40, 1 in 100
• At 45, 1 in 30
• At 49, a 1 in 10
The American College of Obstetricians and Gynecologists (ACOG) recommends that all pregnant
women, regardless of age, be offered a screening test for Down syndrome and certain other
chromosomal birth defects (6). Screening tests are blood tests done in the first or second trimester,
sometimes with a special ultrasound. They help evaluate a woman’s risk for having a baby with
certain birth defects, but they cannot diagnose a birth defect.
ACOG also recommends that all pregnant women have the option of choosing a diagnostic test,
such as amniocentesis or chorionic villus sampling (CVS), instead of a screening test (6). A
diagnostic test can tell if a person does or does not have a certain condition. Amniocentesis and
CVS are highly accurate in diagnosing or ruling out a birth defect, but these tests may pose a very
small risk of miscarriage.
Until recently, providers routinely offered diagnostic tests, rather then screening tests, to women
over age 35 because they have increased risk of having a baby with chromosomal birth defects.
However, ACOG now recommends that providers offer women over age 35 the option of having a
screening test to evaluate their risk before deciding whether or not to go ahead with amniocentesis
or CVS (6).
Does the risk of miscarriage increase as a woman gets older?
Most miscarriages occur in the first trimester for women of all ages. The risk of miscarriage
increases with age. Studies suggest that about 10 percent of recognized pregnancies for women in
their 20s end in miscarriage (1). The risk rises to (1):
• About 20 percent at ages 35 to 39

• About 35 percent at ages 40 to 44
• More than 50 percent by age 45
The age-related increased risk of miscarriage is caused, at least in part, by increases in
chromosomal abnormalities.
Can preexisting health conditions affect pregnancy?
Women over age 35 are more likely than younger women to have a health condition that began
before pregnancy. Some health conditions, such as high blood pressure, diabetes, and kidney and
heart problems, can affect pregnancy. For example, poorly controlled diabetes can contribute to
birth defects and miscarriage, and poorly controlled high blood pressure can slow fetal growth.
At any age, a woman should see her health care provider before trying to conceive. A preconception
visit helps ensure that she is in the best possible health before getting pregnant. A preconception
visit is especially important if a woman has a chronic health condition. Her provider can treat the
condition and make any necessary changes in her medications to help assure that she has a healthy
pregnancy. The provider also can recommend that a woman take a daily multivitamin containing
400 micrograms of folic acid to help prevent certain birth defects of the brain and spinal cord
(neural tube defects).
Are women over age 35 more likely to have pregnancy complications?
Women in their late 30s and 40s are very likely to have a healthy baby. However, they may face
more complications along the way than younger women.
Some complications that are more common in women over 35 include:
• Gestational diabetes: This form of diabetes develops for the first time during pregnancy.
Studies suggest that women over age 35 are about twice as likely as younger women to

develop gestational diabetes (7, 8). Women with gestational diabetes are more likely to
have a very large baby who is at risk of injuries during delivery and of newborn health
problems (such as breathing problems).
• High blood pressure: As with diabetes, high blood pressure can develop for the first time
during pregnancy. This is called pregnancy-induced high blood pressure or pregnancy-
induced hypertension. In its more severe form, it is called preeclampsia. Some studies
have found that pregnancy-induced high blood pressure is more common in women over
age 35 (8, 9).
• Placental problems: The most common placental problem is placenta previa, in which the
placenta covers part or all of the uterine opening (cervix). One study found that women in
their late 30s were almost twice as likely, and women in their 40s nearly three times as
likely, as younger women to have this complication (7). Placenta previa can cause severe
bleeding during delivery, which can endanger mother and baby. A cesarean birth (also
called c-section) often can prevent serious complications.
• Premature birth: Women ages 40 and older are more likely than women in their 20s and
30s to deliver prematurely (before 37 completed weeks of pregnancy). From 2003 to 2005,
16.6 percent of women ages 40 and older delivered prematurely, compared to 12.5
percent of women ages 30 to 39, and 11.9 percent of women ages 20 to 29 (10).
Premature babies are at increased risk of health problems in the newborn period and of
lasting disabilities. Some studies also suggest that women in their 40s may be at increased
risk of having a low-birthweight baby (less than 5½ pounds) (7, 8). (Low birthweight can
result from premature birth, poor growth before birth or both.)
• Stillbirth: Stillbirth is the death of the fetus after 20 weeks of pregnancy. A number of
studies have found that women over age 40 are about two to three times as likely as
women in their 20s to have a stillborn baby (7, 11). The causes of stillbirth in the over-40
age group are not known.
Are women over 35 more likely than younger women to have a c-section?
The chances of having a c-section increase with age. Mothers over age 40 appear to be more than
twice as likely as mothers under age 20 to have a c-section (5). [Terra: I wonder if this is partly
because women having babies over 40 are mostly higher income with insurance] In 2006, according
to the Centers for Disease Control and Prevention (CDC), about 47 percent of mothers over age 40,
41 percent between ages 35 and 39, 27 percent between ages 20 and 24, and 22 percent under
age 20 had a c-section (5).
How can a pregnant woman reduce her risks of pregnancy complications?
Today, most women in their late 30s and 40s can look forward to healthy pregnancies. Women of all
ages can improve their chances of having a healthy pregnancy if they:
• Have a preconception checkup with a health care provider.

• Get early and regular prenatal care.
• Take a multivitamin containing 400 micrograms of folic acid daily, starting before
pregnancy and in early pregnancy, to help prevent neural tube defects.
• Begin pregnancy at a healthy weight (not too heavy or too thin).
• Don’t drink alcohol.
• Don’t smoke and stay away from secondhand smoke.
• Don’t use any drug, even over-the-counter medications or herbs, unless recommended by
a health care provider who knows they are pregnant.
• Eat healthy foods, including foods containing folic acid and folate (the form of folic acid
that occurs naturally in foods). Good sources of folate are fortified breakfast cereals,
enriched grain products, beans, leafy green vegetables and orange juice.
• Don’t eat undercooked meat or change a cat’s litter box. Both are possible sources of
toxoplasmosis, an infection that can cause birth defects.
• Don’t eat fish that can be high in mercury, like shark, swordfish, king mackerel or tilefish.
Limit albacore (white) tuna to 6 ounces or less a week. Women can safely eat up to 12
ounces per week of fish that have small amounts of mercury, including shrimp, salmon,

pollock, catfish and canned light tuna. They also should check with their local health
department before eating any fish caught in local waters.
• Get tested for immunity to rubella (German measles) and chickenpox before becoming
pregnant and consider being vaccinated if not immune. After being vaccinated, a woman
should wait 1 month before getting pregnant.
References
1. American Society for Reproductive Medicine (ASRM). Age and Fertility: A Guide for
Patients. ASRM, Birmingham, AL, 2003, accessed 2/5/09.
2. Dunson, D.B., et al. Increased Infertility With Age in Men and Women. Obstetrics and
Gynecology, volume 103, number 1, January 2004, pages 51-56.
3. American College of Obstetricians and Gynecologists (ACOG). Age-Related Fertility Decline.
ACOG Committee Opinion, number 413, August 2008.
4. Fong, S. and McGovern, P. How Does Age Affect Fertility? Contemporary Ob/Gyn, April
2004, pages 37-46.
5. Martin, J. A., et al. Births: Final Data for 2006. National Vital Statistics Report, volume 57,
number 7, January 7, 2009.
6. American College of Obstetricians and Gynecologists (ACOG). Screening for Fetal
Chromosomal Abnormalities. ACOG Practice Bulletin, number 77, January 2007, reaffirmed
2008.
7. Cleary-Goldman, J., et al. Impact of Maternal Age on Obstetric Outcome. Obstetrics and
Gynecology, volume 105, number 5, May 2005, pages 983-990.
8. Joseph, K.S., et al. The Perinatal Effects of Delayed Childbearing. Obstetrics and
Gynecology, volume 105, number 6, June 2005, pages 1410-1418.
9. Usta, I.M. and Nassar, A.H. Advanced Maternal Age. Part I: Obstetric Complications.
American Journal of Perinatology, volume 25, number 8, September 2008, pages 521-534.
10. National Center for Health Statistics, final natality data.
11. Bahtiyar, M.O., et al. Stillbirth at Term in Women of Advanced Maternal Age in the United
States: When Could the Antenatal Testing Be Initiated? American Journal of Perinatology,
volume 25, number 5, May 2008, pages 301-304.
May 2009
© 2010 March of Dimes Foundation. All rights reserved. The March of Dimes is a not-for-profit organization recognized as tax-exempt under Internal Revenue
Code section 501(c)(3). Our mission is to improve the health of babies by preventing birth defects, premature birth, and infant mortality.
Advanced Maternal Age and Egg Quality (Vata effects)

Randine Lewis, Ph.D., Lic.Ac
This article is written from the view of TCM - however gives interesting information and perspective.
.
Biologic Age vs. Chronologic Age
Many humans live over 100 years. Most forms of medicine throughout history have sought to improve longevity. In the
ancient Chinese medical text, the Nei Jing, there is a dialogue between the Yellow Emperor and an old Taoist teacher
named Chi-Po. The Yellow Emperor asks, "Why does medicine exist?" Chi-Po's answer is, "...because people have
severed themselves from their roots (the Tao)". Reconnecting a woman with her spiritual roots is an important aspect in
maintaining her health and her youth. Understanding which energies decline with maturation can help restore youthful
energetic and, in essence, turn back the reproductive clock. One's longevity is deeply connected with one's inner
harmony. The result is manifested internally and externally. Nature is kind and forgiving. Enhancing our natural
reproductive capacity will maximize the possibility of a child; however, we cannot wait too long and override nature.
According to an old Chinese proverb, "The Yangze never runs backwards...man recaptures not his youth."

The average reproductive life span for a woman is about 30 years. Years ago, women didn't menstruate on the average
until age 15 or 16. Today girls of 10 or 11 are already menstruating. Part of this is due to the overabundance of synthetic
hormones in our diet. We are coming of age faster and going into menopause later. We should be able to prolong our
reproductive health as well as longevity. Specifically applied techniques of Oriental Medicine can restore a more youthful
endocrine system.
Correct dietary practices and exercise routines are the first factors to contemplate in raising your fertility quotient and
maintaining reproductive vigor. R.G. Godsen & C.E. Finch, in Definition & Character of Reproductive Aging &
Senescence, state, "Dietary and endocrine manipulations can also slow the pace of ovarian aging." One study in Biol
Reprod, 1985, Nelsen, Godsen & Felicio, found that feeding a low calorie diet to rodents slowed the disappearance of
ovarian follicles. Whole foods, mainly consisting of organic fruits and vegetables, will help restore vitality, as well as
avoiding alcohol, caffeine, and nicotine. Moderate tobacco use has been estimated to advance the onset of menopause
by up to three years, and increase the rate of follicular atresia by 7% (Godsen, et al.) Any form of stimulant (including
herbal) will age us prematurely. Moderate exercise at least three times per week helps improve the circulation to the
internal organs as well as improving skin and musculoskeletal tone.
There is a belief in the reproductive medical community that age is the only factor that determines ovarian health. Medical
studies conclude that ovarian decline occurs around age 40. These studies, however, do not take into account the
relevance of environmental stressors and dietary factors. Environmental factors play an incredibly crucial role as far as
reproductive aging is concerned. In
20% of monozygotic twins, the age at menopause differs by five or more years. Genetic parameters of oocyte aging have
used mathematical models to calculate and determine that an 80% variation in ovarian aging is genetically determined,
leaving a 20% distinction for environmental factors which are within our control. Guess what?! Our ovaries do not have a
predetermined, finite halflife. They are organs that respond to favorable surroundings just as the rest of our bodily systems
do. They are not locked away in untouchable safes. This is very good news, however, because just as they respond
negatively to poor diet, drugs, toxins, and stress hormones, they also respond positively to a healthy diet and pure
lifestyle.
Our ovaries and the eggs residing in them have been present since before we were born. During embryologic
development, the seven million germ cells which will become all of the 300,000 - 400,000 eggs we will possess at birth will
be carried through menopause, when the follicular supply falls to less than 100. Certainly as we age, the DNA contained
within the eggs becomes less stable. However, a human egg which has been lying dormant for 32 years is not itself
tremendously more stable than one which has been resting for 40 years. When most women approach the peri-
menopausal hormonal fluctuations, they still have thousands of eggs remaining within their ovaries! What makes them
less responsive? Hormonal fluctuations. Once scientific study found that when the ovaries of older, anovulatory rats were
transplanted into hormonally youthful rats' bodies, they became capable of ovulating. Neuroendocrine changes take place
while the ovary is still well endowed with follicles. These variations begin with central, hypothalamic control of the release
of FSH. Acupuncture and herbal therapy can forestall age related decline.
What happens as we approach middle age is that our own hormonal makeup wavers. The hypothalamic - pituitary -
ovarian axis, an invisible network of hormonal relationships which govern our reproductive status, becomes less stable
with age. The ovaries become less predictable because of the hormonal fluctuations and the eggs contained within quit
responding predictably to the hormones. Once they become less responsive to the FSH, more of them cycle through and
go to their "resting place." We need to provide more hormonal fuel for the remaining thousands of eggs, i.e., strengthen
the hypothalamic-pituitary-ovarian axis, when age becomes an issue. Acupuncture techniques have been proven to
regulate the hypothalamic - pituitary - ovarian axis. The result will then be manifest in the ovaries and their hormone
production.
Contrary to popular reproductive belief, follicular growth from the resting state until ovulation takes up to 100 days, or
more than three menstrual cycles. Follicles are selected from the primordial pool of resting follicles almost a year before
ovulation, and are recruited to become active. During the initial pre-gonadotropin period the follicle responds to regulatory
factors within the ovary itself, which are like hormones. These growth factors are like hormonal precursors. One important
ovarian growth factor, insulin-like growth factor, is the precursor to the youth hormone which is secreted by the thymus
gland called growth hormone. Others have names like insulin-like growth factor binding protein, interlukin, tumor necrosis
factor, inhibin, vascular endothelial growth factor, and activin. These ovarian growth factors help determine the eventual
fertility potential of the oocyte (egg).
During this period which lasts for many months, the healthy,responsive follicle determines its own fate with these
regulatory proteins. The (0.03mm) follicle is first chosen from the primordial pool to double in size (to about 0.06 mm) and

become a primary follicle, about 150 days prior to ovulation. It reaches its secondary phase approximately 120 days
before ovulation, when it again doubles in size. The follicle then cycles through the pre-antral and early antral phase and
grows from about 0.12 mm to about 1.0 mm in approximately 65 days. It has quadrupled in size during this time, and has
gone through many stages of proliferation.
It is only during the last two to three weeks of its cycle through the ovary that the follicle becomes dominant and
responsive to FSH. During the selection phase, which lasts approximately ten days, it more than doubles in size as it
differentiates further. The follicle itself acts as its own gland by autocrine and paracrine mechanisms to make itself
responsive to FSH. Now the follicle grows to twice its previous size again, surfaces and becomes the estrogen-producing
follicle which then makes itself receptive to luteinizing hormone by expressing a receptor at the preovulatory phase. It
fulfills its major purpose as it releases its egg, whose chromosomes are beginning to rearrange, for a chance to become
fertilized. The follicle then finalizes its life cycle by becoming its own endocrine gland called the corpus luteum, which
secretes progesterone to maintain a pregnancy. Imagine the potential energy required for these great follicular
achievements! This is not an undertaking for the frail!
A woman who is over age 43 or 44 will often be turned away from any chance at assisted reproductive technology
because of the age and therefore poor state of her ovaries. She may fail to respond as favorably to the gonadotropins as
her younger counterpart, because her eggs have become less responsive to hormonal stimulation. [Terra: I wonder if
there is FSH resistance just as there is Insulin resistance and how to avoid it.] She may produce few numbers of eggs,
whose outer capsule is tougher and thus less capable of fertilization. Those eggs which do become fertilized may have
more inclusions during early embryologic development, meaning there are more waste products put out by the
mitochondria. Less make it to the blastocyst stage, even fewer are capable of implantation and fewer yet make it through
the full embryonic development. That is why a woman over forty is statistically less likely to give birth, and is encouraged
to find alternative ways of becoming a mother. She will be told she has poor quality eggs. Her reproductive
endocrinologist will strongly suggest quality eggs. Her reproductive endocrinologist will strongly suggest that she consider
using a younger donor's eggs. This makes her chances of having a baby, and thus her RE's statistics, much higher.
The reason for the lower chances of assisted reproductive success in older women is because the only portion of the
hormonal process that is manipulated is the last few weeks of this many months' process. Massive doses of gonadotropin
hormones are given to the women in order to (hopefully) recruit more follicles. This doesn't, however, make them of better
quality. Perhaps the reason she has been unsuccessful in conceiving in the first place is because her hypothalamic-
pituitary-ovarian axis has been ailing, and the reflection has been in the resistance of her ovaries, the eggs contained
within, and thus the inability to conceive.
It seems that the older a woman is, this process of follicular development, which takes up the better part of a year,
becomes more susceptible to breakdown. Experience has shown that if the hormonal system is in perfect working order
and a woman has clockwork menstrual cycles, no matter what her age, a healthy egg can be released on time. It then has
a good chance of becoming fertilized, implanting, and making it through embryologic development to become a child. The
emphasis here is on the healthy hormonal cycle.
If each individual element of the hypothalamic-pituitary -ovarian axis is still in healthy interrelationship during this process,
the developing follicles are going to reflect this state of well-being.
How do we give the HPO axis the attention it needs to express its full reproductive vigor? Fortunately, the steps involved
in turning back the reproductive clock are all natural. Unfortunately, rejuvenating the reproductive system takes time.
Through some effort, we will give the entire reproductive -psycho-neuro-endocrinologic system the attention that a young
woman's has effortlessly. We will help urge the body's attention to the mid-brain, the pituitary, the ovaries, the uterus, the
spirit, and the mental and emotional health required to produce healthy eggs.
The Eastern View (acupuncture)

Three energy meridians make up the hypothalamic-pituitary-ovarian axis: the Penetrating, the Conception, and the
Governing meridians. These energies become fulfilled when a girl reaches menarche, and become depleted when a
woman enters menopause. Statistically, the earlier a young woman first menstruates, the later will be her entrance into
menopause. Her reproductive age span is a function of her underlying congenital source qi.[ Terra: Ojas]

The Penetrating meridian represents the HPO axis. It originates in the uterus and presides over the function of
menstruation and governs the hormonal cycles. It is the deepest level of life, which equates with the most innate functions
of our more primitive brain, as it relates to the psycho-neuro-endocrinological system. From it arise the energies of the
conception and governing meridians, the yin and the yang of the endocrine system.[Terra: Compare meridians with Nadis
– Ida and Pingala and Sushuman]
The inherent functions of these meridians are the basic forces of our internal nature which determine cellular health,
cellular division, continued development, maturity and decline. We might say that the Penetrating meridian is responsible
for the follicular manifestation of growth factors and hormonal expression. We all have been programmed with a certain
reproductive energetic potential which governs hormonal fluctuations and eventual decline. This is not fixed. It is subject
to certain environmental and internal factors which can stave off or facilitate the decline.
The usual process of reproductive transition from a fertile to a nonfertile state spans many years. It should be a smooth
transition from an energetic focus on self (pre-puberty), to an energetic focus on reproduction (menarche), to an eventual
outward energetic shift (menopause). This transition is physiological, psychic, and spiritual. The physical ramification of
these shifting energies begins when a girl enters menarche. At about age 14, the hormonal system is effulgent, and the
Penetrating meridian fills to overflowing, after which the menses arrive like a tide. The uterus fills to overflowing from one
full moon to the next. This process occurs every month unless a pregnancy (or other hormonal interruption) suspends the
process, until the woman approaches middle age.
When her reproductive life span is complete, the energies are transferred from the uterus to the heart via the Penetrating
and Conception meridians. She moves from a state of procreation (represented by the kidney system) to a state of
wisdom, represented by the heart. This is seen as a literal shifting of energies. If this energetic transition from the uterus
upward to the heart is not smooth, these rising energies will produce heat signs like hot flashes and night sweats.
Irritability will result from the obstructed flow of qi. The kidney system will become depleted and will no longer be able to
support bone growth.
When we treat menopause with Traditional Chinese Medicine, we make this transition smooth and complete. When we
treat age related fertility factors, we interrupt and stall this transition. Again, we try to regulate the hormones and make
them function as if they are young again. The extraordinary meridians that govern endocrine relationships cannot be
separated from the kidney system.
The Kidney System

The signs and symptoms of declining kidney function parallels an actual decline in hormone levels.
In Chinese medicine the kidney system is responsible for our genetic constitution, and underlies all other metabolic
processes. It dictates growth and development. It provides the essence for the uterus and menstruation. When the kidney
essence is depleted, women go into menopause. The kidneys are responsible for bone and teeth formation and overall
brain function. The kidneys control water formation and overall brain function. The kidneys control water balance and
elimination.
The kidney system provides the substrate for and encompasses the relationship between the reproductive system, the
skeletal system,the neurological system and the endocrine system.
When the kidney system begins to decline as a woman ages, symptoms include either signs of kidney yin vacuity, kidney
yang vacuity, or both. Signs and symptoms of kidney yin vacuity are: low levels of estrogen, night sweats, hot flashes,
vaginal dryness, low back weakness, soreness, or pain, or knee problems, ringing in the ears, dizziness, scanty fertile
cervical mucus, excessive fear, dark circles around the eyes, scanty menstruation, a tongue lacking in coating that
appears shiny or peeled.[Terra: Compare with Vata ]
Symptoms of kidney yang vacuity include have low back pain which is worse premenstrual, a sore or weak low back, cold
feet at night, being cold in nature, low libido, frequent, dilute or nighttime urination, being fearful in nature, early morning
loose, urgent stools, profuse vaginal discharge, dull menstrual blood, cold cramps during the period that respond to a
heating pad, and a moist, pale tongue. [ Compare with Vata]
Spleen Vacuity

The spleen energies weaken with age right along with the kidneys, and often times precede it. The first tip off to declining
spleen function is fatigue. We just seem to require more energy to get the same amount of work done than we did a few
years ago. Enter caffeine, which artificially stimulates the brain, and allows us to function with a little more energy.
However, caffeine itself provides no additional energy to the body... it merely borrows it from... (You guessed it), the
kidneys! When the kidneys are already taxed, and still have to preside over menstruation and hormonal functioning, guess
what gives? Reproduction: that life process which is not necessary for our survival.
Another sign of waning spleen energies is that things start to fall. Our skin begins to sag, our breasts fall, veins appear on
the surface of skin, we get hemorrhoids, and our uterus falls into our bladder. We have to pee more often. Our blood
pressure fluctuates. Our digestion and elimination become more sensitive. Our metabolism changes. We react more to
our environment and catch cold more often. Even our protective mechanisms start to falter. Progesterone drops off during
the luteal phase. Periods come earlier and are often accompanied by loose stools.
Treatment
Happily, we have methods to tonify both the energies of the spleen and the kidney.
• Exercise
• Rest well
• Avoid junk food, caffeine, tobacco, sodas, sweeteners, and refined carbohydrates.
• Do not eat any meat or animal products which have been treated with growth hormone. This includes most of the
meat, eggs, milk products and cheese found at the supermarket.
• Avoid dairy products, raw vegetables, and cold foods.
• Eat foods which tonify the kidney and spleen, and supplement your diet with blue-green algae, wheat grass, and
green power foods.
Kidney Vacuity [Terra: POOR EGG QUALITY DUE TO DEPLETION- LACK OF NUTRITION OR AGNI FOR ARTAVA
VAHA SROTAS]
If you suffer from signs of kidney vacuity, the following foods are found helpful:
black beans and legumes, kelp, parsley, tofu, raspberries, walnuts, wild rice, spirulina, wheat germ, wheat grass, string
beans, mulberry, millet and (non-hormonally treated) organ meats, oysters, clams, lobster, crayfish, pork, venison,
chestnuts, black sesame seeds, lycium fruit, aduki beans, yams, gelatin, chestnuts and corn.Glandular supplements
(including placenta) also fall under this category.
Yin Deficiency [ Terra: Vata pushing P / K and apana] hot flashes, night sweats, vaginal dryness, lack of fertile cervical
mucus)
A diagnosis which includes kidney yin deficiency should be rich in the following foods:
• Wheat and wheat germ, tofu, millet, barley, rice, amaranth
• Black beans, kidney beans, string beans, mung beans, and bean sprouts,
• Seaweed, chlorella, spirulina
• Fruit like apples, bananas, raspberries, blackberries, grapes,mulberries and melons
• Eat shellfish like clams and muscles, eggs, jellyfish, organ meats like kidneys, brains and hearts (all from organic,
non-hormonally treated sources)
• Avoid the use of dry, pungent, acrid spices
Yang Deficiency (pre-menstrual low back pain, low libido, nighttime urination, cold feet) [ Terra: disordered Vata /apana]
• Eat warm foods
• Include ginger root, black beans, aduki beans, lentils
• Include grains like oats, spelt, sweet brown rice, and quinoa
• Fruits should include citrus peel, dates, and cherries
• Vegetables which are yang in nature include parsnips, parsley,mustard greens, winter squash, cabbage, kale,
onion, leek,chive, garlic, and scallion
• Cook with peppers and warming spices and herbs such as anise,ginger, cinnamon, cloves, fennel, basil,
rosemary, dill, anise,caraway, and cumin

Spleen Vacuity
• Consume mostly organic vegetables, sautéed or lightly cooked
• Do not eat raw, cold, foods. Don't consume ice cold beverages,or ice cream and popsicles. Energetically cold
foods should be eaten only in moderation. These include many fruits like mango,watermelon, pears, and
persimmons. "Cold" vegetables include cucumbers, lettuce, celery, spinach and the like.
• Do not eat refined carbohydrates like white bread, or pasta.
• Avoid any food made with white flour.
• Grains like rice, Job's tears barley (coix) and sorghum supplement the spleen.
• Eat yams, pumpkin and pumpkin seeds.
• Avoid sugar and sugar substitutes or any concentrated sweets including honey and maple syrup.
• Avoid damp creating foods like milk and milk products such as cheese or ice cream.
• The typical Chinese diet incorporates these principles. Very little cold,raw foods are eaten, very little breads or
pastries, and almost no dairy products.
• Herbs which help nourish the spleen and kidneys, (and, when taken for the correctly diagnosed pattern
discrimination can lower FSH levels) are Astragalus, Ginseng, Chasteberry, False Unicorn, Vitex,Angelica,
Epimedium, Dipsacas, Atractylodes, Dioscorea, Eucommia,Codonopsis, Rubus, Cuscuta, and Cornus.
[NOTE: Do NOT take herbs if you are undergoing a hormonally stimulated cycle for any assisted reproductive technique
without your primary physicians specific consent and approval.]
Co-Enzyme Q10 is a supplement which is commonly used for cardiovascular disorders. Co-Enzyme Q10 helps support
and improve mitochondrial function, which is the powerhouse of the cell. Recent experimental medical techniques have
been studied whereby the embryologist uses a younger woman's cytoplasm to support the older woman's DNA in IVF
techniques for older women. This procedure has been banned by the FDA, but the objective of this technique was to
improve mitochondrial function. A milder, but probably less potent attempt to perform the same improvement in cellular
function is to supplement with enzymes like Co-Q10.
Reactive oxygen species are continuously generated throughout metabolic processes which damage mitochondrial DNA,
and contribute to the "age-related" decline in egg quality. Anti-oxidants (vitamins C, E, A, zinc, & selenium) and super anti-
oxidants (pycnogenol) help prevent oxidative mitochondrial damage. Improved longevity in more advanced species have
evolved because of a higher intrinsic capacity for repair and stress resistance at the cellular level. We can extrapolate this
into improved ovarian longevity as well.
We know this can be affected by improving our environment, exercising, reducing stressors, eating a more organic, whole
food diet, and supplementing with appropriate nutritional and herbal administration. These factors are within our control!
Many women are also using Human Growth Hormone analogues like Insulin-like Growth Factor, a precursor to Growth
Hormone (which naturally declines with age), to improve the quality and quantity of their egg production. Some companies
are manufacturing products which are touted to encourage your pituitary gland to produce more Human Growth Hormone
through amino acids like L-Arginine, Glycine, L-Ornithine HCl, L-Glutamine, and L-Lysine, and Bovine Colostrum. Human
Growth Hormone is not available as a supplement; the molecule is not utilizable orally. In the United States, Human
Growth Hormone is available by prescription only as Somatropin, and is prescribed for growth hormone failure in children,
and for hormone deficiency in adults. Some studies have shown that DHEA can be used instead of Growth Hormone to
help ovarian response. A study published in Human Reproduction, 2000, reported that DHEA administration of 80 mg./day
for two months improved response to ovarian stimulation after controlling for gonadotrophindose.
One study, published in Human Reproduction, 1999, found that there was an increased ovarian response, endometrial
receptivity, and pregnancy rates in IVF patients who supplemented daily with large doses (16 grams) of oral L-arginine, an
amino acid.
OTHER REPRODUCTIVE ENHANCEMENTS:

Femoral Massage (Increases blood flow to the pelvic organs) Compress the large femoral artery, whose pulse you can
feel just beneath the crease between your thigh and lower abdomen. When the flow has ceased and you feel the
pulsation end at your finger tips, hold for 30 seconds. Repeat on the opposite side. Perform the femoral massage three
times on each side, twice daily if possible. https://www.youtube.com/watch?v=51Sw3GfdbLU
[NOTE: Do not perform this exercise if you have high blood pressure, heart problems, any vasculature impairment,
glaucoma, or have had a history of strokes or transient ischemic attacks.]
Qi Gong Meditation with visualization for age related issuesThis exercise utilizes the basic life force - the breath, for
relaxation,and enhances the body's focus on the reproductive organs. We literally breathe life into and through the
reproductive organs.Lay on your back, with your eyes closed. Relax and breathe deeply.Notice any areas of tension you
feel in your body from your head to your neck, down your arms and hands, through your torso, down your abdomen,
buttocks, thighs, calves and feet. Tense the tight areas in your body even more, one by one. Breathe in, inhaling deeply
down into your lower abdomen. Push your stomach out as you breathe in. Focus your attention on the tension in your
body, then tighten the muscles in the area even more, and relax them fully as your exhale. Exhale all the way, deflating
your abdomen when you breathe out. Breathe the tension in your body out through the breath. Focus your attention on
the tension, the breath, and the relaxation. Nothing more. When the tension in that particular part of your body is gone,
move on to the next part. When you feel relaxed throughout your body, and your mind is clear, begin the visualization.
Continue the deep breathing exercise, breathing deep into your abdomen and relaxing with each exhalation.
Visualize light entering your body through the top of your head with each inhalation. This light is clean and pure and
represents the energy of life and youth. Breathe this light energy from the top of your head and let it pass through the
base of your brain, the hypothalamus, which governs our basic reproductive functions. See this healing light enter the
pituitary gland which is located behind the center of your eyebrows. Still on inhalation bring the focus of the breath down
the midline of your body, between the breasts, down the abdomen, and eventually focusing your breath down to the
region two inches below your navel. This is called the Dan Tien, where our life source begins. Let the breath energy pool
here. At the end of inhalation, bring the focus of light and breath from the area below your navel down to the out to your
ovaries, just inside your hip bones. Let the light flow from the ovaries down the fallopian tubes and into the uterus,
cleansing them of all impurities, and restoring their youthful vigor. When your uterus has bathed in the purity, turn your
attention down to the perineal muscles and perform a kegel exercise, squeezing the perineal muscles to retain the light.
When you release the kegel, begin exhalation. During exhalation, Return the light with the exhalation up the midline and
back through the pituitary gland behind the center of your eyebrows, and through the base of the brain, and back to the
top of the head. Repeat from inhalation until the movements become smooth and continuous.
© Copyright 2003, Eastern Harmony Medical Acupuncture Clinic - All Rights Reserved.
Coming off Hormonal Birth Control

There is clinical evidence that many women experience a delayed return in fertility and/or normal menstrual cycle
patterns following use of hormonal birth control. It takes time for a woman’s reproductive system and endocrine system
to re-establish its natural balance and rhythm, as well as detoxify from the synthetic estrogens and progesterone. The
time needed varies by woman and strength of the Hormonal Birth Control used.
FYI - there are no ill effects in stopping the use of a patch or pill pack before its prescribed end date. However, with
injectable forms, a woman is obliged to wait for its effect to wear off.
Per review of literature and teachings of Justisse.com these dynamics can be expected:
1. How the female reproductive system takes to re-establish natural balance and rhythm depends on:
a. age at which a woman starts to use hormonal contraceptives

b. length of time a woman uses hormonal contraceptives

c. state of her endocrine function at the time of starting hormonal contraceptives
d. woman’s individual biochemical response to hormonal contraceptives
2. Women who start using hormonal contraceptive within the first 2-5 years following menarch tend to experience more
side effects than women who start later and have a slower return to normal cycles.
3. Women who had menstrual irregularities before starting generally have the most difficulty with a return to normal
menstrual cycle parameters
4. Women under the age of 25 who discontinue hormonal birth control take about 10% longer to get pregnant than
women who use other contraceptives
5. Women over the age of 35 who discontinue hormonal birth control take about twice as long to become pregnant than
do women who use other contraceptives.
6. It takes an average 9 cycles for women to reestablish normal menstrual cycles after discontinuing hormonal
contraceptives.
7. These are deviations from normal menstrual cycles can be expected when quitting hormonal birth control:
• Anovulatory cycles (LH surge inhibition)
• Monophasic BBT curve
• Continuous mucus discharge (basic infertile pattern)
• Breakthrough bleeding (unusual or anovulatory bleeding)
• Variable return of peak cervical mucus events
• Shortened luteal phase (less than 9 days)
• Cervical mucus events accompanying ovulation during light and very light days of menses (shortened follicular
phase)
• Painful ovulation
• Atrophy of the endometrial lining (interference w implantation)
• Limited or absent mucus cycles/dry cycles
• G-type cervical mucus secretions (gummy, gluey, yellow) dominate
• Heavy and painful menstrual bleeding
• Very lght menstrual bleeding
• Ovulatory bleeding
8. Some women do not experience a return of fertility.
9. Some women’s menstrual cycles fail to return to their pre “ill” pattern
10. Weight loss or loss of “bloated feeling”
11.Return of appetite and normalization of metabolism (BBT)
12. Reduction of headaches
13. Reduction of sore or engorged breasts
14. Reduction in vascular and cariodvascular symptoms
15. Less anxiety, emotional lability and depression
16. Disappearance of chronic vaginitis or vaginal infections
17. Increased libido
18. Return of menstruation (after injectable or patch forms mostly) on average 9 months after discontinuation and up to
2 years
19. Reversal of hair loss (after injectable forms mostly)
20. Reduction or end of acne

When women are coming off hormonal birth control, especially if wanting to get pregnant soon, be sure to do some liver
cleansing & rejuvenating - PK if possible, &/or with herbs and diet - those hormones likely have loaded down the liver.
After cleansing, feed the ovaries, which have been suppressed for the duration, with Vidari, Bala, marmas for ovaries
(see marma charts under men’s fertility concerns for many available points), and chant the bija mantra for ovaries :
BEEM. Keep their spirits up, letting them know it may take some time to get to normal cycles.
Mechanical Issues Of Female Fertility

Up to 40% of female infertility arises from mechanical issues, chiefly scar tissue blocking the fallopian tubes.
Pelvic inflammatory disease (PID) and endometriosis are the chief causes of these mechanical issues.
Endometritis, salpingitis, tubo-ovarian abscess and pelvic peritonitis all fall into the PID category and are
typically due to undiagnosed or untreated sexually transmitted diseases, chiefly Chlamydia and Gonorrhoea
(8). Because PID can result in sterility, ectopic pregnancy and even a severe life threatening septicaemia,
Ayurvedic practitioners should refer any patients they suspect may be suffering from PID to an Allopathic
physician, and should work in a mainly complementary capacity when dealing with this condition. For this
reason, it is important that young, sexually active women experiencing pelvic or lower abdominal pain be
referred for evaluation of possible PID. PID should also be considered where there is abnormal bleeding,
vaginal discharge or dyspareunia (pain on intercourse). Rakta shodhan (blood cleansing) herbs such as
Manjista, Neem, Turmeric and Burdock, as well as Blood Cleanse formula, will be beneficial for suspected PID,
as will pitta soothing herbs that target the uterus-- Musta and Hibiscus.
In the case of endometriosis, (cystic deposits of endometrial tissue), Ayurveda can be of immense help, as
there is little to be done from the Allopathic side. The main symptom is dysmenorrhoea and there may also be
chronic pain and deep dyspareunia (9). Shatavari, Ashoka, Vidari, Punarnava, Musta, Bilva and Kumari may
be of help, as well as Women's Support.
- From article by Alakananda Ma
Other mechanical blockages include adhesions from previous pelvic surgeries (most commonly c-sections);
pinhole cervix and neurological blockages due to sacral-spinal problems.
Adhesions are deposits of fibrous tissue that form as a natural inflammatory response to tissue damage after
surgery, infectin, inflammation or trauma. They are the most common cause of infertility caused by
endometriosis and PID cited previously. Another common cause is any pelvic surgery- cesareans, bladder
surgeries, and any other surgery in the area. The rate of adhesion formation after surgery is surprising given
the relative lack of knowledge about ADHESIONS among doctors and patients alike. From autopsies on
victims of traffic accidents, Weibel and Majno (1973) found that 67% of patients who had undergone
surgery had adhesions. This number increased to 81% and 93% for patients with major and multiple
procedures respectively. Adhesions are a by-product of healing and can remain even after all trauma or
inflammation is gone. They distort the anatomy mobility and function. There are also microadhesions that can
form and are too smll to be seen and are difficult to diagnose. Adhesions can be in various infertility-causing

locations - on uterine walls, at and in the cervix, on the surface of the ovaries, and in or outside of the fallopian
tubes.
Treatment includes using castor oil packs and abdominal massage to help break them up. This can take time
and effort. It improves soft-tissue mobility, elasticity and distensibility. It may break up adhesions.
A pinhole cervix is where the cervical canal is scarred from treatment for precanercerous cells in a Pap smear.
This blockage not only can damage the crypts that create fertile mucus, they can block the flow of sperm
inward as well as block the flow of menses outward, causing menstrual cramping. Women should be aware
that in some infrequent cases this can even cause the cervix to scar in such a way that during childbirth it can’t
open naturally. For this reason it’s important to be aware of any cervical procedures including biopsies,
cryosurgery (freezing), LEEP, electrocautery (burning off tissue). Surprisingly many women don’t know what
has been done to their cervix.
An indirect kind of blockage can also occur when the lumbar spine, sacrum or tail bone are damaged, leading
to neurological impairment.
Teachings of the Arvigo Techniques of Maya Abdominal Therapy©

For personalized care from a practitioner and more information see www.arvigotherapy.com
Causes of a Displaced Uterus

1. Repeated pregnancies close together with difficult deliveries.
2. Bad professional care during pregnancy, delivery, postpartum
3. Carrying heavy burdens just before or during menstruation and too soon postpartum.
4. Walking barefoot on cold floors and/or wet grass.
5. Wearing high heel shoes.
6. Running on cement surfaces.
7. Injury to the sacrum or tailbone from a fall, severe blow or car accident.
8. Chronic constipation, straining during bowel movements.
9. Poor alignment of pelvic bones with the spinal column.
10. Carrying children on the hip for prolonged periods of time.
11. Modern life
12. Emotional armoring from rape, sexual abuse, or incest.

13. Aging and the pull of gravity on ligaments.

14. Career or long-time hobby in high impact dancing, aerobics or sports.
15. Chronic cough
16. Surgical procedures
17. Motor vehicle or bike accidents
Symptoms of the Displaced Uterus

Menstrual symptoms: Urinary symptoms:
Dysmenorrhea or painful periods Frequent urination
Late, early or irregular periods Bladder infections
Dark, thick blood at onset &/or at end of menses Incontinence
Headache or migraine with menses
Dizziness with menses Circulatory symptoms:
PMS Varicose veins of the legs
Depression Hemorrhoids
Blood clots during menses &/or excessive bleeding Tired, weak legs
Numb legs and feet-esp. when standing still
for awhile
Ovulatory symptoms:
Failure to ovulate Musculo-skeletal symptoms:
Irregular ovulation Sore heels when walking
Painful ovulation Low backache
Polycystic Ovarian Syndrome
Ovarian Cysts Congestion symptoms:
Endometriosis
Endometritis
Uterine Polyps
Uterine Fibroids
Uterine Infections
Pregnancy symptoms: Vaginal yeast repeatedly
Chronic miscarriages Vaginitis
Premature deliveries Painful intercourse
Weak newborns, infants Undiagnosed pelvic pain
False pregnancies
Difficult pregnancy
Incompetent cervix Other:
Spotting Constipation
Infertility Difficult Menopause
Cancer of the cervix, uterus or colon

Ovulatory Issues --Check if ovulating by doing basal body temps for at least one cycle. Be
aware if coming off birth control hormones.
Ovulatory issues include premature luteinization, luteinized unruptured follicle syndrome, and luteal phase
defects, and may be present despite regular menstruation. (10) These issues can typically be addressed with
Vidari, which contains progesterone precursors. An Ayurvedic type of diet, with "higher consumption of
monounsaturated rather than trans fats, vegetable rather than animal protein sources, low glycemic
carbohydrates and high fat dairy," has been of demonstrated help in ovulatory disorder infertility. (11) – From
article by Alakananda Ma
One technique is the use of an aromatherapy ovary patch. Choose the essential oil according to the effect
desired on the ovaries - stimulation, nourishment, balancing. See the book Ayurveda and Aromatherapy by
Light Miller for details on the technique and using essential oils in Ayurveda.
Supporting the Luteal Phase:

• include Vidari, Vitex- Chasteberry (as a tincture)KV-P+, Wild Yam (VP-K+), Sarsparilla root (VP-K=) -See
Maintenance of Lining section for some dosages
• CoQ10 supplement – to support mitochondrial strength;
• Also supporting mitochondrial strength is hormesis- mild stressing of the body – not too much or too
little – supports strongest energy from mitochondrial
Study - Implications of Blood Type for Ovarian Reserve – interesting

Edward J. Nejat; Sangita Jindal; Dara Berger; Erkan Buyuk; Maria Lalioti; Lubna Pal
Posted: 09/13/2011; Human Reproduction. 2011;26(9):2513-2517. © 2011 Oxford University Press
Abstract and Introduction
Abstract
Background: We explored the relevance of blood type to ovarian reserve, as reflected by early follicular phase FSH levels.
Methods: For this cross-sectional observational study, early follicular phase serum levels of FSH (mIU/ml) and estradiol (E2, pg/ml), and
information on blood type (A, B, AB and O) and patient age were procured for female patients, ≤45 years age (n= 544), who were
undergoing fertility evaluation at one of two tertiary care facilities. Serum FSH > 10 mIU/ml was taken to reflect diminished ovarian reserve
(DOR). Data distribution for FSH and age was analyzed and non-parametric tests used for comparisons across blood groups. Multivariable
logistic regression analyses determined the relationship between elevated FSH and respective blood types after adjusting for age and study
site.
Results: Prevalence of blood types according to order of frequency was: O (45%), A (35%), B (16%) and AB (5%). After adjusting for age and
study site, patients with blood type O were twice as likely to exhibit FSH > 10 mIU/ml compared with those with A or AB blood types [odds
ratio (OR) 2.36; 95% confidence interval (CI) 1.27–4.41; P= 0.007], and three times as likely to manifest FSH > 12m IU/ml (OR 3.48, 95% CI
1.46–7.32, P= 0.004). The B blood group antigen failed to exhibit any relationship with ovarian reserve as reflected by baseline FSH (P>

0.05).
Conclusions: The A blood group antigen appears to be protective for ovarian reserve, whereas blood type O appears to be associated with
DOR, in a relationship that is independent of advancing age. Further studies are needed to establish causality and identify the underlying
mechanisms for the association.
Inducing Ovulation Naturally – various opinions from Ayurveda chat group

o Stimulate Marma pts for ovaries - on previous marma charts
o Shatavari does ovulation induction. But the results are not always same. A preparation called phalagrita believed
to be accelerating ovulation. There are many more classical preparations such as rajopravarthini vati,
kumaryasava, ashokarista, pushyanuga churna etc but i am not sure about the exact conditions in which they are
useful. Dr Shivashankar Mora
o Saptasaram Kwatham also which serves as a uterine tonic and hormone regulator. mary smitha
o basti course and uttarbasti is best treatment for ovulation induction. With regards,
Thank you, Vaidyaraj Amrutbhai Prajapati
o Sukumaram Kashayam, Phalasarpis, Ashokarishtam, and uttarabasthi works wonder DR.DILEEP K
NAMBIAR
Fertile Fluid Problems

Review the background on cervical fluid (previous classes). By remembering the origins you will have a good
place to work from rather than just following symptomatic treatments.
The very best way is to balance the woman, and her hormones, with Ayurveda along with Maya Abdominal
Therapy techniques that can all work to bring a true healing to this concern. It may take some months.
Marma points for pituitary and ovary can be used to help balance these glands.
More relief can be found through these herbs and supplements taken internally:
• Fenugreek (thins mucus), licorice (but care with BP high)

• Vit. C (thought to increase the amount of water in cervical mucus),
• Grapeseed Extract (actually helps give additional protection and
support to the sperm as well as helping the Vit. C),
• ProBiotics (makes for a healthy vaginal environment and can help with the
vaginitis, and make the mucus more effective),

• Evening Primrose Oil (increases cervical mucus as well as the quality and effectiveness
creating more "egg-white" mucus - the kind you want) 1500-3000 mg/day DO NOT TAKE AFTER
OVULATION during a cycle you’re trying for pregnancy-can cause uterine contractions,
• Raw Garlic (helps thin mucus use 1-4 cloves daily).
• Drink adequate amounts of water every day, treat dehydration with coconut water if more Pitta (now
available in health food stores, as a fluid replacement) or Salt/Lime juice in water if more Vata
• Vitex agnus-castus. Vitex, Monk’s pepper, Chaste berry.
-Great for women in their 40’s who want to encourage regular ovulation. Tends to affect pineal and
pituitary glands. Fairly slow-acting, generally large doses. Tincture more cost-effective. Take 1
dropperful 4 times a day, for 2-3-4 years. Many women do feel it helps within 6 weeks. You should
see an improvement by 4 months.
• Trifolium pratense—Red Clover-one of the most pro-fertility herbs. All 4 hormone groups present.
Works on human endocrine glands and provides basic building blocks. Helps with fertile mucus
production. Infusion also mineral-rich. Make quart of strong infusion and drink 2 mugs a day.
• Nourishing foods to build= lean animal or vegie proteins; raw almond butter; fresh flax seed oils or fish
oils, raw seeds, Barlean’s womens formula – flax oil with evening primrose oil in it
Implantation Problems
Healthy uterine lining

As we age, uterine lining is something to be concerned about, especially if we are trying to conceive. Without
it being thick enough, the newly conceived zygote is unable to attach itself to the uterus properly and begin its
nine month journey inside the womb. Many times this may result in an early miscarriage, or many times the
menstrual cycle will begin without the woman ever knowing anything existed - Disappointing either way,
especially if you are trying to conceive. There are some natural ways to go about stimulating a thicker
endometrial growth, they will require some lifestyle changes in order to be effective, but if it leads you to that
newborn in your arms, I'm sure you won't feel it was too high a price to pay.
I'll start by saying that our uterine linings are created with estrogen. The more estrogen we have the lusher
and thicker the lining will be, and we will notice more of a good quality menstrual flow. As we age we find our
estrogen levels decreasing, which in turn will decrease the thickness of the uterine lining. You'll know this is
probably happening by seeing scanty menstrual flows, and menstrual cycles that sometimes almost do not
exist. Our endocrine system (our ovaries) are putting out less estrogen at this point. Some women might see
this start happening anywhere from mid thirties into early 40's. The good news is, we can greatly improve this
with diet and lifestyle changes. Some whole food and exercise will go a long way in getting us more normal
menstrual flows again, and improving the health of our endocrine system as a whole, making conception
possible.

The endocrine system consists of 6 glands that have various tasks to carry out. Regarding fertility, we primarily
deal with the hypothalmus, the pituitary, and in women the ovaries. Each of these glands has a role of its own
in making ovulation happen. Poor diet and inactivity radically affect the function of these precious glands, in
turn greatly affecting our fertility. Refined sugar and simple carbs can be a death sentence to fertility and
these glands particularly. Sugar and simple carbs are known for throwing off the endocrine system off greatly,
resulting in various degrees of fertility trouble. If we disrupt the delicate balance of our endocrine system at
any level, whether I’ts the pituitary, hypothalumus, or others, with simple carbs, we stand the chance of
paying the price with many facets of our fertility, including less estrogen production from the ovaries, resulting
in a thin uterine lining. If you’re a more mature woman that’s trying to conceive, sugar and simple carbs
should be avoided completely. Our endocrine systems under normal conditions are finely tuned with one
gland beginning a process and stimulating the other gland into action. This process is negatively affected by
poor diet. If you’re trying to conceive it’s just not worth eating the wrong stuff.
Amended from article published by Lyn Vaccaro I am a mother of eight with a background in health and
wellness, focusing on fertility enhancement, mostly for women of advanced maternal age. I owned and operated my
own retail health food store.
Natural Helps for Increasing the Uterine Lining
• Shatavari and other phytoestrogens

• Myrrh, Deodara; Arvigo formula - FemaleTonic
• Vitamin C: the adrenal glands use massive amounts of vitamin C all day long and during times of stress,
extra vitamin C can help improve health and function of the immune system.
• Bromelain: extracted from pineapple and has been proven to promote endometrial growth.
• Antioxidant rich foods which contain alpha lipoic acids, pycogenol, green tea and resveratrol.
• Silymarin (milk thistle) or kutki: aids in the function of the liver and can help remove toxins and
impurities, which allows for better functioning of the endocrine system and ovaries.
• Omega-3 Fatty acids: used by the endocrine system and aids in the balancing of hormones in the body.
• B-complex vitamins: can help improve the negative effects of stress and can help improve the
production of sex hormones.
• Maya Abdominal Therapy, acupuncture, saltwater foot baths, foot massage, hot water bottle/rice pack
on lower belly – all help circulation, which can help bring effects of other helps to the uterine area.
• Deep belly breathing – this turns off the adrenal glands and allows the reproductive organs to work
more properly. (see handout under Male Fertility Section)
When trying to conceive, estrogen levels play a direct role in a healthy pregnancy and conception. If it is
suspected that a woman has insufficient levels of estrogen in the blood after doing natural therapies for at
least six months, consulting with a fertility specialist and making the necessary dietary and lifestyle can all aid
in improving health and increase fertility naturally for a couple trying to have a baby.
Removing Old Tissue Left In Uterus -Cleansing The Uterus
One of the wonders of the uterus is that she lets go and renews herself with each cycle. However -
sometimes out of ignorance we have impeded her natural process by our behavior & choices.
When the uterus is out of her physiological position, suspended above the bladder, she might not release so
well. She might try harder to push out what she wants to release by cramping. When the downward energy of
apana prana is disorganized then the downward flow won’t carry out all that is to be released.
You might notice the cramps, but also you might see some brownish blood at the beginning or end of your
cycle. That tells you that she's not draining well.
When the uterus is not emptying properly, old tissue may impede implantation when trying for pregnancy, as
well as causing discomfort.
Help her cleanse by:
• Maya treatment to reposition and stimulate circulation

• self care massage on yourself, for similar help
• herbs that promote cleansing at menses – Motherwort tincture; Rainforest Remedies:Female
Tonic (use with caution if excess pitta &/or heavy menstrual bleeding cases) Take these after
ovulation, until menses.
• vaginal steam just before the period to encourage discharge of old materials( V-P+K0)
• After cleansing, Ayurveda can help renew the uterus with nourishing herbs & care of the liver,
which can greatly affect the bleeding phase. Being sure that apana prana is working well, using
Triphala, Dashamula or other herbs to balance along with ashwini mudra
Directions for Herbal Vaginal Steam –

Vaginal steam baths, or “Bajos” (ba-hoes), as they are known in Spanish, are used to assist the cleansing
of the uterus for the treatment of numerous female symptoms in conjunction with the Maya Massage.
They are not safe during any type of bleeding, including menses. They are not safe during pregnancy.
PLANTS: ( Use dosha according to needs): Most commonly used are marigold, oregano, basil & rosemary.
Other herbs useful are: motherwort, St. John’s wort, chamomile, damiana, red clover, dandelion, yellow dock,
squaw vine, horsetail, Mexican wormseed (epazote). Pick three types to use.
Collect your plants outside or at the store, but always with prayer and intention of healing.
If using fresh plant, use about 1 quart full; if using dry, use about 1 cup full.

DIRECTIONS:
1. In a large pot of hot water place the above plants.

2. Crush the herbs into the water thanking them for helping with your healing
3. Offer prayers nine times. These prayers can be to whatever Spirit offers you guidance: Goddess, Jesus,
Christ, God, Mother Earth, Father in Heaven, etc. It is the Prayer & Intention that are important
4. Bring the pot of blessed herbs to a soft boil for 10 minutes, steep for 5 minutes more with the lid on.
5. Place the pot under a slatted chair, lawn chair, etc. that allows the steam to come up through to your
yoni when you sit on it. Be sure it is not so close to burn you with the steam.
6. Sit with your bottom naked. Wear socks to keep your feet warm. Drape fully with a blanket around your
waist to the floor. Be careful not to allow any draft underneath you. Be sure you are enclosed by the
blankets from the waist down, something warm from the waist up.
7. Sit quietly over your pot of herbal steam for 20 minutes. Meditate, read,enjoy with pleasure the herbal
healing. Be careful not to burn yourself. The heat should feel pleasant. If it is too warm, remove the
pot for a few minutes.
8. Rest quietly after the herbal steam bath in a warm room, free of drafts, open windows or air
conditioners.
9. After 20 minutes of rest (more if needed), you may get up, & dress warmly, being careful for the next 24
hours to protect your entire body from cold drafts;. Keep warm and avoid any sudden temperature
changes.
Expect changes in your vaginal discharge & menses; these are normal cleansing reactions. Inform Terra if you
have any unusual discharge or response to this treatment.
Maintenance Of Lining After Implantation

Progesterone is normally produced by the corpus luteum after ovulation which maintains the lining of the
uterus until the placenta is ready to produce the high level needed for a full term pregnancy- some women
have insufficient progesterone with each cycle, so that although they ovulate, they lose the pregnancy
because the lining falls off, sweeping away the zygote.
Three herbs can help progesterone increase. They are tonic herbs that take awhile to work. However, less
side effects in general than the progesterone (which isn’t real progesterone but manufactured)
1. Vitex- agnus castus berries: this helps the pituitary normalize, thus increasing progesterone if you
need it.
a. Tincture ½ - 1 tsp daily in morning as simple or 60 drops 3 x day – if in a formula
b. Take throughout cycle - except for during menses
2. Vidari kanda – progesterone precursors

3. Licorice root - Glycyrrhiza glabra root: this inhibits a liver pathway that breaks down progesterone.
Licorice is contraindicated if you have high blood pressure (but good if you have low) It increases the
hormones for blood pressure, the same way it increases progesterone, by inhibiting their breakdown.
Also diuretic—drink plenty of fluids.
a. Licorice rt tea - let 1/2 tsp herb/ big mug of water simmer 10 minutes before straining and
drinking—best in morning
b. Licorice powder – ½ tsp with water to wash it down – best in morning
Occupational and Environmental Factors
Contemporary agricultural and industrial practices present multiple threats to female fertility. Exposure to
organochlorine herbicides can lead to infertility as can other workplace hazards including heavy metals and
endocrine disruptors. In evaluating a woman complaining of fertility concerns, it is important to take a
detailed occupational and environmental history to determine whether external toxins are playing a role. In
the event that toxins appear to be significant, it is of course important to seek to remove the cause by a
change of work environment if this is in any way possible.
Pancha karma can be of immense value in clearing pesticide residues, solvents and heavy metals from the
system, thus preparing the way for a healthy pregnancy. After pancha karma, Shatavari can be used to tonify
the reproductive system and to balance the pittagenic effects of the environmental toxins.
HONORING the MENSTRUAL CYCLE

Menstrual Consciousness Song (all to the tune of Row,Row, Row Your Boat)
Flow, flow, flow my blood-
Now release the old.
Endings, end wit beginnings again-
New eggs start to unfold.
Follicular Consciousness Song Preconception Consciousness Song
Ri-pen - now my eggs- Welcome womb grow plush
New possibilities Juicy and so deep--
Many hopes & dreams & schemes- Make a place for planting in
Womb open to receive. A baby we will keep.
Ovulation Consciousness Song
Now-my-egg is ripe.
Fer-tile juices flow.

Attracting inspiration now -

Come what I need to grow!
Implantation Consciousness Song Premenstrual Consciousness Song
Wel-come womb receive Har-vest flow-ers now.
Stories yet untold. Hope for fruit is killed.
Hopeful planting, firmly planting Wilting beauty feeds the soul,
Let new Life take hold. Though seeds are unfulfilled.
Fertility Songs
By Terra Rafael
( tune of Twinkle, Twinkle Little Star)
Ripen, Ripen Ovaries For Implantation --(tune of “Away in the Manger”)
Lots of Eggs for Babies, please! Away in my mother womb, juicy and warm
Work your fertile magic now My baby-to-be firmly plants in its home.
You’ll get to rest while the baby grow. The lining prepared to give nurturance there
Ripen, Ripen Ovaries Welcomes the Wee One to grow strong and fai
Lots of Eggs for Babies, please!
(tune of Row, Row, Row Your boat)

Ripe- en well my eggs
In my ovaries.
Merrily, merrily, merrily, merrily
My baby you will be!
(tune of “Pop goes the weasel)

Hormones bathe the fol-licles
All around the ov-aries
And just when everything is right-
POP goes the best egg.
Fimbrae gently guide its way
Towards the welcome womb
And when she meets the happy sperm-
POP comes the baby!

A New View of Pregnancy, Birth & Postpartum - Terra’s Observation

• Pregnancy as part of an extended menstrual cycle: pregnancy = long luteal phase
• Birth as a long, strong orgasm
• Postpartum as a large, long menstrual period
Review of conception, implantation


Maternal Changes in Pregnancy

According to Charaka -- pregnant women look full of ojas; their eyes sparkle. New life has entered - ojo sara qualities.
Uterus, Cervix & Vagina

Uterus changes in size from a few ounces to two pounds, growing under the effect of estrogen. Once the blastocyst
implants, the uterine muscles soften and elongate to enlarge the cavity of the uterus, allowing for growth &
development. It begins pear shaped, becomes globular by end of third month, then becomes elongated, which it
maintains until term. The uterine muscle cells actually grow in size & number during the first five months and then
stretch for the rest of pregnancy. They arrange in three layers: outermost longitudinal; middle oblique; and innermost,
& weaker, circular. The lower uterus predominantly made of circular. These muscles are relaxed to avoid expelling the
fetus by the action of progesterone. The uterus becomes erect rather than tipping forward or backward by the 12th
week. Arteries, veins & lymphatics are all greatly enlarged. Uterine ligaments thicken.
The cervix maintains a constant length but becomes slightly wider and softer after the 3 rd month, due to increased
vascularity and the effect of estrogen, relaxing effect of progesterone, and great proliferation of cervical mucosa &
racemose cells (which form the mucus plug to protect the entry from harmful agents).
The Vagina grows slightly and develops a larger opening, becoming very vascular – all due to estrogens.
Cardiovascular System
Blood – Total maternal blood volume increases by the end of pregnancy to 50% above normal volume – adding about 6
extra cups. RBC volume increases by 30% and this difference leads to a reduction of hemoglobin – a physiological
anemia of pregnancy which shows up about 32 weeks gestation. WBC and platelets also increase. Total protein albumin
& gamma globulin fall in the first quarter and then rise gradually towards term. Beta globulin & fibrinogen fractions rise,
leading to increased erythrocyte sedimentation rate up to four times normal. Serum lipids, especially cholesterol, also
rise.
Heart – Cardiac output increases by 30-50% in pregnancy. Heart rate rises by about 15 %. To balance the increased in
output, the peripheral resistance of blood vessels is reduced by estrogen & progesterone, as well as the open area next
to the placenta, so that blood pressure remains the same. Veins of the legs, vulva and anal canal distend from
hormones and, in later pregnancy, by obstruction of flow by the enlarged uterus.
Distribution of Blood Flow—The greatest part of the increased blood flow goes to the growing uterus, where blood
passes into the chorio-decidual spaces surrounding the chorionic villi where an exchange of nutrients and waste
products occurs before it drains into the endometrial venous system. Blood flow to kidneys, skin & mucous membranes
also rises.

Respiratory System
Movement of the diaphragm is reduced by the increasing size of the uterus, so deeper breaths are needed to increase
the tidal volume. Relaxation of the ribcage allows for breathing into the back and sides more easily, making up for the
uterine obstruction. There is an increased oxygen consumption of 20%.
Alimentary System
Intestinal musculature is relaxed by progesterone, giving rise to esophageal reflux and heartburn; gastric stasis is
common & reduced motility of intestines may lead to constipation. It also allows for greater absorption of nutrients.
Renal System
Relaxation & dilatation of the smooth muscle of renal pelvis and ureters occurs. Bladder muscles also relax, thus urinary
stasis is encouraged with increased risk of UTI.
Renal blood flow increases and clearance of many substances is increased, e.g. urea, uric acid, glucose & amino acids.
Sodium is maintained through a complicated mechanism.
Water excretion by the kidneys increases in early pregnancy leading to frequent urination. This diminishes as pregnancy
progresses. However, late pregnancy frequency may occur due to pressure on the bladder by the uterus & fetal head.
Skin
Increased pigmentation may occur – especially along the linea alba of the abdomen; the areola of the breasts; the face
(chloasma of pregnancy).
Stretch marks can occur on the abdomen, breasts, buttocks & upper thighs with the advancing pregnancy & growing
body. Some try prevent them with oiling. They may be hereditary.
Skeletal System
A well nourished woman has unchanged bones & teeth.
Joints become more mobile, especially the pelvis, due to the hormone relaxin. This leads to instability later in pregnancy.
Endocrine
Many of the endocrine glands undergo changes in pregnancy.
The Pituitary Gland enlarges during pregnancy and adrenocorticotrophic hormone (ACTH), thyroid-stimulating hormone
(TSH), and melanocyte-stimulating hormone (MAH) are increased. The posterior pituitary homones – oxytocin & anit-
diuretic hormone (ADH) are probably also increased.
The Adrenal Glands: The medulla appears unchanged in pregnancy but increase in the cortex. The production of
corticosteroids rises.

The Thyroid Gland enlarges but no evidence of increased thyroid activity (although the woman’s basal body temp is
usually higher during pregnancy).
Development of the Baby:
Why the mother must be protected and nurtured during pregnancy according to both
systems:
Fetal development according to Kasheppa via Dr. Vasant Lad
Fertilization Imbalances of conception lead to lifelong imbalances. (ie. If Pitta - don't conceive in summer; if Vata - don't conceive in
fall; if Kapha - don't conceive in spring)
1. Fertilization – usually occurs in the fallopian tube-Present in the fertilized ovum are the 5 elements:
Earth = solidification
Water= moistening
Fire=metabolic change in fertilized ovum
Air =meitotic division
Ether = space, allowing growth
All to give a form, a shape to the soul
These elements derive from four sources: the mother, father, nutrient rasa and atma
• Early Cell Layers relate to layers of disease & healing of the body:
Outer layer = ectoderm = BAHAYYA=> Plasma & Blood
Middle layer = mesoderm= MADYAMA=> Muscle , Fat, Bone, Majja, Reproduction
Inner layer = endoderm= ABYANTAR ( ANTAR)=> Digestive Tract
• Origination of tissues and qualities:
PATERNAL - creates Hair, Nails, Teeth, Bones (hard tissues)
MATERNAL - creates Skin, Blood, Muscle, Fat, Liver, Spleen (soft tissues)
SOUL ATMAJ - Awareness
• Physical derives from Astral which derives from Subtle which derives from Causal
2. Cluster of cells formed = Kalala = zygote This is the first 3 days

prana pulsating in sperm & egg tejas leads to division of cell by mulitplication
3. Peshi= morula 4 days. Kledaka spaha nourishes the egg in the womb
Implantation
4. Apana vayu brings Kalala to implantation within the fundus of uterus at about 7 - 10 days post fertilization ; some
women experience spotting at the implantation. Kasheppa calls it kalala rakta
-Villi- like structure formed, amniotic fluid moves within & trophoblast - kala => forms the placenta =
garbha nabhi
-7 dhatus forming

5. 5 Weeks after fertilization - the vital organs begin to form : ie the heart tube microforms
7. 6 Jiva = individual soul -- controversy about when it actually enters: some say at 3 months; Kasheppa says
consciousness is there w/ agni & tejas Weeks - microscopic brain and thread-like spinal cord
The development of the fetus in the uterus is discussed in the Charaka Samhita in the section called Garbhava
Kranti, and special regimens are prescribed for each month in the subsection Garbhini Paricharya. The basic wisdom
to be understood is to take greater care during the first three months of pregnancy and during the eighth and ninth
months.
Monthly development according to Kasheppa

1-2 months
• Eyes Nose Mouth Ears start forming; Arms & legs start developing; sex organs start appearing
• length = 1" head to heel weighs = 1/13th oz
3rd month
• Grows to 3" long weighs 1 oz
• Fingers, nails, toes developed
• tooth buds & jaw begins to appear
• Rudimentary kidney & uterus formed
• Excretes waste into amniotic fluid
• Movement begins (mother can't feel because so subtle)
• The fetus quivers
• Achieves consciousness and can feel pain
4th month
• fetus gains stability, less chance of congenital anomalies after this
• All vital organs well formed & start functioning
• 6-7" long 4 oz wt
• fine hairs on body, few on head
• heartbeat audible about 140 / min
• movement fast - mother can now notice
• Mind starts Functioning -- experiencing past life events in the womb
• cravings of baby expressed through cravings of mother
• mother said to be bicardiac : has two hearts --her own and that of her baby, therefore she has two minds also.
The mother's cravings should be satisfied in as healthy way as possible to welcome the divine soul which is
incarnating - he/she speaks through those cravings to a certain extent.
5th month
• 12" long 1 1/2 lb
• hair develops, by product of asthi dhatu , including eye lashes & eye brow

• facial expressions
• father can hear heart by ear on belly
• movement vigorous -- father can feel
6th month
• Increase in strength, complexion and ojas
• up to 15' long about 2 1/2 lbs
• looks like miniature human
• skin has creamy covering on it called vernix (Kamala in sanskrit) which is a protective layer of sebaceous and
lanugo becomes more prevalent (body hair)
• Calcium begins to be deposited
• at 6 1/2 month about 3 lb and 90% survival rate in modern science
7th month
• 16 1/2 ' long and 4 lbs
• organs have independent function
• Has optimum levels of vata, pitta and kapha
• vayus start functioning
• subdoshas start functioning
• Dhatus complete and agni active
• ojas still unstable - moves between mother & baby
8 & 9 months
• weighs 6 1/2 -8 lbs
• meda dhatu increases
• increased survivble, but not out untill lungs mature
• (if overweight, may be diabetic or K problem)
• lungs mature
• In the 8th month- ojas (vital fluid) moves from mother< => fetus : eat more ojas producing foods and stay at home
& rest at this time to ensure good vitality for both mother & baby. Avoid wasting energy - spend more time doing
much less, letting the energy go inward. Be in a natural environment; eat ghee, milk, ashwaganda/shatavari; chant
OM; meditate; avoid - anger, worry, overwork, drugs or stimulants, hunger, sorrow, excessive sex, devitalized food.
Sometimes the baby may seem “dead” when the ojas has moved towards the mother and then becomes more lively
again when it moves back to the baby; for the same reason the mother may vacillate in ojas.
• 9th month – prepare in earnest for labor – in ancient times, go the the birthing house to live until the birth.
• Baby may remember its previous life as well as emotions of intra-uterine life, especially if in a sattwic environment
Apana - Importance in Pregnancy

As you’ll learn throughout these lessons on pregnancy, Apana is of prime importance to many healthy
functions of pregnancy. It helps the egg to implant firmly. It holds the baby in until it’s well developed. It

ensures a healthy development of the baby. It brings the baby into a proper position to be born. For these
reasons and other, apana must be cared for during the pregnancy. This helps assure a good labor and
birth as well.
Protecting and Correcting the Apana vata in Pregnancy
• Care of apana before pregnancy!!!

• Daily walks
• Avoid holding or forcing urination or bowel movements, including release of gas. Avoid constipation due to
inappropriate diet, dehydration, or lack of physical activity.
• Avoid jarring activities - snowboarding, falls, gymnastics, excessive jumping, jarring sexual activities.
• Sattva and things that bring sattvic happiness help; sattvic liver herbs such as guduchi are indicated sometimes,
with history of drugs of any kind allopathic or recreational, alcohol,
• Intercourse in first trimester and at 7 months per Ayurveda to be generally avoided, except last few weeks when
the semen gives strength to baby (and helps to soften the cervix for labor) . Chinese Taoist sexology advised
similarly, except in those times just enough activity to hold an erection with gentle coitus giving reproductive
organ reflexology physical and emotional treatment that is beneficial for both partners, and baby by honoring
with a gentle love connection.
• More mushy foods, if needing fiber, hydrate it well first, in constipation during pregnancy. Tip – psyllium mixed
into a fruit juice splashed fruit bowl is a great way to take fiber; also oatmeal, cooked with more water. Less dry
foods and more healthy dietary oils helpful for easy apana vayu without using laxatives. Soupy, creamy, healthy
sauces, cooked veggies for vatas especially the latter. Bedtime warm milk with ghee.
• For late pregnancy and early labor to support good labor, both the Dhanwantari Institute and Vaidya Bharat
quote classical use of small warm sesame oil or bala or ashwagandha basti rectally – about 1/3-1/2 cup max. An
MD and Vaidya in the UK routinely advises on alternate days small oil basti anytime after 8.5 months. (Ref
discussion on http://www.groups.yahoo.com/group/perinatalayurveda some months ago . I don’t know who
would want to do that many, which is probably a way to self regulate excess! But she says makes for easy
delivery with all her clients. All these ways help lubricate and soften tissues for smoother birthing and better
stretching of tissues.)
• Dr Sarita Shrestha , Ayurvedic ob/gyn recommends a pichu or small clean gauze pad soaked in warm sesame oil
or bala oil vaginally at bedtime in the last month of pregnancy. Be sure there’s a thread to pull it out when it’s
time. Remove it after any toileting or in the morning.
• Both Ayurveda & Maya tradition suggest eat slippery foods for the end of pregnancy like okra, gruel with plenty
of ghee, and papaya --slippery foods to “grease the passage” before birth (another way of saying, having healthy
apana).
• Herbal choices in pregnancy, according to specific needs: bala, pinch of amalaki
• Therapies, according to time in pregnancy and specific needs: pelvic floor exercises, vata soothing diet and
lifestyle After the 8th month: apana mudra https://www.youtube.com/watch?v=XYsQG6xGLb8 gentle basti,
gentle yoni basti, pichu
PRAKRUTI OF THE BABY is determined by -

• -season of conception ex. make love /conceive in summer , baby more likely to have high Pitta
• -parents prakruti ex. Kapha high in both parents, most likely a Kapha baby
• -diet, lifestyle, & emotions of mother in pregnancy

Western Fetal Development –Childbirth Graphics “Life unto Life”






Mode of life of pregnant woman (Kasheppa ch5?;v 11-20)
The pregnant woman should be made to use garments and ornaments which are meritorious, auspicious, new, intact ,
without having piece, having masculine names and loveable. She should neither use nor procure the articles of feminine
or neuter gender names.[Terra: this is to attract a male child, most probably.] The abode, well fumigated, worshiped,
free from mosquitos etc, insects and having sound of vedic hymns being recited by brahmanas, songs and musical
instruments, is desired.
The pregnant woman after getting up in the morning and performing normal routine, should be busy in worship of
teacher and god, should worship the rising sun by incense, fumes, homage and pray in a loud voice. The pregnant
woman should not look at declining moon, setting sun and both the rahus. Knowing about solar or lunar eclipse, should
go inside or middle of the house, be busy in religious rites and oblation and pray for freedom of planets. She should not
hate the guest, offer alms to beggars, and not turn them out. For pacification, should perform oblation in spontaneously
burning fire. She should not oppose or tie the ewer (?), fill with water, ghrta, garland, the pot filled with ghrta and curd.
The pregnant woman should not obstruct or tie any thing by thread and thin rope, should avoid daily coitus and keep all
her bands (clothes etc) loose.
Exercise in Pregnancy
One problem we have in Boulder is that some people exercise excessively. During pregnancy it is especially worrisome
because people who exercise a lot may not be able to eat enough calories to be well nourished and bike/walk/run
several miles a day. These people may also have eating disorders and be addicted to exercise to control emotional
problems. Over-exercise is as much a problem as under- exercise.
Consideration to an early or fragile pregnancy must also be made. Jarring exercise is not recommended in the first
trimester. Overheating can cause pitta problems for some mothers and some babies.
Ayurveda says you should never exercise to your full capacity. That should be saved for life threatening
situations only. By over- exercising you imbalance your body in ways that may seriously compromise your hormonal,
neurological and immune systems – as well as your reproduction capabilities. Following the general recommendations
by Ayurveda for exercise works well with pregnancy taken into consideration.
General Ayurvedic Exercise Guidelines

If you have questions about your exercise regime, please consult with your practitioner. Exercise is an area where health or
imbalance can be promoted, depending on how it is suited to the person and situation. In pregnancy, the strain on loosened joints
and pelvic floor must be taken into account as well as the current condition of the pregnant woman.
General recommendations:
• A regular exercise regime is useful to promote health and help maintain strong digestion and daily elimination.
• Only exercise to half of your capacity. Too much exercise increases Vata and will begin to use up your reserves.
You can tell if you have reached one half of capacity by noticing how long you did an activity and felt exhausted.
Then do it only half as long on a continuing basis. Or, stop when you start to break a sweat on your forehead,
under your armpits and along your spine.

• Avoid exercising when hungry or within 2 hours after eating.
• Hyperactivity will gradually increase Vata- even if you feel fine exercising constantly when you are in your 20’s
and 30’s, it may gradually build Vata imbalances which will show up later in your 40’s & 50’s, pushed deep in
your tissues (bones, nerves, reproductive organs)
• Avoid strenuous exercise if you have acute digestive disorders, chest complaints, infections, or inflammatory
problems to avoid aggravating the doshas causing these problems. Even if you temporarily relieve the
complaint, you may be pressing it deeper into the tissues rather than helping the causative imbalance or toxic
condition.
• Massage is a passive form of exercise. Regular massage will help reduce the effects of stress as well as give
many of the good benefits of exercise. Benefits will accumulate over time with regularity.
• Hatha yoga asanas are a great exercise-building both strength & flexibility. Excessive use of heating or cooling
poses may effect doshic balance if practiced on a regular basis. Don’t talk while doing poses. It’s very important
to do the “Corpse” pose after doing other poses, to allow the pranas & toxins moved by poses to settle down.
Women during pregnancy need to moderate their practice according to their current condition &, be sure that
your instructor lets you know which poses are contraindicated during pregnancy.
• Always be sure to drink plenty of fluids after exercise or massage to allow toxins to be eliminated and to avoid
dehydration-especially in the dry climate of Colorado. Sometimes we sweat more than we think because it is so
dry that it evaporates very quickly. Also, just breathing the dry air here is dehydrating—so when you exercise &
breathe more you need to replace that fluid.
• Anyone with a serious health condition, especially concerning the heart, should consult with their practitioner
before beginning any new exercise regime.
• Pregnant women should always moderate their exercise according to their condition.
Doshic Exercise recommendations:
Vata
People with a Vata constitution or imbalance are prone to bad effects from over- exercise. Their joints are more at risk both
immediately and in the long run. Low impact exercise is important, always being aware of and gentle with the joints. Horseback
riding and mountain biking, as well as any jumping exertions are also Vata aggravating.
Yoga asana classes best for Vata are slow, repetitive, gentle, with no jumping, Careful attention to alignment and listening to one’s
own body is important to protect the joints. Iyengar style yoga including Sivananda are recommended.
Pitta
Those with a Pitta constitution or imbalance can be aggravated by playing competitive sports and by overheating when exercising.
Pitta may push too hard & too long, so must also guard carefully about over exercising, especially by comparing their performance or
body with that of others.
Yoga asana classes best for Pitta are in a moderate temperature and atmosphere, avoiding over exercising. Avoid Bikrams style
heated yoga. Classical asana with shivasana after each asana would be balancing, which is Sivananda style. Anusara can occupy the
busy minds of these people.
Kapha
Kapha people or those with a Kapha imbalance need vigorous stimulating exercise on a daily basis. This is key to any weight
loss/control program. Their heaviness is offset by more movement. Because they usually have great stamina, they can afford to
exercise the longest.
Yoga asana classes best for Kapha are vigorous, stimulating, and may emphasize vinyasa –Ashtanga or Jivamukti is best for these
people.
From Notes- Alakananda Devi’s Ayurveda classes

Pregnancy Exercise Recommendations of Dr. Sarita Shrestha (practice in Nepal)
Never stretch the abdomen when pregnant

Classical yoga (Iyengar is most classical) – do it gently – but avoid back bends
spinal twist; side bend; meditation postures; lazy fish w/legs corssed & push thighs open; gentle forward
bending poses
Pranayama –
do 5 rounds of Alternate nostril breathing
Sadanta or Shitali (good for pyorrhea) – cooling; inhale through teeth & exhale through nose 3 x
Ujjayi 5x strengthens respiratory
Bramari 3x
AUM 3x
(Vibration is important- it carries deeply into cells, especially important in pregnancy)
Meditation – visualize Mother Goddess in the 3rd eye
Rub hands & palm eyes – then open slowly
Prenatal Exercise/ Yoga by Dr. Lad

1. Walking - 20 min - one mile length
2. Deep Breathing - strengthens , relaxes, prepares for birth - alternate nostril breathing; belly breathing; ujjayi breathing -
can practice in standing pose: swallow after inhalation - 1 count chin lock, then exhale slowly as unlock chin 2 counts
Practicing this will give great capacity for pushing in labor.
3. Yoga - stretching
Mountain Pose Alternate hip flexion Thigh stretch Modified spinal twist
Breast support General stretch w/help of wall Pelvic floor stretch
Arms & legs Pelvic tilt

Stretch Relieve back
Vajrasana w/ Turtle Pose = inhale, raise head up & back; exhale, lower chin to chest. Repeat 7 times; then contract
perineum, as inhale, suck anus in; exhale, relax
The Turtle brings longevity & fearlessness
The contracting of anus = Ashwini mudra - female horse
4. Healthy swimming pool, then it's ok to swim; most are over chlorinated.
1 / week unless private & clean pool.
5. SoHam Meditation = "So" with inhalation; "Ham" with exhalation
This enhances the entry of prana to the pelvic floor & brings flexibility to the pelvic area when done in sitting
position
Creates samskara of SoHam on baby =spiritually uplifting
Ashwini mudra and Kegel exercises – to strengthen apana and the pelvic floor see: ACY pp 42


Nutrition in Pregnancy
Pregnancy Nutrition Basics – midwifery handout for pregnant women
Even if your diet looks great, be sure that amounts are adequate for caloric needs. Many women who eat very "clean" diets may not be
eating enough calories and this can be just as detrimental to health as eating poor choices. "If a woman is not obese and her
ingested calories are just one-third less than she requires, half of her protein intake will be burned for energy. "(Brewer, 1983 from
Holistic Midwifery by Anne Frye Vol 1)
Frye offers this helpful chart for determining caloric needs in pregnancy (p231, Holistic Midwifery Vol 1)
:
physical factor daily calories daily protein
Baseline non-pregnant need 2000 46g.
Preconception Increase to 2250 Increase to 56-70 g
>20 wks pregnant Increase to 2600-2750 Increase to 80-100 g
Poor nutrition/low wt. beg. of preg. + 500 cal to basic diet +20 gr to basic diet
Less than 16 yrs of age + 200 cal to basic diet +20 g to basic diet
Activity/ Stress factors +220 per factor +20 g per factor
Multiple gestation +500 per extra baby +30 per extra baby
• Choose healthier choices to substitute for any unhealthy foods you usually eat. ex If you like to eat chips, try crisp vegies
dipped in something creamy & nutritious.
• Adding herbal infusions is one way to add lots of nutrition without eating lots more fruits & /or vegetables –ask Terra for info on
this
• If you’re into snacking, the rule is you must eat a protein, a whole grain & fruit or vegetable before you eat junk food (learned
from Valerie El Halta at IH Advanced Mw workshop) Also try healthier forms of snacks, ex. eating ice cream, be sure it's at
least all natural.
• It’s time to change some diet habits – if you have been starving yourself for years to "keep from getting fat"; if have been
eating very restrictive vegan or macrobiotic diets (you need to know that the leaders in these fields say that if your body tells
you to eat something while you are pregnant, you should listen to it! ) During pregnancy, not only is your body & whole
metabolism different than before -- there is a whole other person involved in being fed.
• Allow yourself to have naughty eating habits—but only once in awhile. When I was pregnant with my first child I was anemic
and had to constantly be aware of eating enough "iron foods" and enough protein. Towards the end I was sick & tired of it so I
gave myself one day off a week where I didn't even think about how much of this or that I was eating. (I never had a problem
about not eating enough!) Find ways to avoid guilt-tripping and obsessing about diet, which I believe may be almost as
detrimental as eating poorly.
• Avoid very hot, spicy, and sour foods especially in the first 3 months
Ayurveda recommends you eat to balance your imbalances and pay attention to cravings—it may be something the
baby needs.
Vata Pregnant Woman –take predominantly sour, sweet, a little hot & spicy, less dry food, less raw salad, cereals, warm
foods, less beans,cooked greens, some oily & heavy food to ground.
Pitta Pregnant Woman –take predominantly sweet(fruit and grains) & bitter foods, such as bananas, coconut, cereals,
greens, dried fruits.
Kapha Pregnant Woman –take warm & bitter foods, with very little salt, cooked, greens, not too sour of fruit, light
foods, such as amaranth & quinoa instead of oatmeal.
And a key teaching in Ayurveda is: it doesn’t matter how well you eat if you can’t digest!! Remember the Agni
Strengthening practices when eating. Remind Women How to Protect Their Digestive Fire.

Nourishing Infusions
One simple way to add nutrition is to drink nourishing herbal infusions. An infusion extracts the nutrients from herbs
into hot water over time. Some good choices in pregnancy:
• Raspberry Leaf V+(in excess) PK- : in dry Colorado – 1-2 cups/day unless low in Vata, watch for dehydration
• Nettle Leaf V+ (in excess) PK- :in dry Colorado – 1-2 cups/day unless low in Vata, watch for dehydration
• Oatstraw VP- K+ (in excess): choice I use most in Colorado, unless very Kapha pregnant woman; considered
rejuvenative by Dr. Lad
Read the handouts below for more information on these herbs.
How to make an herbal infusion : 1 oz dried herb (3x more if fresh herb) in quart jar w/lid. Add boiling hot water and let
steep 4 hrs (or overnight). Strain and drink. Refrigerate any left to use later.
The following excerpts about pregnancy herbs & healing infusions are from:
Peter Holmes –Energetics of Western Herbs
Susun S. Weed – Wisewoman Herbal













Ayurveda concepts of pregnancy nutrition
(This section written by Dr Scott Gerson, NAMI, as taken from ancient texts)
The food she eats should be delicious to her. Much of the diet should be in a liquid or semi-liquid form, moist,
nourishing, enriched with all the six rasas (tastes) and supplemented with deepana (agni promoting) plant
medicines and spices which are known to increase appetite and digestive power. Ayurveda specifically
mentions the following foods as healthy during all trimesters of pregnancy: rice, milk, wheat (godhuma),
amalaki fruit, raisins, grapes, mango (amra) butter, ghee, and small quantities of raw sugar (sarkara).
Garbhini Parichaya
During the first trimester, stress is laid on stabilizing the pregnancy and nurturing the uterine bed through rasa
and rakta dhatus. The embryo gets nourishment directly by percolation (upsnehan). Hence more jaleeya (liquid)
substances such as juicy fruits, coconut water, milk, and so on are advocated.
In the first month, sipping cold milk along with meals and eating only in the morning and evening (i.e breakfast
and dinner). Tandulodaka (lit.water from rice washing; e.g. modern equivalent: rice milk) During the second
month, the intake of warm milk decoctions medicated with sweet herbs like Vidari, Sarkara (Cane juice),
Shatavari, Yasthimadhu, Brahmi, all of which are jivaneeya (life-supporting) and garbhasthapak (helping
maintain implantation). Honey and ghee are also recommended. During the third month Ayurveda recommends
warm milk with added honey and ghee. Also, the ground rind of amalaki fruits with coldwater.
During the fourth month, the head, torso and extremities start to become differentiated, the motor and sensory
nervous tissues start to develop, the heart takes its place, and the fetus makes known its needs and desires via
the mother's physiology. This is the period when the woman craves for certain foods and tastes. Normally, the
needs of both the fetus and the mother are the same. Therefore, Ayurveda recommends that the mother´s
cravings be fulfilled as far as possible, as long as they are not absolutely unreasonable (i.e. a diabetic mother
craving excessive ice cream, a hypertensive mother craving excessive salt, etc.). Shankhpushpi, gulkand (rose
petal jam), and brahmi help in calming the nerves and are also good prajasthapans (maintainers of pregnancy).
From the fifth to the seventh months, plant preparations which give strength to the uterine muscles and
nourishment to the embryo, are advised. Ashwagandha and Guduchi are particularly good in this regard. They
help to ensure optimal condition of the placenta and uterine tissues as well as of the umbilical cord. The diet
should be one of rice, milk, butter and ghee. Fruits which are orange or yellow in color are advocated such as
mangoes, apples, carrots, amalaki etc. Leafy vegetables are also advised. During the seventh month, hairs form
on the fetus and the mother’s abdominal skin begins to become stretched giving rise to itching and striations
(kikkisas). This can be treated by taking sips of the infusion of jujube berries or butter medicated with
manjistha, the application of the pulp of sandalwood and lotus or of a paste made of neem, turmeric and
manjistha, or oil medicated with tulsi leaves or jasmine.
From the eighth month forward, there should be less fat, less salt and less water in the diet. Ayurveda
recommends rice kanji cooked in milk with a little ghee. After the completion of the eighth month, herbs which
are mild diuretics and urinary antiseptics, such as punarnava, gokshuru and sariva, are advised. Fennel seed
powder in small quantities is also recommended for its mild carminative and anti-spasmodic actions.

Special nourishing therapies for the dhatus in pregnancy —month by month

(via Dr. Vasant Lad & Dr Sarita Shrestha)
month 1 cool milk
2 boiled milk w sweet tasting herbs
3 boiled milk with honey and ghee (sarita= khir)
4 milk with 12 grams of butter (sarita=yogurt)
5 ghee (sarita= khir)
6 sweet herbal ghee (sarita=after 5th cottage cheese, khir can mix w milk)
7 same as 6
8 milk, easily digested grain broth, and ghee
9 medicated oil enema, oleation of uterus and genital tract, daily body abhyanga
Vagbhat Sharirasthana 2/54-60 According to months of pregnancy:
• 3rd - Milk with the kalka of (ksheerkakoli), shatavari, anatamula

• 4th - Milk with the kalka of (Dhamasa), anantamul, (rasna), manjishtha, yashtimadhu
• 5th - Milk with the kalka of Kantakari, (bruhati, khshirivriksha)
• 6th - Milk with the kalka of (prishniparni), bala, (shigru), gokshur, (madhuparnika)
• 7th - Milk with the kalka of( shringatak, bis,) draksha,( kaseru), yashtimadhu, sugar
• 8th - Milk boiled with roots of( kapitha), bilva,( bruhati,) patol, (ekshu, nidigdhika).
• 9th - Milk with the kalka of anantamula, (dhamasa, ksheerkakoli), yashtimadhu.
Prenatal Rituals to Nourish the Developing Sense Organs(from the Rig Veda and Garbo Upanishad)
• What the mother sees goes through her retina and sends messages to the forming baby to tell her to make eyes.
The same process occurs for taste, smell, hearing, & touching .In this way what the mother experiences directly
influences the development of the baby's sense organs.
• Each month certain rituals are done to nourish the developing sense organs:
o 1st month : Ears - Shabdha chant & hear music for the ears
Touch-Sparsha herbal paste to the skin; special bath w/ herbs etc. ; gentle oiling
o 2nd month: Eyes- Rupa fire ceremony; herbs offered - vacha, brahmi, jatamnasi, raw bhasmati rice &
ghee
o 4th month Mind- Manas Mantra whispered into Right ear by Guru
o 5th month Intelligence Brahmi ghee; calamus root powder w/ gold water (boil gold in water - use 10
drop water & w/ pinch of calamus)
o 8 & 9th month Fresh tulsi w/ honey; brahmi w/ honey

Water in Pregnancy per Dr. Lad:correct amount=7 cups for K; 8-12 cups for P; >12 cups for V
Ayurvedic tonics - chyvan prash (cold season) or shakti prana (hot season or P+), 1 tsp daily on empty
stomach, 15 min later 1 cup warm milk (if not lactose intolerant) ,almond, oat, or rice milk (if sensitive to milk).
General Pregnancy Herb Formula –

These herbs have been used traditionally for pregnant women in India & Nepal for centuries. Dr. Sarita Shreshtha, Ob-
gyn and Ayurvedic Doctor of Nepal worked for a major Indian Medicine company as an herbal formulator and teaches
Ayurveda around the world. She recommends the herbs in this formula are safe to support women during pregnancy
Shatavari (Asparagus racemosus)
Therapeutic actions-
• Nourishes & rejuvenates the tissues

• Promotes vitality & strength
• Maintains healthy female reproductive system
• Removes excess pitta
• Bolsters immunity
Pharmacological Actions-Alterative, analgesic, antibilious, anti-inflammatory, antispasmodic, aphrodisiac, astringent, calmative,

demulcent, diuretic, galactagogue, nervine, nutritive, refrigerant, rejuvenative, stomachic
Contraindications – High toxicity of system may inhibit digestion of this herb;Excess use can cause excessive mucus, poor digestion;
Do not Use during a fever
Vidari (Ipomoea digitata)
• Nurtures all the tissues of the body

• Nourishes the fetus in the womb, increasing fetal circulation and strengthening placenta
• Increases fertility
• Helpful for ovarian cysts and endometriosis by rejuvenating and removing excess Kapha
• Spermatogenesis is promoted and reduces enlarged prostate
• Reduces hepato-spleenomegaly
• Heals peptic ulcer
Pharmacological Actions- Antispasmodic, analgesic, aphrodesiac, diuretic, galactogogue, nutritive, rejuvenative
Contraindications-Excess mucus or congestion; Do not Use during a fever
Guduchi (Tinospora cordifolia)

• Gentle Liver tonic & stimulant

• Diuretic
• Reduces excess Pitta (heat, inflammation) in all systems- therefore helps with dyspepsia, bronchitis, chronic diarrhea,
leucorrhea, rheumatism
Pharmacologic actions-Antibilious, anti-inflammatory, astringent
Contraindications-None
Bacopa (Bacopa monniera)
• Rejuvenative for mind, memory, emotions, nervous system

• Gentle blood purifier, thus helps skin conditions especially psoriasis, eczema, & gout
• Antidiuretic- supports kidneys
• Fortifies immune system
• Balances Vata & Pitta- good for all doshas
• Longevity
Pharmacologic actions-
Antidepressant, nervine, hepatic tonic, rejuvenative
Contraindications-Itching; Large doses (several teaspoons/day) may cause headaches or spaciness; not with SSRI medications
Ashwagandha (Withinia somnifera)
• Nourishing to nervous system-relaxing and toning – promotes sleep and intellect
• Adaptogen for immune system-balancing hyperimmunity or low immunity – increases ojas
• Benefits all muscle tissue, including uterine, reducing inflammation & toning
• Reduces Vata & Kapha
• Increases strength
• Rejuvenating
Pharmacologic actions-Adaptogen, tonic, anti-inflammatory, immunomodulator, anti-tumor, nervine, mild sedative, analgesic,
reproductive tonic, aphrodisiac, antianaemic
Contraindications - Caution in excess pitta and ama with congestion. Caution in pregnancy, although traditionally used in India
during pregnancy to strengthen the uterus and health of the mother and child. Its spasmolytic activity on the uterus has led certain
quarters of western phytotherapy to restrict its use in pregnancy.
Safety - No drug-herb interactions are known. There are some theoretical interactions between ashwagandha and
immunosuppressant, thyroid and some sedative medications, but those are not evidence based. As ashwagandha appears to have
some hypoglycaemic activity in humans, it is advisable to monitor blood glucose in susceptible individuals.

General Ayurveda recommendations for Pregnancy-

Read Ayurveda for the Childbearing Year pp 50-58
More Per Dr. Lad:
• Movement is healthy -- with moderation. Walk 1 mile -- not 2 miles (a little heavy). Frequent swimming in public,
chlorinated pools is not good (only once/ week), but in pure water, in moderation, is good. No jogging, tennis,
dance (depends on type -- no loud music); no excessive exercise -- will increase Vata
• 8th month is a risk to take air or long car trip. OK up to 35th week; short flights are ok but after 7 months more
risky.
• No long tub bath ; increases Pitta if hot.
• No X rays.
• No sex when vaginal bleeding; otherwise gentle sex is OK. For Vata women, pregnancy makes her nervous with
tendency to jealousy; intimacy helps to promote her feelings of security.
• Alcohol in pregnancy leads to poor memory in child, hydramnios, &/or hepatic dysfunction in the child
• Excess sweet leads to overweight baby, possibly diabetic
• Hot spicy food increases pitta and such diseases as inflammatory or hemorrhagic skin conditions
• High salt leads to wrinkled skin and baldness for the baby
• Smoking cigarettes effects the baby's lungs as well as the mothers
• Tranquilizers lead to dull mind in the baby
• Very poor nutrition can lead to stillbirth or retarded growth
per Kasheppa via Dr Lad:

• Don't sleep on your back -- may cause cord problems due to more space to move, especially 5-6-7 months.
• Left lateral is the best way to lie.
• Don't sleep in open air; cold air will stimulate the skin w/ cold & make the child increased in vata
• Don't walk at midnight - baby may be attacked by evil spirit and cause congenital insanity.
• Avoid arguments with husband & friends -- may lead to petit mal epileptic convulsions in baby
• Also avoid hatred, envy, quarreling
• Intense grief will lead to high Vata; emaciation of baby; High anger leads to antisocial baby
• Excess sleep can lead to anorexia and kapha problems or dullness
Western PN Care & How To Augment It With Ayurveda
• Western medical PN Goals: to watch for disease development; be sure baby is growing properly
• Midwifery goals: above plus social, psychological, and spiritual support for transition of motherhood
• Both: Usual schedule: monthly until 32 weeks then every other week until 36 weeks then weekly.
Highly invasive procedures and ultrasounds are often routine with medical prenatals.
• Medical Tends to be fear-based, high tech, low touch with very little nutrition counseling in general
• Women need – calming, clear information, choices and emotional support. They also need touch –
massage is good for them to help integrate their body changes with their psyches & release tension.
• Emphasize need to take it easy the 8th month for ojas time – in our culture most women work too
much, too long while pregnant. This can lead to weakened mothers &/or next generation.
How to work with a client using Artificial Reproductive Technologies
• Let her know that herbal therapies may take time to work and give her the option of putting off
medical treatments as long as practical to improve her chances. Many women don’t feel they
can wait any longer-the ticking of the clock is too loud for them, so don’t pressure but gently
inform.
• Be sure that her uterus & ovaries are in a good position – during cycles where there is a try for
pregnancy, don’t disturb the uterus after stimulation, or ovulation/insemination, or when
indicated by using drug patches on the abdomen (sometimes she can put them on her thigh on
the day of an abdominal treatment).
• Use subtle and mental therapies throughout. Stress reduction and spiritual upliftment are
essential and rarely sufficiently addressed by the medical team.
• Help her formulate questions for the medical team – having sufficient information will help her
feel more relaxed.
• Give her herbs before and after but not during the actual cycle – the medical goal is for them to
completely control her physiology. They can’t do that when you give her herbs.
• During the actual cycle – any therapies that change her physiology besides stress reduction
should be ok’d by her medical team.
• I always find it difficult to allow clients to choose to do treatments that may be bad for their
health (and their baby’s health) so that they can conceive. I try to inform before they make a
choice AND support them whatever they choose.
Some Substances to Avoid in Pregnancy for Health's Sake

This interesting article highlights how environmental toxins, drugs, etc act to activate genes which can disrupt fetal
development and set up disease states in the body: http://www.sciencedaily.com/releases/2010/09/100924122533.htm
Teratogen Information websites:

Organization of Teratology Information Specialists – links to state information http://www.otispregnancy.org/
TERIS, Teratogen Information Service, information on over 2800 agents
http://depts.washington.edu/~terisweb/teris/

Fetal Alcohol Syndrome websites:
Center of Disease Control – http://www.cdc.gov/ncbddd/fas/
National Organization for Fetal Alcohol Syndrome-http://www.nofas.org/
Smoking & Pregnancy website:

Cigarette Smoking during Pregnancy – http://www.chem-tox.com/pregnancy/smoking.htm
Links to Learning DisabilitiesAttention Deficit Disorder - A.D.D. -Hyperactivity and Behavior Disorders
AYURVEDIC PROCEDURES CONTRAINDICATED IN PREGNANCY-per ancient

texts
Massage during first trimester
Panchakarma Techniques:
• Head-evacuation – snuffing therapy and Nasya
• Sudation
• Emesis
• Purgation
• Enemas – until seventh month of pregnancy
STUDIES OF INTEREST
Phytoestrogens during pregnancy may decrease risk of breast cancer later in

life for the exposed babies. by Dr. Hope Ricciotti
• Data have begun to accumulate on the effects of a phytoestrogen-rich (soy and flaxseed) diet during pregnancy
and a decreased risk of breast cancer later in life in the babies exposed to phytoestrogens in utero. This data, in
both animals and humans, indicates that there may be a protective effect of a phytoestrogen rich diet in
pregnancy in preventing breast cancer in babies later in their life.
• Phytoestrogens have been shown to freely pass from the mother’s bloodstream, through the placenta, and into
the blood circulation of the fetus. The levels of phytoestrogens in the mother’s blood stream are very similar to
those in the fetal circulation. Consequently, scientists have postulated that consuming phytoestrogens during
pregnancy may have beneficial effects on the fetus that could decrease the future risk of hormone-dependent
cancers in these babies by modulating the amount of estrogen in their in-utero life.
• Estrogen Exposure in the Womb
There is scientific evidence that suggests that high concentrations of phytoestrogens in pregnant women
decrease the probability of the future occurrence of breast cancer in their daughters. The theory behind this
hypothesis is that phytoestrogens are potential modulators of estrogen action on the body because they act as
estrogen antagonists. They bind to the estrogen receptor in the breast, and because they are a much weaker
estrogen than estradiol, the body’s natural estrogen, the breast is exposed to much less estrogen. This effect is
particularly significant in situations when our body’s own natural estrogen levels are highest, such as in
pregnancy. They also may decrease estrogen action by inhibiting several enzymes important in estrogen
production and metabolism.
• This hypothesis has received support from studies that show a lower risk of breast cancer among daughters of
women with preeclampsia or eclampsia during pregnancy. The blood of these women was tested and was found
to have low estrogen levels. The offspring of these women were followed and found to have lower rates of breast
cancer later in life. The theory here is that these babies were exposed to less estrogen, and as adults had lower
rates of breast cancer.
• Pregnancy and Childhood Diets and Estrogen Levels
Although there does not appear to be a direct correlation between dietary fat in adult women and their risk of
breast cancer, there may be an association in children and adolescents. A diet which is high in fat and low in fiber
in childhood or during adolescence may increase breast cancer risk by affecting estrogen metabolism. Estrogen
levels in childhood and adolescence affects the growth of the mammary glands in the breast and their sensitivity
to toxic compounds, which enhances the occurrence of precancerous lesions. There is evidence that
phytoestrogens can decrease this risk.
• In an experiment, newborn rats were given phytoestrogens in their diet. The rats were less susceptible to
carcinogens, took longer to develop a mammary tumor, and had fewer multiple tumors than the rats who had no
phytoestrogens in their diet. In the rat mammary tissue on the microscopic level, there was a decrease in the
proliferation of mammary cells and less mature development of the ductal cells. This implies a protective effect of
phytoestogens in the diet on the growth of mammary tissue in newborns, resulting in structures that are less
susceptible to cancer. This may explain why the protective effect of the Asian diet appears to occur early in a girl’s
life.
• Additional support for the theory that a mother’s diet in pregnancy affects breast cancer risk in her daughters
comes from the Nurses’ Health Study at Harvard . Researchers there found a link between birth weight and later
risk of breast cancer: the bigger the baby, the greater the risk. A baby’s birth weight is largely determined by how
much weight a woman gains during pregnancy. Thus prenatal factors seem to affect later risk of developing
breast cancer.
• It is therefore possible that a high phytoestrogen diet during pregnancy and childhood may protect our daughters
from breast cancer. There is also evidence that phytoestrogens may protect men from prostate cancer. There is
no evidence that suggests that eating soy during pregnancy affects the endocrinologic (hormone) status of their
offspring in any negative way. 10/14/2002
• http://secure.caregroup.org/obgyn/ask_doc/ask_doc_questDisplay.asp?id=49 retrieved 12 July 2010
Undernourishment in Pregnant, Lactating Females Found Key to Next Generation's

Disease
ScienceDaily (June 13, 2011) — A new study published by the American Physiological Society offers the strongest
evidence yet that vulnerability to type 2 diabetes can begin in the womb, giving new insight into the mechanisms that
underlie a potentially devastating disease at the center of a worldwide epidemic. The study, conducted in baboon
primates, finds that when mothers are even moderately undernourished while pregnant and breastfeeding, their
offspring are consistently found to be prediabetic before adolescence. It is the first time that diabetes has been shown
to have prenatal origins in a primate model.
According to Peter W. Nathanielsz, senior author of the study, "We pass more biological milestones before we are born
and in the early weeks of life than at any other time." Poor maternal nutrition, which translates to less sustenance for
growing fetuses, is a stubborn problem in parts of the U.S. and the developing world, Nathanielsz said. Thus, "Poor
nutrition at critical periods of development can hinder growth of essential organs such as the pancreas, which sees a
significantly decrease in its ability to secrete insulin. Our study is the first to show in a primate that poor nutrition during
fetal and early life can damage the pancreas and predispose one to type 2 diabetes."
The study, "Emergence of insulin resistance in juvenile baboon offspring of mothers exposed to moderate maternal
nutrient reduction" was conducted by Nathanielsz and colleagues Jaehyek Choi, Cun Li, and Thomas J. McDonald of the
School of Medicine at the University of Texas Health Science Center at San Antonio, and Anthony Comuzzie and Vicki
Mattern of the Texas Biomedical Research Institute in San Antonio. The study was funded by the National Institute of
Diabetes and Digestive and Kidney Diseases. It is published in the online edition of the American Journal of Physiology --
Regulatory, Integrative and Comparative Physiology.
Background
Type 2 diabetes occurs when the body develops resistance to insulin, a hormone that regulates blood sugar. Although
the body may initially compensate by secreting more insulin, eventually the pancreas cannot produce enough of the
hormone to keep blood sugar from rising. In poorly controlled diabetes, elevated blood sugar severely damages the
heart, blood vessels, eyes, kidneys and nerves. The consequences can be fatal and include heart disease, stroke,
amputations, blindness and kidney failure.
Worldwide, diabetes is an escalating public health crisis. According to estimates from the World Health Organization
(WHO), 366 million people will be diabetic by the 2030, up from 171 million in 2000. This is a 114 percent projected
increase.
Formerly called "adult-onset diabetes," type 2 diabetes is seen increasingly in children at earlier and earlier ages. Excess
body weight and physical inactivity are known causes, but Nathanielsz and his collaborators have long been interested in
whether some individuals might be predisposed to diabetes from birth, or even earlier. Nathanielsz conducts research
on this and similar topics through the Center for Pregnancy and Newborn Research in the UT Health Science Center's
Department of Obstetrics and Gynecology.
The Study
For this study, to avoid the complication of influences from genes, researchers selected 18 female baboons similar in age
and other observable characteristics and housed them with a fertile male baboon. All females became pregnant. From
30 days of gestation, 12 females were randomly assigned to be fed an appropriate diet for their weight. The other six
received 70 percent of the chow given to control females on a weight-adjusted basis. The female baboons continued on
their respective diets through delivery and the weaning of their offspring. Once the young baboons were weaned, they
were fed normal diets.
Just before they reached puberty, the six young baboons from nutritionally restricted mothers showed increases in
fasting glucose, fasting insulin and other hallmarks of prediabetes. The 12 young baboons whose mothers received
adequate nutrition displayed none of these traits.
The central importance of this observation is that the mothers' food intake was only moderately restricted -- similar to
the decrease faced in the United State by many people living with food insecurity. There are 925 million undernourished
people worldwide, including 19 million in developed countries, according to the Food and Agriculture Organization of
the United Nations.
The researchers conclude that even moderate nutrient deficiencies during pregnancy result in offspring predisposed to
type 2 diabetes, particularly if they are exposed to other risk factors in later life, such as a Western diet and physical
inactivity leading to obesity. A fetus may also receive fewer nutrients due to teenage pregnancy, where the growing
mother competes with her offspring for resources; in pregnancies complicated by maternal vascular disease, which may
occur in women who become pregnant later in their reproductive life; and when placental problems exist. The decrease
in fetal growth observed in the newborn baboons was only about 10 percent, very similar to many human babies born
growth restricted.
Next Steps
According to Dr. Nathanielsz, the next step is separating the effect of nutrient deficiencies experienced during pregnancy
from those that occur during breastfeeding.
Story Source:
The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by American
Physiological Society.
Journal Reference:
1. Jaehyek Choi, Cun Li, Thomas J Mcdonald, Anthony G Comuzzie, Vicki Mattern, and Peter W Nathanielsz.
Emergence of insulin resistance in juvenile baboon offspring of mothers exposed to moderate maternal
nutrient reduction. American Journal of Physiology—Regulatory, Integrative and Comparative Physiology, 2011
DOI: 10.%u200B1152/%u200Bajpregu.%u200B00051.%u200B2011
American Physiological Society (2011, June 13). Undernourishment in pregnant, lactating females found key to next
generation's disease. ScienceDaily. Retrieved June 14, 2011, from http://www.sciencedaily.com
/releases/2011/06/110613142212.htm
Eating Disorders Associated With Reproductive Health Problems

Oct. 8, 2013 — Women with eating disorders are less likely to have children than others in the same age group, indicates
a study conducted at the University of Helsinki, Finland. The likelihood for miscarriage was more than triple for binge-
eating disorder (BED) sufferers and the likelihood of abortion more than double for bulimics than others in the same age
group.
According to a Finnish study, women with eating disorders are less likely to have children than others in their age group.
The discrepancy is the most apparent in anorexia sufferers. In this group, the number of pregnancies was less than half of
that of the control group.
The likelihood of abortion was more than double for bulimics than for others in the same age group. Meanwhile, the
likelihood for miscarriage was more than triple for binge-eating disorder (BED) sufferers. For women who had been in
treatment for BED, nearly half of their pregnancies ended in miscarriage.
"Early recognition, effective care and sufficiently long follow-up periods for eating disorders are crucial in the prevention
of reproductive health problems," states researcher Milla Linna from the University of Helsinki, Hjelt Institute.
Eating disorders are common in Western countries, particularly among girls and young women. It has been estimated that
5-10% of all young women in developed countries suffer from an eating disorder at some point in their lives.
Conducted jointly by the University of Helsinki and the National Institute for Health and Welfare, the 15-year register-
based study examined the reproductive health of patients treated at the eating disorder clinic of the Helsinki University

Central Hospital in 1995-2010 and a control group. Members of the control group were of the same age and gender and
from the same region as the patients. More than 11,000 women participated in the study, of which 2,257 were patients of
the eating disorder clinic and 9,028 were control group members.
"This study does not provide an explanation for the reproductive health problems observed in women with eating
disorders. Based on previous research, however, it seems likely that the problems can at least partially be attributed to the
eating disorder. Both being underweight and obese are known to be associated with the increased risk of infertility and
miscarriage. Eating disorders also often involve menstrual irregularities or the absence of menstruation, which may lead to
neglecting contraception and ultimately to unwanted pregnancies," hypothesises Linna.
A follow-up study is currently underway, focusing on the course of the pregnancies and deliveries of women who have
had eating disorders.
Journal Reference:
1. Linna MS, Raevuori A, Haukka J, Suvisaari JM, Suokas JT, Gissler M. Reproductive health outcomes in eating
disorders.. Int J Eat Disord, September 2013
Helsingin yliopisto (University of Helsinki) (2013, October 8). Eating disorders associated with reproductive health
problems. ScienceDaily. Retrieved October 9, 2013, from http://www.sciencedaily.com
/releases/2013/10/131008091241.htm

Class 8, Women’s Health w Ayurveda: Pregnancy Concerns
Snap shots of Pregnancy- Read ACY pp 43-45
Ayurvedic Herbs for pregnancy & labor — Read ACY pp 19-21 – KNOW THIS
All types of abnormal presentations, fetal deformities and maternal diseases are
mainly caused by the vitiation of apana vayu. Moreover, pregnancy itself is a factor
which causes instability in vayu. If there is stability in the equilibrium of vayu the
delivery will be without much discomfort or pain. So, take all steps for maintenance of
normal vayu during pregnancy, delivery, and thereafter.
Bala is the herb of choice in this condition- it alleviates vayu and also has a tonic and
nourishing action on the genitor-urinary system. The root is most useful and usually the
oil soluble fraction is used in the therapy. Some other useful drugs may be added –
recipe in Sushruta: Cikitsa 15: 15-18. This is used bth internally and externally, as well as
enema (note: at end of pregnancy only) for correcting the bowels and vaginal
douche(note:at end of pregnancy only) to strengthen the organs and make the local
tissues soft.
From Ayurveda for Mother and Child 1988 by Vaidya Bhagwan Dash –
sourced by ancient texts
Ayurvedic Helps for Discomforts of Pregnancy
TREATMENT OF DISORDERS OF VATA- or abnormalities of urine retention due to vata or colic due to vata
drink the leaves of eranda (castor plant) with milk
HYPERACIDITY w/ coated tongue

figs
small pinch amalaki
IMPROVE DIGESTION
carefully follow eating and digestion
pippili w/ghee or milk

GAS & HEARTBURN & INDIGESTION

Stomach crowded by pregnancy—posture!!
Shatavari
Shanka bhasma (watch heavy metals)
Kama dudha 1/4 tsp
or if Vata pulse and no heart burn, then hinguastak churna 1/8 tsp w/ warm water
coriander, pinch of amalaki
HEMORRHOIDS
Topically apply warm castor oil, slice of raw potato
Avoid constipation but - no triphala (vitiates fetus) so use: IN PREGNANCY -- USE NO BASTI OR CASTOR OIL
INTERNALLY
-1 cup hot milk w/ tsp ghee
-sat isapgol 1 tsp or metamucil either at bedtime
VAGINAL BLEEDING—contact physician or midwife also—can be life threatening

Ashoka -- 1/2 tsp w/ 1 cup milk
ABDOMINAL SKIN ITCH

Topical castor oil, or neem oil or coconut oil (external castor oil won't cause labor=muscle relaxant)
Due to vata – meat-soup mixed with either oleaginous substances and sprinkled with powdered rock-salt
or meat-soup with shashtika rice with milk (per Kasheppa)
HEMORRHOIDS
Topically apply warm castor oil, slice of raw potato
Avoid constipation but - no triphala (vitiates fetus) so use: IN PREGNANCY -- USE NO BASTI OR CASTOR OIL
INTERNALLY
-1 cup hot milk w/ tsp ghee
-sat isapgol 1 tsp or metamucil either at bedtime
VAGINAL BLEEDING—contact physician or midwife also—can be life threatening

Ashoka -- 1/2 tsp w/ 1 cup milk
ABDOMINAL SKIN ITCH

Topical castor oil, or neem oil or coconut oil (external castor oil won't cause labor=muscle relaxant)
Due to vata – meat-soup mixed with either oleaginous substances and sprinkled with powdered rock-salt
or meat-soup with shashtika rice with milk (per Kasheppa)

SWOLLEN FEET
poor circulation; water retention
-Punanarva 1/2 tsp in 1 cup water
-Cumin / Coriander/ Fennel tea
-Walk & exercise
-Put pillow under feet when sleeping; sleep on left side to encourage circulation
INSOMNIA
Tagar 1/4 - 1/2 tsp w/ milk or
Garlic milk , w/ ghee if desired; use goats milk or almond milk if no dairy for Vata type insomnia
MOOD SWINGS
Tranquility tea = brahmi, jatamansi, shankapushpi
Also brahmi oil to soles of feet & skull - husband can apply
ANAL FISSURE (per Kasheppa)

Cold milk medicated with herbs of madhura group and mixed with honey or sugar
Lickable of Honey and oil
Lickable of Yastimadhu (Licorice rt) and molasses
EXCESS SALIVATION
Trikatu 2 pinches with honey
DYSENTERY (per Kasheppa)
Molasses, paste of sesame, sugar and madhuka mixed with rice-water cures dysentery immediately
Rice-gruel treated with curd-water and mixed with a small quantity of ghrta should be given for
drinking
ERUCTATION (BELCHING) (per Kasheppa)

Lickable made with bhadradaru (larch), haritaki, rock-salt, kustha and mixed with molasses as well as
ghrta
HICCUP AND DYSPNEA (per Kasheppa)

Lickable made with pippali gairika (red ochre), bhargi, hingu, karkataki with honey
RETENTION OF URINE (per Kasheppa)

Drink a decoction or juice or paste or medicated milk of these: shatavari, roots of darbha, madhuka,
ksiramorata, pashanabheda, ushira, and fruits of kataka. Successful in all types of urine retention.

POSSIBLE DANGER - SEE A MEDICAL DOCTOR or MIDWIFE IF:

-any bleeding
-severe nausea & vomiting (=every 3 hours) -swelling hands,feet & face
-eclampsia -blurry vision -pain not releived by BM
-intense headache -some rashes -gush of amniotic fluid
-frequent /burning urination -accidental fall or trauma -fever > 100 w/ cold
Threatened miscarriage, miscarriage, abortion

Miscarriage Basics
Bleeding in early pregnancy occurs for about 25% of pregnant women. About 10% of all pregnancies end in
miscarriage. Most bleeding and miscarriage occur in the first trimester. When miscarriage does occur, 60%-
80% are associated with a defect of the embryo or trophoblast that is incompatible with life or would have
been grossly deformed.
What are signs of impending miscarriage?
Usually bleeding & cramping occur and increase until the pregnancy tissue is passed. However, these symptoms don’t
always mean a miscarriage is occurring; they may stop and the pregnancy continue to normal labor and birth months
later. That is why midwifery or medical consultation may be required to determine what is happening.
Other signs of miscarriage might be a change in breast growth or other symptoms the woman had been experiencing
with pregnancy.
With Ayurveda pulse reading, the artava pulse may be deranged with Vata and/or Pitta (These readings also do not
always mean a miscarriage and must be evaluated with other symptoms.)
How long does a miscarriage take, when is it complete, and what does it look like?
The time from when an embryo is no longer alive and when it is expelled varies widely – from hours to a month or more.
The miscarriage is complete when all placental tissue and uterine lining have been passed, and when cramping and
bleeding have considerably diminished.
The appearance of the products of a miscarriage varies tremendously, depending on the length of gestation, when the
fetal growth stopped, and how long after this the miscarriage occurs. One can sometimes see a small placenta, cord,
amniotic sac, and fetus; often none of these are visible. Whatever is visible is usually intact. There are often blood clots.

What can a woman miscarrying at home expect?
An uncomplicated miscarriage is accompanied by cramping but not heavy bleeding (heavy bleeding is indicated by
soaking a full-size regular sanitary pad in less than half an hour) and is free of any signs of infection (fever, shaking, chills,
sweating, or foul-smelling discharge). When the body is expelling miscarried tissue, the bleeding is often heavier, but
this should not last for long. At least a phone consultation with a midwife or other birth professional is recommended.
What can a woman miscarrying in a medical setting expect?
If staying at home is inadvisable, a woman can miscarry in a hospital emergency room or a health provider’s office.
Medication may be recommended to help the uterus contract more effectively. If the placental tissue or uterine lining
fails to pass completely & spontaneously, if heavy bleeding occurs, or if signs of infection are present, a dilatation and
curettage (D&C) is performed. The cervix is mechanically opened and the uterine lining is gently scraped out.
Avoiding Miscarriages & Causes of miscarriage

Causes of miscarriage per Dr. Lad & myself
Unviable development of the zygote; Increased P; Increased V & apan pran disorders; Retroverted uterus;
Dilated cervix; Habitual miscarriage (p); Endometritis (P); Metorrhagia - high oestrogen, low progesterone (P); Too much
or Inappropriate exercise - riding, backpacking, swinging on a swing, wrong posture, excessive sex, too much of even
walking; Voluntary suppression of natural urges, especially to fart, pee or have BM (this +V); Frequently hearing loud
noises; Eating extreme foods or too little or too much; Diseases
First avoid these conditions - treat them before pregnancy if possible or gently at the beginning of pregnancy, if
necessary. If a miscarriage threatens , find the cause! Contact your care provider &/or Ayurvedic practitioner for help
sooner than later. Get off your feet!
Ashtanga Hrdyam – Garbhasrava (abortion – first 3 months)

Administer lubricating and coolant things both externally and internally-ex. Poultice on yoni, vaginal tampon-keep
moistening it.
Anoint her with shatadhauta ghrta and have her lie in a tub filled with water processed with drugs (ushira, ambhoha,
hima, bark of trees with milky sap); give milk and ghee mixed with sugar, honey, and filaments of kumuda, kamala, and
utpala; eat shrngataka and kasheruka, etc.
Blood-letting should be done without administering purifactory therapies.
If they haven’t completed three months of pregnancy treat after informing them there is doubt of success.
Treatment – herbs that are sheeta associated with dryness; fasting, drinking water processed with Ghana, ushira,
guduchi, aralu, dhanyaka, duralabha, parpata, candana, ativisa and bala
Dr. Lad's Treatments for Threatened Miscarriage:

Treatment for P Cause
P pacifying diet & herbs - bitter & astringent:
also Shatavari
Tikta
Shankh (conch) bhasma
Pearl, red coral elixirs
Brehan - nourishing therapy
Treatment for V Cause
Snehan - oleation therapy
Svedan - sweating therapy
Basti - Dashmula enema (very gentle on douching)
Ashwagundha 500mg, Bala 500 mg to strengthen fundus of uterus
Treatment for retroverted uterus
asanas - forward bend; half headstand; rabbit; elevated lotus; plough pose; bow pose
Maya Abdominal Therapy
Treatment for dilated cervix
asanas - same as for retroverted uterus
licorice ghee to cervix topically w/ sterile cotton swab
aloe vera juice douche (very gently)
ashoka orally -see below
Treatment for habitual miscarriage or for any causes
look for emotional cause
slippery elm, scullcap, valerian tea - to alleviate fear of pregnancy
wear yellow sapphire in gold on Right index finger
keep pregnancy secret to avoid disturbing
General formula for threatened miscarriage by Dr. Lad:
1/4 - 1/2 teaspoon Ashoka with ghee or warm water. Continue after bleeding stops to strengthen pregnancy.
Another formula for preventing threatened miscarriage:
shatavari, ashok, ashwagunda, brahmi, amla, & a digestive herb such as pippili
-Ectopic pregnancy - This is a possibly life-threatening condition where the fertilized egg gets stuck somehow in the
fallopian tube ( or rarely, elsewhere in the abdomen) rather than in the uterus. Ayurvedically is is a Vata disorder or a K
disorder, if the ovum is sluggish. When the egg develops large enough it will burst the fallopian tube, causing pain,
bleeding, possible peritonitis. Symptoms are: Sudden intense pain or persistent pain or cramping in the lower abdomen,
usually on one side or the other; irregular spotting after pregnant ( internal bleeding is not necessarily proportional to
externally seen bleeding); fainting or dizziness lasting more than a few seconds; the uterus does not grow as expected.
See or contact a practitioner IMMEDIATELY with these symptoms. Early diagnosis makes a big difference in outcome.
AYURVEDIC PREVENTION OF ECTOPIC PREGNANCY
Dr. Lad gives these preventions if there is a history of ectopic pregnancy. Do them before the next conception.
Stop treatment after 2 months of pregnancy ( best consult personally w/ an ayurvedic practitioner before taking herbs) -
Sun salutation & pelvic exercise of plough, camel & cobra asanas
arogyavardhini 200 mg & chandra prabha 200 mg, 2 times a day
& also, purnanarva 300 mg & kutki 100 mg , 2 times a day
Sources: Dr. Vasant Lad -Notes from lecture on Ayurvedic Gynecology &
-tape on"Pregnancy & Newborn"
Assisting Inevitable Miscarriage

by Terra Rafael, Registered Midwife, Certified in Arvigo Techniques of Maya Abdominal Massage & Ayurveda
Over the years of midwifery practice I have worked with many women around miscarriage. The natural course will most
often come with patience. Also, incomplete miscarriages are more likely when we intervene in the natural processes of
the body.
However, I do believe in a woman's right to choose for herself not to wait for a totally natural miscarriage. For some,
the emotional burden is too great, knowing that they are carrying death inside of them. That is the disadvantage of
seeing into the womb -- before this technology women most often wouldn't be aware of the physical form of the baby
dying until her body let go of it.
Using the steps of healing by Susun Weed we might stay with each step a self-determined amount of time or do them all
at once, according to the needs of the situation. As we go deeper into the steps the interventions become stronger and
thus, side effects of the interventions may also be larger. That is why it's best to try gentler steps to see if they work first.
0."do nothing-let the natural course unfold"-this is waiting it out to see when the body might naturally miscarry. This is
the safest course because it doesn't mess with the body's own integrated process. If the woman is not healthy or is out
of balance some how then perhaps her body may stall in an unnatural way and need more help. It is common for it to
take a couple of weeks after demise for the miscarriage to complete itself.
1."gather information"- in this case the woman finds out the pros & cons of D&C, and other methods of completing her
miscarriage. She also checks in emotionally, psychically, & spiritually, however she may do this, to see what is in accord
with her inner needs and the needs of the baby's spirit. Doing a conversation with the soul of the baby can go a long
ways towards letting go-- sometimes the physical body of the baby is not viable but the soul connection maintains. She
might do this on her own or with the help of someone trained or experienced in guiding this work.
2."Engage the energy" is the next step-- to use the elements and energetic sources to move the process forward. This
would include homeopathy, reiki, flower essences, using the heat, breath, affirmations, and other subtle means. It
might include her moving her body-- dancing, running, other means of engaging her metabolism. It might also mean
going fully into her grief process--crying, yelling, moaning, pleading.
3."Nourish and tone" comes next. Foods & nourishing herbs are in this step as well as emotional & spiritual
nourishment. Drinking raspberry leaf infusions to tone the uterus and give it the strength to expel the miscarried one is
part of this step for this situation.
4."Stimulate and sedate" is the next step. Here is where we begin with stronger remedies-- medicinal herbs and I
would include Maya Abdominal Massage here in this case. The dangers here are over stimulation or overriding the
natural process in a way that might cause excess bleeding, or on an emotional level, allow denial of the grief process.
These remedies are best used with a healthy level of understanding and the ability to deal with the consequences. It is
not just a matter of some tissue to be removed-- the woman’s whole physiology has been pregnant and must shift.
Messing with that could mess with her hormonal system in ways we don't understand.

Herbal tinctures that may be of use are cottonroot bark (traditionally used for abortions), a combination of Blue & black
cohosh (traditionally used to stimulate labor), or Angelica (used to release the placenta). Each of these needs to be used
properly to avoid undesireable side effects so please use them with the help of a trained & experienced person, a
naturopath or herbalist or midwife. (available from WishGarden Herbs in Boulder)
Maya abdominal therapy is stimulating in this case, used to cause the conceptus to separate and the uterus to contract.
The danger would be if it is only partially loosened by the massage and the uterus doesn't responsively open the cervix
or contract enough to expel it-- then excessive bleeding can occur. Blood loss would need to be monitored by someone
who is competent to tell when a woman might be in trouble-- don't just leave her alone. Incomplete miscarriages are
also possible without excess bleeding-- the possibility of infection is there. Incomplete miscarriages are more likely
when we intervene in the natural processes of the body.
5. "Drugs" according to Susun Weed this includes anything you can't make in your own kitchen. In this case the woman
could choose to use a medical abortifacient.
6. "Break & enter" - use surgery, or any forceful means to achieve the end. This includes a variety of things women have
done to abort, including medical dilatation & curettage ( the cervix is forced open by some means and then a tool is
inserted into the uterus to scrape out its contents), or suction abortion (cervix forced open and a tool is inserted to suck
out its contents).
Please remember to address the woman holistically-- not just getting rid of the miscarried tissue, but deal her grieving
heart as well. Also- there is some reason she miscarried. She may need balancing with Maya abdominal therapy once
her bleeding stops if her uterus is out of place. In Ayurveda we treat this to help the body rebalance the energies and
strengthen the uterus. Be sure she is well nourished and rebalanced before she tries to get pregnant again.
Early Pregnancy Bleeding/Miscarriage
Early pregnancy miscarriage is more likely an apana vayu provocation; after three months, more likely a pitta
problem.
Threatened Abortion: vaginal bleeding in the first half of pregnancy; spotting
-Ayurvedic: evaluate cause and treat causes by balancing doshas; – treat with Shatavari ( with cold milk, coconut
milk or ghee) Use pregnancy safe herbs that balance Vata &/or Pitta, as indicated. Commonly used to prevent
miscarriage: ashoka, licorice, lotus, guduchi, ashwagandha (ashwagandha may cause constipation & swelling which can
be treated with a SMALL DOsES of triphala with ghee & water)
- Flower essences: Rescue Remedy –for calming fears & shock; others per her emotional situation
-Western Herbs: black haw root, false unicorn, and wild yam; lobelia is helpful to stop contractions but it is
important to know how to use it; Uterine Tonic Tea, with red raspberry (magnetic momma or materni-tea).
-Vitamin E: 2000 iu daily during crisis and folic acid and Vitamin B
-Bed rest
-Give the women help in becoming clear within herself
-Have the parents talk to their baby about their true feelings and the choices the baby can make to stay or leave
- Avoid stimulating the uterus: No intercourse, breast stimulation, or orgasm during bleeding episodes and
three days after or during the usual times of menstruation; avoid lifting, moving heavy objects, constipation or any
bearing down . Balance apana with gentle Ashwini mudra while avoiding bearing down
-If it is after 10-12 weeks, use the doppler to try and find a heart beat if desired.
-Have a serial HCG test or ultrasound done to determine viable pregnancy, if desired
Inevitable Abortion: Broken membranes or cervix is open.
Deciding when it is inevitable is a sensitive task. Refer to midwife for her opinion.
- For a miscarriage which is uncomplicated, and if parents wish, a midwife can treat it like other births- Inform the
client that if she goes to the hospital they will likely do a D&C. It may be more traumatic for them, and they might opt to
stay home. It may help them let go and be done. Let them decide, if she is not hemorrhaging or showing signs of
infection.
- Take time to assist her with looking inward as needed
-Have her take her pulse and temperature postpartum 3X a day for a week; extra Vitamin C and echinacea
tincture,( 3 dropperfuls 3-5 x a day) or other anti-infective herbs for several days to prevent infection.
-If she loses a substantial amount of blood, check for anemia, or have her follow the anemia protocol.
-Ayurvedic care post miscarriage –pulses, dashmula tea, possibly oil enemas
-Maya Abdominal massage to be sure uterus well placed and to nourish the area with good blood flow—after
bleeding is completed
-wait for 2-3 normal menses before trying to conceive again.
Missed Abortion: nonviable fetus that has not passed out of uterus.
Signs: threatened abortion, then breasts get smaller, uterine growth may regress, no fetal movement or
heartbeat heard. This can (rarely before 20 weeks gestation) lead to a clotting disorder.
1. Refer to an MD for an ultrasound to check viability.

2. A midwife might try induction by herbs, acupuncture, etc. if needed.
3. Refer to MD for a D&C if natural means don’t work.
4. Assist her with emotional and physical healing as with miscarriage/abortion protocol.
Watch for complications from the miscarriage or abortion

• Address emotional needs
• Calm the reproductive tract after interruption of the pregnancy cycle
• Balance energy
• Be sure that her uterus is properly positioned after the miscarriage experience
• Wait at least 3 normal menstrual cycles before conceiving again
Repeated Miscarriages—Basic Medical Information
Causes
After several miscarriages, you may wonder whether you will ever be able to have a healthy baby. Be hopeful. The
chances of having a successful pregnancy are good even after more than one miscarriage.

Often, the reason for repeated miscarriage is not known. Sometimes, though, it has a certain cause. Known causes
include:
• Chromosomal problems
• Illness in the mother
• Hormone imbalance
• Disorders of the immune system
• Abnormalities of the uterus
• Environmental and lifestyle factors
If you have had more than one miscarriage, each may have had a different cause.
Chromosomal Problems
More than half of miscarriages in the first 13 weeks of pregnancy are caused by
problems with the chromosomes of the fetus. Chromosomes are tiny structures inside
the cells of the body. Each carries many genes. Genes are the basic units of heredity.
They determine all of a person's physical makeup, such as sex, hair and eye color, and
blood type.
Problems with the number or structure of chromosomes, or with the genes they carry,
can lead to miscarriage. Often this is nature's way of ending a pregnancy in which the
fetus was not growing as it should and would not have been able to live.
Most chromosomal problems occur by chance. They have nothing to do with the
mother's or father's health. They are not likely to occur again in a later pregnancy.
In a small number of cases, though, problems with the parents' chromosomes can
cause repeated miscarriage. There are tests to find out whether chromosomal problems
are a factor in repeated miscarriage.
Illnesses in the Mother

Certain illnesses in the mother have been linked to a greater risk of repeated
miscarriage. These include:
• Systemic lupus erythematosus and other autoimmune disorders

The fetus inherits 23
• Congenital heart disease
chromosomes each from its
• Severe kidney disease, especially when linked with high blood pressure
(hypertension) mother and father to make
• Diabetes that is not controlled 23 pairs. The 23rd pair
• Thyroid disease determines the sex of the
• Intrauterine infection fetus: XX is female and XY is
male
Sometimes treatment of the illness can improve the chances for a successful
pregnancy. This is even more true if the illness is under control before a woman
becomes pregnant. Other illnesses may need care or close watching during pregnancy.
Hormone Imbalance
Progesterone is a hormone that prepares the lining of the uterus during the second half of the menstrual cycle to
nourish a fertilized egg.

If the egg is not fertilized, it is shed with the uterine lining during the menstrual period. If the egg is fertilized,
hormones prepare the uterus for pregnancy.
Early in pregnancy, enough progesterone must be made to maintain the pregnancy. If not, miscarriage will occur. If
tests show that a woman's body is not making enough progesterone, her doctor may prescribe supplements to correct
the problem.
Disorders of the Immune System

The immune system is designed to recognize and attack foreign substances within the body. Antibodies are formed to
help the body fight off disease and heal itself in case of infection. Normally, the mother's body protects the "foreign"
fetus from attack by her own antibodies. It is thought that this protection may be absent in the blood of some women
who have had repeated miscarriage.
Other immune system problems are caused by differences between the mother and the fetus and even between the
mother and the father. For instance, the mother's immune system may produce antibodies to the cells of her body.
This can cause pregnancy loss. Tests can be done that may help find problems with the immune system.
Abnormalities of the Uterus

Several abnormalities of the uterus are linked to repeated miscarriage:
• Congenital abnormalities. These are defects present from birth. For instance, a woman may have a uterus that
is divided into two sections by a wall of tissue (septate uterus).
• Uterine fibroids (leiomyomata). Uterine fibroids are benign growths (not cancer) made up of uterine muscle
tissue.
• Incompetent cervix. An incompetent cervix is one that begins to widen and open too early, in the middle of
pregnancy, without any sign of pain or labor.
Most of these can be treated with surgery.
Environmental and Lifestyle Factors

The risk of miscarriage may be increased in pregnant women who:
• Smoke
• Drink alcohol
• Use illegal drugs
• Are exposed to high levels of radiation or toxic agents
Special Care for Future Pregnancies
Sometimes the problem that caused the miscarriages can be treated. Surgery may help some problems of the uterus
and cervix. Treatment with antibiotics can cure infections. In other cases, hormone treatment may help.
If chromosomal problems are found in the parents, your doctor may advise genetic counseling. A genetic counselor
can help you and your partner learn what risks a genetic problem might pose for future pregnancies. The fetus can be
tested for some problems in future pregnancies by amniocentesis or chorionic villus sampling.
Coping with Repeated Miscarriage

The loss of a pregnancy - no matter how early or how late - can result in feelings of grief. You may be troubled and
even overwhelmed by grief and discouragement. For many women, the emotional healing takes longer than the
physical healing that follows a miscarriage.
Grief can cause you to blame yourself although you did nothing wrong. You might find yourself thinking about the
early days of your pregnancy, searching for a clue that would explain the loss. You also may find yourself angry at
your partner or other loved ones.
Other signs of emotional stress might include:
• Headaches
• Loss of appetite
• Not being able to sleep
• Feeling tired
• Having trouble concentrating
Your feelings of grief may differ from those of your partner. You are the one who felt the physical changes of
pregnancy. Your partner also may grieve, but he may not express his feelings the same way you do. He may feel that
he has to be strong for both of you and may not share his hurt and disappointment. This may create tensions between
the two of you just when you need each other the most.
Emotional pain is as real as physical pain, even though the injury cannot be seen or touched. If you feel sad, allow
yourself to grieve. Grieving will help you accept the loss and get on with your life. Above all, don't blame yourself for
the miscarriages. Self-blame is self-punishment, and you do not deserve punishment. You need and deserve love,
support, and reassurance.
Reach out to those closest to you and ask for their comfort and support. Talk to your doctor. There may be support
groups in your area that are eager to help. Counseling can help both you and your partner if you think that you can't
deal with your feelings alone.
Finally . . . Even if you have had repeated miscarriages, you still have a good chance to have a successful pregnancy.
This is true even if the causes of the past pregnancy losses cannot be found. Future pregnancies will need prompt and
early care. Your doctor will check your pregnancy closely and provide any special care you may need as your fetus
grows.© Copyright February 2000 American College of Obstetricians and Gynecologists
Balancing & Nurturing Women after Miscarriage or Abortion

After miscarriage or abortion, it is important for the woman to calm the upset of her system changing course abruptly
and being forced to let go of the baby. It is also important for her to allow herself the full range of feelings about the
situation--from relief & happiness for having it done to grief & regret at having to go through with it. Repressed
physical and emotional reactions can lead to later reproductive problems.
She needs to allow her body some rest. Resting allows for the best physical recovery. The process or procedure leaves
her uterus vulnerable and possibly out of it's proper location, which can be worsened if she does lifting of heavy objects,
or makes high impact movements (like jogging, dancing/jumping, snowboarding or mountain biking) or is on her feet for
long periods of time.
This rest period is also a good time for her to go through her emotions--even though she might rather be really busy and
avoid them. She usually needs someone as a support person to be with her, to witness her process and acknowledge it--

a close friend or a therapist can do this. Performing some ceremony about letting go of that pregnancy suited to her
spiritual beliefs can be good--possibly a literal burial or cremation (usually at her own place-not a mortuary). The
ceremony can also include openness to future pregnancies, if that is her wish. It can be very simple and symbolic or
have lots of talking--whatever suits her feelings & desires. Having some friends &/or family there symbolizes the
support of her community at the time of this difficulty.
Ayurvedically, the Vata dosha & apana prana (downward energy of the pelvis) will be activated due to the sudden
change. To calm this, a Vata soothing regime is helpful -- calm, quiet environment & daily routine; and eating foods that
are cooked, easily digestible warm, soupy, nutritious with mild digestive spices &/or onions & garlic and healthy oils.
Soups & stews with root vegetables and some greens are ideal. Avoid: dry, cold foods, leftovers, beans (choose nuts
instead if vegan), sprouts, raw salads (eat cooked greens instead, with some vinegar or lemon juice and some healthy oil
or butter). Baked apples with cinnamon & butter are good. Follow this diet and lifestyle through the next menstrual
period.
Taking the herb trifala will help rejuvenate the apana and very mildly detoxify and balance. Banyan Herbs or local health
food stores sell Trifala tablets and you can take 1-2 at bedtime with water for the next 3 months or so. It should allow
for smooth, regular bowel movements-- if you get too strong of eliminative reaction (this is unusual), reduce the dose or
stop.
The woman can receive or give herself massages with warmed sesame oil (not the toasted type) and then take a warm
bath up to once a day--twice a week would also be fine. Be sure to be careful maneuvering in a bathtub while oily to
avoid falls. To remove oil from your hair--massage shampoo into the oil before wetting your oily head to mix it well with
the oil rather than keeping it on the surface. She should do this until her next normal menstrual period. This will allow
her body & nervous system to calm down and get back into rhythm.
Her next period may or may not be on schedule. When her bleeding from the abortion or miscarriage has stopped she
can do other helpful things to help normalize her reproductive tract.
• If she has the advise of an Ayurvedic Practitioner she may want to do therapeutic enemas to calm the apana
prana further (commonly using Dashamula and sesame oil). Herbs to support and rejuvenate the reproductive
tract are available as well, according to her specific condition. Pulse readings can help determine the need for
this.
• She can receive one or more treatments of Maya Abdominal Massage-- check www.arvigomassage.com for a
practitioner nearby. This will help to replace the uterus in the proper position, stimulate the circulation, lymph
and energy to flow properly and bring the best level of healing to the area. Putting the uterus in place will
promote healthy conception, implantation and pregnancy when she so desires it. It also keeps the uterus from
stagnation that could lead to future problems with menstrual cramping, cysts, abnormal cells, polyps or fibroids.
• The Maya Abdominal Massage therapist can also assist her in doing a vaginal steam bath, which can reduce any
swelling in the uterus and help it clean out fully with the next normal menstrual period. A special herbal formula
for the uterus, Female Tonic, is also available to help the uterus back to health, when indicated.
Through care during the time after a miscarriage or abortion, reproductive health can be increased and many “female
complaints” can be prevented.
Nausea & vomiting

Nausea and vomiting are common discomforts of pregnancy. Most common in the first trimester, it occasionally
resurfaces at the very end as well. Those with twins often experience it due to the very large abdomen pushing up on
the stomach.
Hyperemesis Gravidarum (lots and lots of vomiting in pregnancy) is a more serious problem. It can lead to
dehydration, malnutrition, and metabolic disturbances. For every 1000 births, 3-4 women are hospitalized for this
condition. Look for the possibility of molar pregnancy with this.
In general, NAUSEA AND VOMITING ARE SYMPTOMS AND THERE IS NO ONE CAUSE. Each case must be looked
at individually to evaluate what might be the most helpful comfort measures. Some likely causes include: excess or
deficit of hormones; imbalanced metabolism; sensitivity to the hormones of pregnancy; allergy to fetal proteins coming
through placenta; swings in blood sugar.
Pathology to rule out: appendicitis, hepatitis, twisted ovarian cyst, peptic ulcer, kidney infection (after 22
weeks).
Helps:
- Ayurveda: treat doshic imbalance – especially common is Mother has pitta prakruti/vikriti in pregnancy
Some Ayurvedic remedies – try one at a time
-Pomegranate juice with pinch of cardamom prn

"and baby will have beautiful hair like a peacock" as well as help with morning sickness
-dry roasted black cardamom powder – 1 tsp in morning w/ milk (if tolerated) use only if vomited less than 10 x
***(CAUTION- GREEN cardamom can possibly cause SAB)***
- Peacock feather - burn to ash (smells bad), pulverize, take a pinch w/ honey
- Gulwel sattwa 300 mg
Shankha bhasma 200 mg 1/2 tsp TID, before food -(use only if you understand the herbs)
-Homeopathy: Ipecac: continuous nausea; not thirst; not better after vomiting; repugnance to food; pain
around navel. Colchicum: thought of food makes nauseated; better when doubled over; odors nauseate; loathes sight or
smell of food. Phosphorous: thirsty for cold water but vomits as soon as it gets warm in stomach; stomach feels empty,
hollow. Nux Vomica: "dry heaves"; miserable and cranky until afternoon; violent vomiting; bilious. sour. Natrum
Phosporicum: nausea without other symptoms.
-Herbs: Fresh ginger root tea as needed; Raspberry Tea; peppermint tea
-Vitamins: Vitamin B supplement, esp. B6
-Aromatherapy: Early pregnancy: lavender oil calms. Later preg: peppermint oil massage on upper belly or
between shoulder blades clears and focuses. If severe, cold compress over forehead, a little oil on temples. Also good:
cardamom / coriander oils
-Others: Eat salted crackers before arising; try very hot or very cold liquids; small frequent meals are better than
large, esp. for blood sugar problems; avoid fatty, fried foods, highly seasoned foods; eat anything you can keep down,

even if its not the most nutritious; drink Recharge for fluid replacement if vomiting; eat protein before retiring or in
middle of night (yogurts good)
Lack of appetite
Because of the importance of good nutrition during pregnancy for the health of both mother and baby, a lack of appetite
is something to be addressed. Sometimes it is nausea that causes a lack of appetite- in that case calling for addressing
that problem. Careful questioning and examination is indicated: is it a Vata , Pitta or Kapha problem? Blood sugar dips
can cause a lack of appetite as well.
• Try Agni Kindler before meal time. If Pitta seems involved, include some fresh turmeric root, if available.
• Women may be too busy with work and family, etc to take time for regular meals and throw off their agni.
Remind of how the regularity of meal time can help with appetite and digestion. This is a Vata problem.
• Other times it is “distaste”- nothing appeals for eating. Try favorite foods, comfort foods, a friend’s gourmet
cooking. Smelling the delicious food cooking may help appetite (or may make her nauseated).
• If a woman has accumulated Kapha in her stomach she will probably have a lack of appetite as well as possibly
nausea.
Two herbs indicated for distaste, both used with great caution in pregnancy, especially first trimester:
• Amalaki VP-K+ Belching, misperistalsis, belching, malabsorption, distaste – use only small amounts in
pregnancy – increases downward movement. Be sure it’s a V or P problem
• Hing VK-P+ Removes gas, poor appetite, distaste – use very small amounts in pregnancy as needed when
appropriate- increases heat in the body ie. V or K problem.
Appetizer/stomachic formula by Kasheppa:

Pippali, pippali mula (pippili root), musta, tagara as well as honey used with milk
Fever in Pregnancy
Fever in pregnancy is significant in that it can adversely affect the baby if severe or prolonged. Early in pregnancy it can
be teratogenic.
Kasheppa says “amongst all diseases, the fever of pregnant women is most troublesome.”
Etiology per Kasheppa

In the pregnant woman, fever develops due to hunger, tiredness, massage, dryness, excess heat, retention of
undigested/unmetabolised materials, abnormal or irregular application of oleating and sedating drugs, and also
abnormality of tejas, by psychological abnormalities and also by climbing the mountains and pollen of grass, straw and
flowers.
Fever Treatment principles during pregnancy per Kasheppa

• To the pregnant woman seized with fever, fasting should be given for one day, then tisane (herb tea) free from
oleaginous (oily) substance and without salt should be given.
• The woman suffering from fever should give up sharp diet and tisane, and also sudation and exercise; should
drink only gruel.

• After reduction of the doshas by use of gruel, the soups of cereals should be given; with further reduction by use
of soups, the wise knower should give meat soup or milk; use of medicine is not beneficial. Considering the
duration of pregnancy and association of doshas, the physician should use medicament from the fourth month
onwards.
• Choosing medicines: Knowing the predominance of vata, pitta and kapha in the fever of the body and
considering the heaviness and lightness, medium treatment should be used. Knowing the strength of
complication and also looking into the endurance and knowing the status (age) of the fetus, the lekhana drugs
(scraping) may be given
• Treating thirst: Avoid very hot water. If VK cause cold water is like a poison and in pitta caused fever water
boiled then cooled is considered good. Water boiled in a stone flask/bottle then cooled removes thirst. This is
especially for fevers of recent origin.
• Massage and nasya not advised.
• Treatment of fever due to vata -
o Decoction of vidarigandha, kalashi, gandharvahastaka, madhuka, and bhadradaru mixed with sugar and
juice of matulunga
o Lukewarm decoction of vidarigandha etc group of drugs mixed with bhadradaru
o Decoction of eranda, aruna both brhatis and madhuka mixed with paste of rasna
o Lukewarm or cold decoction of both panchamula mixed with paste of rasna
o After digestion/metabolization of fever- salt-free liquid tisane should be taken in diet
• Treatment of chronic fever-
o Milk or gruel made with milk or meat-soup of wild animals cooked with drugs capable of eradicating
vayu is beneficial.
• Treatment of fever due to pitta-
o Decocted sariva etc mixed with sugar and honey should be given for drinking after getting up in the
morning.
o Tisane made with payasya, ksirakakoli, mrdvika and madhuka mixed with sugar and honey should be
given
o Nilotpala, payasya, sariva, madhuka, honey, pippali, marica, usira, lodhra, laja (parcehed paddy) with
sugar- these mixed with milk an dhurned should be given for drinking
o Roots of nala, vanjula nad roots of gundra, saha, sahadeva, markava, patali, tender leaves of latex-
yielding trees and also of jambu and amra, tupala, ariva, usira, candana and leaves of padma should be
ollected; anointment with finely levigated all and given orally mixed with grta is nutritive
o Levigated yava one kudava and manjistha ½ pala, hundred pala sour liquid (kanji) with this one prastha
sesame oil should be cooked- cures burning sensation and fever
o Congenials in fever due to pitta - cold tisane and also milk is congenial. In chronic fever due to pitta the
soup of black-gram cooked with drugs that eradicate pitta should be given
• Treatment of fever due to kapha-
o Well cooled decoction of rasna mixed with honey given for drinking
o Drinking decoction of bhadradaru mixed with rasna and honey
o Decoction of candana mixed with pippali and honey
o Decoction of rasna, vasa, and amrta

• Treatment of mixed fevers- In fever due to combination of doshas the physician should use herbs according to
strength; in fevers developing due to combination of all the three doshas, the measures capable of suppressing
all the three doshas are beneficial.
o Kapha and Pitta fever – decoction of shriparnika and amrta mixed with honey and yastimadhuka should
be given for drinking
o Vata with shlesma fever – decoction of vrhatpanchamula mixed with paste of rasna given for drinking in
the morning.
o Vata and Pitta fever – decoction of vidarigandha, etc. mixed with sugar and honey should be given for
drinking
Ayurvedically, fever means the digestive fire is low (eat only very digestable foods, ie. Light soups during a fever –when
not pregnant, fasting is recommended). After the fever subsides, digestion must be rekindled by herbs safe for
pregnancy & that person to ensure proper digestion & assimilation of food taken in.
Other Helps for Fever:

-General fever formula from Sarita Shrestha-Godanti, Guduchi w/sitopaladi, sudarshan, tulsi, a little Vacha, a little pippili
- Peppermint oil on feet
-Fluids Lots!!!
-Bed rest
-Echinacea honey or glycerite or tea or garlic to fight infection
-Peppermint/elderflower tea to help body go through fever process quicker.
-Essential oils of Bergamot, Chamomile, Lemon, and Tea Tree
-Have women track fetal movement. Be sure it is not longer than an hour and a half for 5 movements.
-Fetal Heart Tones will often be elevated as well
-Acetaminophen (not aspirin) if fever is longer than 4 hours over 100 degrees to cut fever. If fever higher than 100
degrees then treat- it can effect baby; cause a seizure

Ayurvedic Herbs for Hypotension in Pregnancy – Dr. Sarita Shrestha
Coral ash – to raise BP (also a source of Calcium)

Makardhoowaj- also same effect
Shatavari – always use for this
Licorice & guduchi won’t dehydrate but will act as tonic
Be sure electrolyte balance is good- RECIPE for Rehydration drink:
Pinch black salt
1 tsp lemon juice
molasses or jaggery
pinch hinguastak churna-pacifies V & K
all in a glass with warm water
Of Adrenal origin-
Safe to use Vidari during pregnancy, good for adrenals and all the tissues when properly digested. In this case also
Licorice will be useful, as it helps adrenals and can increase blood pressure. Shatavari help increase rasa.


For Round Ligament pain – Calcium fluoride Tissue Salt (inexpensive, available through amazon or some health food
outlets.

Vaginal Infections
Vaginal Health Vaginitis Testing Without Microscopy
[Clinician Reviews 8(4):133, 1998. © 1998 Clinicians Publishing Group and Williams & Wilkins.]
Use the following chart for vaginitis diagnostic tests when microscopy is not available (check again 2 weeks
after treatment if mixed infection is suspected):
Whiff pH Hydrogen Suspicious history
peroxide*
Yeast - Low - Recurrent symptoms, rash
Bacterial vaginosis + High - Sexually transmitted diseases (STDs),

multiple partners
Trichomonas +/- High + STDs, multiple partners
Desquamative inflammatory - Variable + Monogamous, no STDs

vaginitis
* Mixing a drop of 3% hydrogen peroxide with vaginal secretions on a microscope slide will immediately produce
foaming bubbles in the presence of white blood cells typically found in Trichomonas infection and desquamative
inflammatory vaginitis, but will not react with candidiasis or bacterial vaginosis.
Ruth H. Christos, MN, RNCS, FNP

Augusta, Ga
Significance in pregnancy:
There has been some research correlating different types of vaginal infections with premature labor &/or
rupture of membranes. The evidence is far from conclusive since these organisms are common and could be
coincidental rather than causative. Yeast, at the time of birth is associated with thrush in the baby’s mouth and
mother’s breasts postpartum.

Treatments:
Check pulses to determine artava imbalances as well as symptoms to determine best choice of treatments.
-Yeast: Yeast is commonly found in the digestive tract, including the mouth and rectum, therefore to prevent recurrent
infections careful hygiene is important, like wiping front to back, using condoms for oral or anal intercourse, eat yogurt
or acidophilus to keep yeasts in body under control, frequent handwashing with a nailbrush to keep yeast on hands
under control, wash underwear and bedlinens in hot water and bleach in extreme cases.
o Determine by symptoms and pulse if Vata, Pitta or Kapha excess and treat diet and symptoms
accordingly. Dietary control may be necessary for some with a tendency to high blood sugar-which
feeds the yeast. Avoiding sweets, fruit, fruit juices and anything sweetened with them may be
necessary.
▪ Pitta type discharge= itch irritation burning, 4-4.5 pH, nl yellow on pH paper - yogurt helps
▪ Kapha type discharge= cottage cheesy discharge - yogurt may make it worse
o There are 9 different species of yeast. It takes 1-3 days to kill the albicans but others may be more
difficult to treat
• Pau D’arco - anti-fungal for yeast- use in douche - DURING PREGNANCY DO A VERY GENTLE DOUCHE
ONLY - USE A BULB RATHER THAN A GRAVITY BAG= LESS FORCE AND USE 1-2 CUPS LIQUID ONLY
• Vinegar/water douche daily, followed by acidophilus insert (2 pills or capsules near the cervix),
DURING PREGNANCY DO A VERY GENTLE DOUCHE ONLY - USE A BULB RATHER THAN A GRAVITY BAG=
LESS FORCE AND USE 1-2 CUPS LIQUID ONLY
• Boric Acid Tablets (2 inserted into vagina), followed by acidophilus insert (2 pills or capsules near the
cervix)
• "Yeast Guard" Homeopathic Vaginal Insert per directions,
• a small peeled unnicked clove of garlic inserted into vagina.
Treat partner as well with penis soaks with anti-fungal liquids/herbs
Directions for Penis Soaks taken from James Green's "A Male Herbal":
To perform a penis soak simply hold a (tall, medium or short) drinking glass or mason jar filled with a strong
infusion or decoction of appropriate herbs and hang in there for about 5-10 minutes. The tea
should be as warm as possible.
It is helpful to include the testicles in the soak too, so you might graduate to a vase or a jar as a container. An
alternative method is the common sitz bath, filling a small basin or plastic tub with the warm herb tea and
sitting in it. This is probably more trouble to prepare, but it is comfortable and frees both hands, so you can
read a magazine, shave or adjust the VCR while you're sitting there.
Soak for 5-10 minutes at least, but preferably 2-3 times a day
-Medical Treatment for yeast: Nystatin, gynelotrimin( rec. as most effective by gyn.)
TRICH & BACTERIAL VAGINOSIS:
• PREGNANCY: insert 1 clove of fresh peeled unnicked garlic into vagina overnight change every 12 hours for 7-10
days,
• PREGNANCY: insert 2 acidophilous tablets in between doses of garlic. Garlic oil capsules can also be used in
same dosage as cloves,

• Ayurvedic douche = Tumeric 2 tsp; Triphala 1 Tablespoon; Licorice 2 Tablespoons in 2 cups pure water , simmer
10 min, strain; use at body temp
• NOT WITH PITTA SYMPTOMS: insert 1- 1,000 mg time-release capsule of Vitamin C at bedtime and follow with
acidophilus insert in early morning.
Be sure to treat sexual partner to prevent reinfection and use condom if sexual intercourse desired during treatment
time. Natural remedies for men: 1 part goldenseal, 1 part myrrh, 1 part echinacea in a capsule or roll them in a bit of
honey to make pills (pea sized). take 8 pills or capsules daily for 3 weeks. Can also do a penis soak in anti-infective herbs.
Trich can survive in wet sponges several hours and in urine 24 or more hours. Drink 8 0z. cranberry juice a day to keep
trich and bacteria from growing in urine.
Aromatherapy: . Use with local wash, bidet or sitz bath.

• Bergamot-reduces inflammation and swelling,
• Tea tree Oil-promotes healing and reduces spread of infection,
• Lavendar- infection and swelling
*******REFER FOR INFECTIONS WHICH JUST DON'T GO AWAY, they could be an underlying cause in body which needs
to be treated such as blood sugar problems, HIV, candida.
GENITAL HERPES -- worrisome for conception/pregnancy; viral infection that goes dormant/then active; first infection is the
most dangerous for the baby
See Lesson 6 -Fertility concerns for Genital Herpes treatment from Dr. Vasant Lad – ok in pregnancy
from Lorraine Fairmont, CNM

Herpes Outbreak Prevention:
• DIET- Avoid:arginine rich foods: chocolate, oats (including oatmeal and protein shakes), gelatin, seeds, and
nuts . While it may be impossible to cut the listed food from your diet, keeping them from your diet while a
herpes outbreak heals may speed recovery. Furthermore, taking a lysine supplement before eating the listed
food may prevent the arginine from making your herpes outbreak worse, so you may keep food like peanut
butter in your diet without suffering from a cold sore if you're also eating a lot of cheese or are taking a lysine
supplement.
• Avoid stress and stimulants (like coffee)
• Avoid friction to the area - possibly wear no underwear, be sure not to wear tight pants
• Elderberry syrup - when stressed or if eat foods - safe for pregnancy - anti-viral
• Melissa extract (lemon balm) OK late in pregnancy. Apply repeatedly to avoid recurrences esp at end of
pregnancy
TREATMENT:
If notice it’s starting - take homeopathic Natrum Muraticum
Be sure fluid balance is good - dehydration=> outbreaks

Support immune system
Work on gut imbalances - can cause an outbreak
Take LOTS of garlic - up to 12 odorless garlic capsules - when feel lesion starting --MAY BE EXTREME FOR PREGNANCY
Diarrhea (per Kasheppa)

Causes of diarrhea-
• Eating of contrary things • Eating of unripe/immature rhizomes, roots and

• Eating before digestion of previous meal fruits
• Indigestion • Use of polluted water
• Over-eating • Dryness
• Suppression of feeling of fear and agitation • Hunger
• Accumulation of doshas • Grief
• Emaciation • Eating of heavy and abhisyandi (moisture
producing) things
Treatment of diarrhea due to ama

Kapha/shleshma ama -Digestives should be given. Seeds of kutaja, musta, patha, ajamoda, arala, ativisa and
shubha levigated with luke-warm water should be given for drinking
Pitta ama – Patha, candana, fruits of kutaja and mainly ativisa etc levigated with congenial water given for
drinking
Vata ama – Hingu, rock-salt , naga, both brhatis, fruits of kutaja, mainly pippalimula and ativsa levigated with
luke-warm water given for drinking
Tridoshic ama – decoction of brhatyadi group of drugs given for drinking
AFTER digestion of ama, in all of thes, retentive treamtne (constipating) is beneficial.
Treatment of diarrhea due to shleshma/Kapha

Drinking decoction of ambasthadi group of drugs mixed with honey and rice-water
Levigate fruits of kutaja, dhataki, marica,lodhra, katavanga and devadaru with honey then mixed with rice-water
Drink keshara of nalina pasted with rice water and mixed with honey
Treatment of diarrhea due to pitta

Decoction of nya grodha etc sweetened with honey
Kana, flowers of dhataki madhuka, pulp of bilva, mixed with sugar and honey
Padma, samanga, kernel of mango, madhuka, padmakesara, lodhra and mocarasa mixed with sugar and honey
Treatment of diarrhea due to vata

Decoction of khuddaka-pancamula exluding eranda mixed with kala and katavanga
Finely levigated padma, samanga, kernel of mangobrhati and pulp of bilva with curd
Pasted pippali, dhataki, padma, samanga, mocarasa, matsyandika and indradhan;ya mixed with rice water

Finely levigated musta, young unripe fruit of bilva, ananta and madhuka mixed with ghrta and jiggery given for
drinking with curd
General recipe for diarrhea

Pippali dhataki, lodhra, samanga, padmakeshara, padma, mocarasa, bark of dirghavrnta and kesara – all finely
pulverized then mixed with ghrta, matsyandika and honey becoming fit as a lickable
Urinary Tract Infections

In pregnancy, a women's urinary system works overtime. This can make her more susceptible to urinary tract infections
(UTIs). Colorado State Regs state referral required if positive lab results, client needing antibiotic treatment.
Prevention of UTIs includes:

-avoid douches, bubble baths, and feminine hygiene spray
-avoid coffee and harsh teas
-avoid any food you are allergies to
-don't wear tight fitting clothes
-wear cotton underwear, or better yet, none!
-always wipe from front to back
-urinate before and after sexual intercourse
-urinate when you have the urge- don't hold it in
-drink Plenty of fluids to keep urine dilute
-completely empty the bladder each time you pee—don’t rush it! When the baby is dropped low you may need
to gently lift up on your lower belly to allow room for any trapped urine to escape.
A UTI is defined as a urinary bacterial count of >100,000 colonies of bacteria. Symptoms that may indicate a UTI are:
-suprapubic, side, or back pain
-frequent and urgent need to urinate
-dysuria (painful urination), with urination, or residual
-fever/chills
-hematuria (blood in urine)
-there may be CVAT (costal-vertebral angle tenderness)
-clean catch urine check may show leukocytes or nitrites
When there are one or more signs of a UTI which are not explainable by other reason, a urine culture should be done.
When results are known, evaluation should be made to determine if natural remedies or antibiotics are more
appropriate.
Natural Remedies: Using natural remedies it must be remembered that any organism overgrowth must be controlled
– this requires more than taking a remedy just until the woman feels better. She should continue treatment for at least
10 days to be sure that organisms will not be developing immunity to the remedy by allowing the strongest to survive
after treatment is discontinued. If results aren’t forthcoming after 2-3 days treatment, go to antibiotics.
Prevention/very very mild UTI -500mg Vitamin C two times daily
-If kidney problems are not present, drink one quart unsweetened cranberry juice, lemon juice or vinegar in
water daily. Also : pomegranate juice &/or cranberry pills to prevent infection from “sticking” to the walls of the bladder
-maintain good hydration while not overloading the kidneys
- tinctures - ginger for e. coli; haritaki, tulsi, cinnamon, brahmi
-no sugars, including honey, maple syrup, etc.
-Usnea tincture—herbal antibiotic safe for pregnancy & specific for bladder/lungs
-Uva Ursi Tea. 1 Cup daily for three days, or tincture 1 dropperful 2x day for three days. WARNING- BE SURE TO
BE WELL HYDRATED WHEN TAKING UVA URSI AND DO NOT CONTINUE FOR LONGER THAN A WEEK.
-drink 5-10 cups weekly of Nettles tea to strengthen kidneys (this is more preventative than treatment)
-Essential oils sitz baths. (for comfort or prevention, more than treating an actual infection.)
Bergamot-for stinging and tenderness
Sandalwood-soothing after passing urine(local wash)
Lavendar-boost body and fight infection
Chamomile-muscle spasm of irritated bladder-compress over area of pain
-Ayurvedic treatment would treat both the organism overgrowth & underlying imbalance which precipitated
that overgrowth with individualized plan. Herbs to consider: Gokshura, Guduchi, Lotus Seed, Root of sugar Cane, Kusha
grass, Shilajit
-recheck UA weekly, and culture as indicated. Be sure the symptoms being gone also means the infection is
gone
-consult with health care practitioner if symptoms persist or if women's condition is poor. UTI's and preterm
labor have been associated so treat it seriously! Medical treatment is usually with ampicillin.
- If not an infection but bladder irritation, Maya Abdominal Massage may hellp if uterus is low on bladder and it’s not
near term yet.
Pyelonephritis: kidney infection. May come about from an undiagnosed or untreated UTI. Signs and symptoms:
-fever, chills, shaking
-nausea and vomiting
-anorexia
-low back pain
-CVAT usually bilateral, if unilateral right side only
Management: Equal incidence prenatally and postpartum. Serious if untreated. Immediate referral to physician for
antibiotic therapy. Treatment may include hospitalization, bedrest, hydration, lying on side opposite most affected
kidney, and watching for septic shock. Follow-up is very important because recurrance is common. Urine cultures
should be negative on several occasions before the client is considered completely cured.
Varicose Veins

Valves in veins keep blood flowing one way-- back towards the heart, since the force of the pumping heart is less on the
return journey. When these valves become weak and loose, some blood pools in veins instead of moving forward. In this
way, the veins swell up. These swollen veins may be just below the skin or deeper & unseen.
Superficial varicosities are very prominent dark blue veins bulging out from under the skin and more usually on legs and
feet. (Hemorrhoids are actually a variation of this in the anal area. Women may have vulvar varicosities, while men may
have scrotal ones.) Deep varicose veins are less visible and are very painful. Symptoms can include an achy or heavy
feeling in your legs and burning, throbbing, muscle cramping and swelling in your lower legs.
Varicosities can be aggravated by

• constipation,
• injury,
• pregnancy,
• lack of exercise which circulates the blood,
• too much standing or sitting still,
• sitting with your legs crossed or
• obesity.
It seems to be hereditary.
The danger of varicosities is that clots may form in the stagnant blood, come loose, and enter smaller vessels in the
heart, lungs or brain causing blockages leading to stroke, pulmonary embolism, or heart attack. Preventing stagnation in
the varicosities is important! Any heat, swelling or pain of the leg should be checked for clots. Do NOT massage! We
don’t want clots to move upward to cause a dangerous blockage.
SUPPORT HOSE is one help. These tight stockings are put on in the morning before walking so that the blood in the
vessels has equalized during bed time and isn’t pooled. They gently squeeze the legs, preventing pooling while on your
feet for long times. Foot massages can be useful, if clots are not there. I’ve seen this greatly improve varicosities in the
lower leg and ankles.
EXERCISE is important. Walking is great—with hose. Be sure to ELEVATE LEGS AFTER ANY PROLONGED TIME ON YOUR
FEET.
Herbs for Varicose Veins
• “Varicosity Extract for Pregnancy”(using only herbs safe for pregnancy), follow directions on the bottle.
• available from WishGarden Herbs, Boulder 303.516.1803 www.wishgardenherbs.com
Positioning & Yoga for Varicose Veins
• To relieve discomfort and prevent more pooling you can rest in positions which elevate the legs- on a slant
board, with legs straight up a wall. Do this once or twice a day.
• Some people benefit from slanting their bed with the feet slightly up.
• Avoid sitting or standing still for long periods of time!
• Avoid crossing legs, which cuts off circulation in the legs!

• Yoga poses for varicosities include shoulder stand, head stand, back bend & corpse pose.
Aromatherapy for Varicose Veins
Aromatherapy can provide some symptomatic relief for varicose veins. Suggested Essential oils are Geranium, Lemon,
Rosemary, Cypress, Ginger, Neroli, Peppermint, Lavender, Helichrysum and Juniper. Use these externally, in a carrier oil,
over the local area.
• Cypress added to a bath is great. 3-6 drops in the tub as the water is filling. For best dispersal add some cypress
oil to bath gel base first.
• Helichrysum is said to dissolve coagulated blood.
• Rosemary oil stimulates circulation of blood.
Intrauterine Growth Retardation
A newborn is considered growth retarded if birth weight is below the 10th percentile for gestational age. It
can be classified as symmetrical (primary) or asymmetrical (secondary). RULE OUT SMALL FAMILY GENES .
High altitude may also contribute to symmetrical IUGR. These two causes lead to 3% “IUGR”.
In symmetrical IUGR, all organs are reduced in size with equal reduction in body weight and head size.
This growth retardation may be noted in the first half of the second trimester. Symmetrically IUGR babies
rarely experience asphyxia and labor is tolerated as usual. 20% of these babies had problems in the 1st
trimester of pregnancy.
Asymmetrical IUGR is characterized by the head and brain being proportionally bigger than the rest of
the body. This is apparently caused by a compromise in the uteroplacental blood flow. This type comprises
the majority of cases noted medically and is usually not evident prior to the third trimester. These babies are
particularly at risk for perinatal asphyxia, pulmonary hemmorhage, hypocalcemia, and hypoglycemia in the
neonatal period. Birth weight will be reduced to the tenth percentile, wheras cephalic size may be between
the 95th and 15th percentile. 70-80% of these babies had problems in the 3rd trimester, even though they
were a normal weight. Possible to catch up in weight by the 2 nd year of life.
Causes: a single or combination of causes are noted: FIND CAUSE AND REMOVE IF POSSIBLE
-poor maternal nutritional status with associated inadequate weight
gain &/or anemia.
-drug abuse
-chronic vascular or renal disease
-toxemia
-pregnancy at high altitude
-multiple gestation
-fetal infection
-fetal anomaly
-smoking
Premature birth causes the most infant mortality. IUGR is the second highest infant mortality syndrome. 3-
7% of all pregnancies are complicated by IUGR. Growth-retarded infants have a five-fol increase in perinatal
asphyxia and an eight-fold higher perinatal mortality rate than normal infants.

When IUGR is suspected, investigate possible causes that can be changed. If early intervention does not seem
to remedy the situation, refer for consultation with physician. Serial ultrasounds may show whether there is
growth retardation or merely a due date discrepancy. Ultrasound may rule out fetal anomalies or multiple
gestation.
Care for early intervention and prevention:

-educate the client about this condition and what she can do to safeguard her baby's growth and
health.
-emphasize the importance of very good nutrition and do diet profiles regularly to keep on top of the
kind of diet and amounts of food the client eats, even a person with a "conscious" diet may get IUGR if they do
not eat enough food! Be aware of the possibility of eating disorders, especially if a women starts her
pregnancy underweight or overweight.
-Make sure the client gets enough rest. If she is working she still needs lots of rest. Some people may
need to curtail or quit work if it places too graet a strain on the women's pregnancy. A pregnant women with
other small children may need childcare to help so she can get adequate rest.
-Monitor client and fetal weight gain to be sure it is adequate. Watch for clients who may fear gaining
weight and give them informational and emotional support for adequate weight gain in pregnancy.
-Teach the client about ultrasound and how it is used to rule out high risk situations if it is necessary in
the care plan.
-VIDARI , ayurvedic herb, for nourishing all of the tissues, including placenta and baby.
-Neroli EO in massage oil to belly to increase circulation.
NIH website about IUGR:

http://www.nlm.nih.gov/medlineplus/ency/article/001500.htm
Diabetes in Pregnancy
Uncontrolled diabetes is a condition which can be dangerous to mother and baby during pregnancy, birth and
postpartum. While the mother is basically starving on a cellular level because the sugar in her blood is not
able to enter the cells because of inadequate or blocked insulin, the baby is being bathed in high levels of
blood glucose. It is a condition which we surely wish to avoid.
Risks to babies of true diabetic moms include:(from Anne Frye Understanding Lab Work in the Childbearing
Year p.232 4th ed.-please get this book and read it if you are serious about midwifery!)
-growing large, fat, edematous and fragile (macrosomic); being subject to hypoglycemia at birth due to
rapid postpartum decrease in available glucose, and possible shoulder dystocia due to large size.
-prematurity with respiratory distress and other problems
-2-3 times higher rate of fetal abnormalities than in the non-diabetic population (occuring more
frequently the longer the mother has been diabetic or when glucose levels are poorly controlled)
-unexplainable intrauterine death-especially after 36 weeks gestation
Risks for Diabetic Mother Include:

-Higher rates of toxemia, circulatory, visual and kidney problems (Anne points out that the risks for
some diseases in diabetic pregnancy may be due to the medical management used for the diabetic
pregnancy).
Screening For Undetected Diabetes:

During pregnancy, the natural increase in body stress may turn up a tendency to diabetes in a women. It's
also possible that a borderline diabetic was undetected before pregnancy. A women with previous history of
gestational diabetes must be referred to a physician and cannot, under state regs, have a home birth or work
with a DE midwife. At any time during care, the women must be referred to a physician for +2 glucosuria or
greater or two consecutive occasions or s/s of gestational diabetes accompanied by glucosuria. It might be a
good idea to test women's blood if she seems to be spilling glucose in her urine, or has other s/s. These tests
are usually done after a 12 hour fast, and may involve a sweet carbonated drink, and must be done in a lab.
She may opt for a glucose stick at a prenatal with a glucometer before she tries the others.
These are accepted signs to do further testing if the women has 2 or more signs evident.
-familial history of diabetes, esp. if onset is before old-age
-poor obstetrical history, such as spontaneous abortion, miscarriages
-previous baby born >9 lbs
-non-pregnant weight greater than 180 lbs.(weight/height ratio in account)
-recurrent yeast infections
-recurrent glucosuria (glucose in urine) of at least +2 not explained by dietary intake preceding the
urine sample
Signs and symptoms of diabetes

-polyuria-excessive urination
-polydipsia-excessive thirst
-polyphagia-excessive hunger
-weight loss
-weakness/fatique
Helps:
-fenugreek with soup
-garlic milk
-spinal twists (modified for pregnancy) and lateral bends
-Ayurvedic formula individualized to needs including ONLY IF YOU ARE AN ADVANCED AYURVEDIC
PRACTITIONER OR DOCTOR : little shilajit,little neem,amla or a little Trifala,chandra Prabha,poss gold
preparation,Guduchi, cedrus deodar
http://www.nlm.nih.gov/medlineplus/ency/article/000896.htm
http://www.diabetes.org/gestational-diabetes.jsp
Hypoglycemia in Pregnancy, on the other hand, is a more common and insidious condition which is related.
Unstable blood sugar can be an precursor to diabetes. See the attached pages from Anne Frye for information
and useful guidelines.



Hypoglycemia is best addressed BEFORE pregnancy with

balancing through PK, herbs and lifestyle.

Twins article by Midwife Willy Fenske





I attended 3 twin births—one ended up in the hospital due to prematurity.

I also assisted one client go to term with her twins who was planning a hospital birth.
I believe that twin births can be at term—unlike most medical people who tend to assume they will be premature. You can
help babies avoid the dangers of prematurity by supporting women during their twin or other multiple pregnancy.

Third Trimester Concerns
Anemia in Pregnancy - by Ceci Kramer
Blood is the life-maintaining fluid that circulates through the body's heart, arteries, veins, and capillaries. It carries away
waste matter and carbon dioxide, and brings nourishment, electrolytes, hormones, vitamins, antibodies, heat, and
oxygen to the tissues. The cells use the oxygen to fuel the combustion (burning) of sugar and fat, which produces the
body's energy.
Anemia is a condition of too few red blood cells, which can lead to a lowered ability of the red blood cells to carry iron
thus oxygen to tissues. The deficiency occurs either through the reduced production or an increased loss of red blood
cells. To produce red blood cells, the body needs (among other things) iron, folic acid and vitamin B12. If there is a lack
of one or more of these ingredients, some type of anemia will develop.
What are the most common types of anemia to occur during pregnancy?
Anemia of pregnancy
In pregnancy, a woman's blood volume expands to support the growth of the baby, during this time mother will have as
much as 50% more total blood volume. Red blood cells and plasma both increase; plasma increases more. The
proportionately larger increase in plasma causes the concentration of red blood cells in her body to become diluted,
called hemodilution resulting in a lower hematocrit. It is acceptable for the hematocrit to be 33% in the third trimester
whereas 38%-46% is normal for non pregnant women. This is sometimes called anemia of pregnancy and is a normal
process, with the hemoglobin concentration around 11.5, it’s lowest, between weeks 25 and 30.
Iron deficiency anemia

This the most common type of anemia in pregnancy. As the baby demands more blood, the mother will require more
iron in order to make the necessary red blood cells and hemoglobin. Some women will not be able to keep up with the
demand. It is estimated that women will need approximately 50% more iron during pregnancy; increasing from 18 to 30
milligrams (mg) per day.
The pregnant woman may need blood tests to measure serum ferritin to see where her iron storage is at the beginning
of the pregnancy, and if it is low, again mid-way through. Additional iron supplementation may be necessary to make
sure she does not become anemic. Unfortunately, many women start pregnancy without sufficient stored iron (low
ferritin) to meet the increased demands of a growing fetus. These women can develop iron deficiency anemia. This is
especially true during the third trimester, when blood volume is highest, and the baby is drawing on the mother’s stored
iron to store his or her own iron for the first six months of life; therefore, red blood cells and hemoglobin are at their
lowest.
Megaloblastic Anemia
Folate deficiency
Folate, also called folic acid, is a B-vitamin that works with iron to help with cell growth. Folate deficiency in pregnancy is
often associated with iron deficiency since both folic acid and iron are found in the same types of foods. Research shows

that folic acid may help reduce the risk of having a baby with certain birth defects of the brain and spinal cord if taken
before conception and in early pregnancy.
Vitamin B12 deficiency

Vitamin B12 is important in forming red blood cells and in protein synthesis. Women who are vegans (who eat no
animal products) are most likely to develop vitamin B12 deficiency. Including animal foods in the diet such as milk,
meats, eggs, and poultry can prevent vitamin B12 deficiency. Strict vegans usually need supplemental vitamin B12 by
injection during pregnancy. This type of anemia is known as pernicious anemia when not related to pregnancy or diet
and is thought to be an auto-immune disorder where one is not able to absorb vitamin B12.
Pregnant women may be at an increased risk for anemia if they:

• Have morning sickness severe enough to cause frequent vomiting
• Have had more than 2 pregnancies close together
• Are pregnant with more than one baby
• Have an iron-poor diet
• Had a heavy pre-pregnancy menstrual flow
• Lack of folic acid in the diet
• Lack of vitamin B12
• Loss of blood due to bleeding from haemorrhoids (piles) or stomach ulcers
• Teenage pregnancies
What are the symptoms of anemia?

Women with anemia of pregnancy may not have obvious symptoms unless the cell counts are very low. Each woman
may experience symptoms differently and the symptoms may resemble other conditions or medical problems.
In addition to what Terra already listed, there might be:
• Pale skin, lips, palms of hands

• Tiredness / Fatigue
• Vertigo
• Labored breathing
• Rapid heartbeat (tachycardia)
• Palpitations
• Shortness of breath
• Difficulty concentrating
• If the anaemia is severe (less than 6g of haemoglobin per decilitre of blood), it may cause chest pain (angina) or
headaches
How is anemia diagnosed?

Anemia is usually discovered during a prenatal examination through a routine blood test for hemoglobin or hematocrit
levels, when either is low, additional blood tests and other evaluation procedures may be needed to determine what
type of anemia is present.

• Low Hemoglobin--the part of blood that contains the most iron and distributes oxygen from the lungs to tissues
in the body
• Low Hematocrit--the measurement of the percentage of red blood cells found in a specific volume of blood
• A description of the red blood cells – their different form and color will be included in the result of the blood test
• In women of Afro-Caribbean or Mediterranean origin, additional tests are performed to screen for genetic
causes of anemia, e.g. sickle cell anemia and thalassemia.
Questions to ask that may help diagnose anemia:

• Have you felt unusually tired or fatigued?
• Have you experienced unusual weakness?
• Have you experienced shortness of breath?
• Have you felt easily confused or lost your concentration?
• Have you felt dizzy or have you fainted?
• Has your skin become unusually pale, including decreased pinkness in your lips, gums, lining of your eyelids, nail
beds, and palms?
• Have you experienced a rapid heartbeat?
• Have you been feeling unusually cold?
• Have you been feeling sad or depressed?
Prevention of anemia
Eating a healthy, balanced and varied diet during pregnancy helps maintain the levels of iron and other important
nutrients needed for the health of the mother and growing baby.
It may be difficult to get the recommend 27mg of iron a day since even nutritious diets only provide you with about 12-
14mg of iron. In order to avoid iron deficiency, it is often necessary for pregnant women to take iron supplements. The
Centers for Disease Control and Prevention (CDC) recommends that all pregnant women take a daily supplement of
30mg of elemental iron as a preventive dose.
A majority of prenatal vitamins contain 30mg of iron. Pregnant women who are diagnosed with iron deficiency anemia
are usually advised to take a total dose of at least 120mg of iron each day, so an iron supplement in addition to your
prenatal vitamin may be necessary. Some forms are time-released, while others must be taken several times each day.
Iron supplements may cause nausea and cause stools to become dark greenish or black in color. Constipation may also
occur with iron supplements. Side-effects on the gut can be resolved by taking the iron with or after food or by starting
with a low dose and increasing gradually.
To absorb the maximum amount of iron from the diet, it will help to also eat a diet rich in vitamin C. Raw vegetables,
potatoes, lemon, lime and oranges are all good sources of vitamin C. Antacids may decrease absorption of iron.
Good food sources of iron, different from what Terra already listed, include the following:

• Legumes, such as lima beans, green peas, pinto • Cumin seeds
beans, black-eyed peas, garbanzos • Fenugreek seeds - Methi
• Romaine lettuce, Spinach, Mustard greens, • Celery seed - Ajamoda
Collard greens, Turnip greens, Kale, Chard • Turmeric - Haridra
• String beans • Thyme
• Shiitake mushrooms • Kelp
• Brussel sprouts • Meats--beef, venison, pork, lamb, liver, and
• Asparagus other organ meats
• Broccoli • Poultry--chicken, duck, turkey, liver (especially
• Leeks dark meat)
• Baked potato with the skin • Fish--shellfish, including clams, mussels, oysters,
• Pumpkin seeds sardines, and anchovies
• Tofu • Whole grains, yeast-leavened whole-wheat
• Anise seeds bread
Vitamin supplements containing at least 400 micrograms of folic acid are now recommended for all women of
childbearing age and during pregnancy to reduce the risk of having child with spina bifida.
Food sources of folate include the following:
• Dried beans and peas • Muesli

• Citrus fruits and juices and most berries • Beef
• Romaine lettuce, Spinach, Mustard greens, • Brussels sprouts
Collard greens, Turnip greens • Whole grains
• Asparagus • Rosemary
• Broccoli • Basil
• Cauliflower • Coriander
• Beets • Marjoram
• Lentils • Thyme
• Squash • Bay leaf
• Papaya • Parsley
• String beans
Ayurvedic treatment for anemia

Called Pandu Roga in the texts; Charak CikitsasthanaCh. 16 Vs 5 says “aggravation of all 3 dosas is considered to be the
causative factor for pandu with the only difference that while vayu and kapha are aggravated generally, the pitta is
affected predominately”. This chapter also talks about rakta dhatu being reduced and the loss of the properties of ojas
especially unctuousness. Pandu is considered a condition where there is excessive vitiation of the dhatus by the doshas
or dosa-dusya. There is a loss of potency, a loss of “sara” or excellence of the tissues. The aggravation of pitta brings
about the diminuation of a specific portion of rasa responsible for the nourishment of rakta dhatu. Charak goes on to
recommend pancha karma, as we know is contraindicated in pregnancy.

So, as per Dr. Vaidya – prevention of pandu with diet is of the utmost importance. He also noted that the use of
Mahamanjisthadi Kwath is indicated; equal parts of:
• Manjistha • Amalaki
• Bakuchi • Vasaka
• Neem • Shatavari
• Agnimantha • Bala
• Haritaki • Yashtimadhu
• Daruharidra • Patol
Gestational Hypertension
At the mild end of the spectrum is gestational hypertension, which occurs when a woman who previously had normal
blood pressure develops high blood pressure when she is more than 20 weeks pregnant. This problem occurs without other
symptoms. Typically, gestational hypertension does not harm the mother or fetus and resolves after delivery. However,
about 15% to 25% of women with gestational hypertension will go on to develop preeclampsia.
This is a rise in the women's blood pressure after 28 weeks with no other signs of PIH present. It may be asymptomatic,
or the women may complain of dizziness, headaches, visual disturbances. Elevated BP is defined as over 140/90 or a rise
of 30 points systolic and or 15 points diastolic over her baseline. It is noted on two separate occasions at least 6 hours
apart on same arm, in same position.
Colorado State requires transfer of care if BP >140/90 or rise of 30 systolic /15 Diastolic.
Causes: Drugs, other stimulants, stress, lack of exercise, pitta imbalance.
Dangers in Pregnancy: Placental abruption, small for gestational age baby, cardiovascular stress, preterm labor,
intrauterine Growth retardation (IUGR)
Prevention:
-Avoid stimulants including spicy foods, pepper, cola, black tea, coffee,
nicotine, cocaine, diet pills, chocolate. These foods overstimulate Pitta.
- Drink Nettles/Raspberry Leaf infusion daily – check if ayurvedically correct for high individual usage.
- Aerobic Exercise and tension relieving stretching throughout pregnancy but not to the point of excess.
-Support finding ways to support or solve emotional stresses.
- Good nutrition, evaluate each visit, adequate of protein, salt to taste, good digestion so nutrition is actually
useable.
- 8 oz. clear fluid every 2-3 hours.
-Sarita recommends Gokshura, 7th month, as a routine, preventative tea
Possible remedies, when present:
- Deep relaxation in left lateral position 3x daily for at least 30 minutes,
more with greater severity.
-Ayurvedic herbs- Jatamansi- antihyepertensive, calm, sleep
Gokshura – diuretic
Guduchi- diuretic, tonic
Punanarva-if swelling, cooling brain effect
Another formula by Dr. Sarita –
Rudraksha, Jatamansi, & Guduchi , Punanarva: kidney, liver rejuvenator, lowers edema, BP 1/2 tsp Daily & Amla:
regulates BP with diuretic action along w/ personalized plan

- Garlic, parsley, onions, and cucumber watermelon and buckwheat are foods that help. For best results
each large amounts, raw, daily. Garlic oil capsules help some, but aren't as effective 2-10 capsules daily.
- Hops tea, nightly for sleep in last months (not in first trimester due to steroidal component) 1 tsp./1 cup steep
20 minutes.
- Passion Flower 2-4 caps daily or 15 drops tincture 3x daily. Although
BP may return to normal quickly/ continue for several weeks for greatest benefit.
-Skullcap Infusion 2 cups daily to reduce tension.
-Hawthorn Berries, a vasodilator, works cumulatively, especially for
essential hypertension. A cold infusion, 1 oz crushed dried berries steeped in 2 cups cold water overnight, brought
quickly to a boil, strained and sipped. 1 cup daily every day. For tincture, take 15 drops 2-3x daily.
-Calcium: 1 qt. oatstraw daily.
-Aromatherapy Baths with lavendar, chamomile. Or sprinkle on bed
sheets for better rests.
Up to date web info: http://www.nlm.nih.gov/medlineplus/highbloodpressureinpregnancy.html
Pre-eclampsia by Heidi Nordlund

Symptoms of preeclampsia, eclampsia, & HELLP syndrome
Preeclampsia
Signs/ Symptoms/ Physiological Changes:
Water Retention: excess edema (Kapha): +1 = minimal, slight edema of feet and pretibial
areas.
+2 = marked edema of lower extremities.
+3 = edema of hands, face, lower abdom-
inal area and sacrum.
+4 = Anasarca (severe generalized edema)
with ascites (accumulation of serous
fluid in the peritoneal cavity)
This is usually the first symptom to appear although some women may have the condition without edema. Cause for
water retention may be lack of serum albumin to hold fluid in blood and reduced renal plasma flow and glomerular
filtration (not known for certain).
Hypertension: Bp 140/90 or rise of 30 systolic &/or 15 diastolic above baseline noted on two separate occasions at least
6 hours apart on same arm, in same position. Diastolic is best indicator. Cause is increased peripheral resistance due to
peripheral vasoconstriction and arteriolar spasm (Vata).
Proteinuria: Clean catch rules out contamination from vaginal discharge or red cells that will test positive for protein.
Rule out other possible causes of proteinuria such as UTI. Helps evaluate severity and progression of preeclampsia. It is
usually a later development of the condition due to kidney damage, and so if excessive proteinuria (+2 or more ) is
noted, steps need to be made immediately.

Hyperreflexia: Increases nervous irritability, cause is uncertain. It may be caused by cerebral edema or increased
intracellular sodium and decreased intracellular potassium levels. Test baseline at first prenatal visit for individual
response. (Vata)
Evaluate Deep Tendon Reflexes (DTR) 0 = no response, abnormally low
+1 = diminished response, low Nrml.
+2 = average response, normal
+3 = brisker than average, may be
high normal or abnormal.
+4 = hyperactive, very brisk or jerky
clonic response, abnormal.
Clonus is a more serious indicator. To check for clonus, vigorously dorsiflex the foot with knee in a fixed position.
Clonus is a spasmodic alternation of muscular contraction and relaxation. When found, it is abnormal and should be
noted how many beats of contraction there were as a measure of severity.
Other Signs: Visual disturbances, abdominal pain (in upper right quadrant where the liver is)(Pitta), nausea and vomiting,
hemoconcentration (Pitta), headaches (cerebral), convulsion.
Eclampsia
Women with preeclampsia can develop seizures. The following symptoms are cause for immediate concern1:
• Severe headache
• Vision problems, such as temporary blindness
• Abdominal pain, especially in the upper right area of the belly
• Nausea and vomiting
• Smaller urine output or not urinating very often
HELLP Syndrome
HELLP syndrome can lead to serious complications, including liver failure and death.
A pregnant woman with HELLP syndrome might bleed or bruise easily and/or experience abdominal pain, nausea or
vomiting, headache, or extreme fatigue. Although most women who develop HELLP syndrome already have high blood
pressure and preeclampsia, sometimes the syndrome is the first sign. In addition, HELLP syndrome can occur without a
woman having either high blood pressure or protein in her urine.
Risks During Pregnancy
Preeclampsia affects the placenta as well as the mother's kidneys, liver, brain, and other organ and blood systems. The
condition could lead to a separation of the placenta from the uterus (referred to as placental abruption), preterm delivery,
and pregnancy loss. In some cases, preeclampsia can lead to organ failure or stroke. In severe cases, preeclampsia can
develop into eclampsia, which can lead to seizures. Seizures in eclampsia cause a woman to lose consciousness, fall to the
ground, and twitch uncontrollably.2 If not treated, these conditions can cause the death of the mother and/or the fetus.

Risks After Pregnancy
In uncomplicated preeclampsia, the mother's high blood pressure and increased protein in the urine usually resolve within
6 weeks of the infant's birth. Studies, however, have shown that women who have had preeclampsia are four times more
likely to develop hypertension and twice as likely to develop ischemic heart disease (reduced blood supply to the heart
muscle, which can cause heart attacks), a blood clot in a vein, and stroke.
Less commonly, mothers who had preeclampsia during pregnancy could experience permanent damage to their organs.
Preeclampsia could lead to kidney and liver damage or fluid in the lungs.
One of the serious complications of hypertensive disorders in pregnancy is HELLP syndrome, when a pregnant woman
with preeclampsia or eclampsia sustains damage to the liver and blood cells. HELLP syndrome occurs in about 10% to
20% of all women with severe preeclampsia or eclampsia. The letters in the name HELLP stand for the following
problems:
• H - Hemolysis, in which oxygen-carrying red blood cells break down

• EL - Elevated Liver enzymes, showing damage to the liver
• LP - Low Platelet count, in which the cells responsible for stopping bleeding are low
Risks of preeclampsia & eclampsia to the fetus
Preeclampsia affects the flow of blood to the placenta. Risks to the fetus include:
• Lack of oxygen and nutrients, leading to poor fetal growth due to preeclampsia itself or if the placenta separates
from the uterus before birth (placental abruption)
• Preterm birth
• Stillbirth if placental abruption leads to heavy bleeding in the mother
According to the Preeclampsia Foundation, each year, about 10,500 infants in the United States and about half a million
worldwide die due to preeclampsia. Stillbirths are more likely to occur when the mother has a more severe form of
preeclampsia, including HELLP syndrome.
Preeclampsia also can raise the risk of some long-term health issues related to preterm birth, including learning disorders,
cerebral palsy, epilepsy, deafness, and blindness. Infants born preterm also risk extended hospitalization and small size.
Infants who experienced poor growth in the uterus may later be at higher risk of diabetes, congestive heart failure, and
hypertension.
Preeclampsia is more common among women who have histories of certain health conditions, such as migraine
headaches, diabetes, rheumatoid arthritis, lupus, scleroderma, urinary tract infection, gum disease, polycystic ovary
syndrome, multiple sclerosis, gestational diabetes, and sickle cell disease.
Preeclampsia is also more common in pregnancies resulting from egg donation, donor insemination, or in vitro
fertilization.

Treatments
Preeclampsia
The only cure for preeclampsia is delivering the fetus. Treatment decisions need to take into account the severity of the
condition and the potential for maternal complications, how far along the pregnancy is, and the potential risks to the fetus.
Ideally, the health care provider will minimize risks to the mother while giving the fetus as much time as possible to
mature before delivery.
If the fetus is at 37 weeks or later, the health care provider will usually want to deliver it to avoid further complications.
If the fetus is younger than 37 weeks, however, the woman and her health care provider may want to consider other
options that give the fetus more time to develop, depending on how severe the condition is. A health care provider may
consider the following treatment options:
• Bed rest (to try to lower blood pressure and increase the blood flow to the placenta).
• Anticonvulsive medication, such as magnesium sulfate, might be used to prevent a seizure.
• In some cases, such as with severe preeclampsia, the woman will be admitted to the hospital so she can be
monitored closely. Treatment in the hospital might include intravenous medication to control blood pressure
and prevent seizures or other complications as well as steroid injections to help speed up the development of
the fetus's lungs.
When a woman has severe preeclampsia, the doctor will probably want to deliver the fetus as soon as possible. Delivery
usually is suggested if the pregnancy has lasted more than 34 weeks. If the fetus is less than 34 weeks, the doctor will
probably prescribe corticosteroids to help speed up the maturation of the lungs.
In some cases, the doctor must deliver the fetus prematurely, even if that means likely complications for the infant
because of the risk of severe maternal complications The symptoms of preeclampsia usually go away within 6 weeks of
delivery.
Eclampsia
The only cure for eclampsia is to deliver the fetus. Magnesium sulfate (a type of mineral) may be given to treat active
seizures and prevent future seizures. Antihypertensive medications may be given to lower the blood pressure.
From Ysha Oakes, Postpartum AyurDoula and founder of Sacred Window School:
1-2 drops of grade A Fennel or Coriander seed with mint and lemon essential oil in a liter of drinking water has been
supportive to clients suffering from edema, adult onset diabetes and pre-eclampsia.
Patient Education
All pregnancies are at risk of preeclampsia. Yet some healthcare providers may overlook symptoms that suggest
preeclampsia because they are also hallmarks of a normal pregnancy, or their patients may not report symptoms for
fear of over-reacting. Something as simple as a headache could be a symptom of underlying and life-threatening
preeclampsia.

Our research shows that fewer than one-half of well-educated women are informed of the signs and symptoms of
preeclampsia and yet, in many settings, the expectant mother or somebody close to her could be the first responder to
any symptoms. These findings do not bode well for women with lower literacy or who do not receive regular prenatal
care. The Preeclampsia Foundation urges health care providers to ensure they and their patients properly understand
the signs of preeclampsia. Only through adequate knowledge and diligent follow through, can we move women to care
earlier and thus alleviate the worst of the adverse outcomes.
References
http://www.nichd.nih.gov/health/topics/preeclampsia/Pages/default.aspx Last Updated Date: 11/30/2012

http://www.preeclampsia.org/ includes some personal stories on their site
http://www.hellpsyndrome.org/
http://www.mayoclinic.com/health/preeclampsia/ds00583
Prevention & curing preeclampsia- from Sarita Shrestha, Ayurvedic OB-GYN -MD
Reduce blood urea, swelling:
• Jatamansi (prevents seizure • Ashwaganda (prevents seizure
• Gokshura (diuretic • Licorice (purifies, cooling, prevents abortion
• Guduchi (diuretic, tonic, anti-inflammatory • little Manjistha or Sandalwood (cleanse blood
• Punanarva mandura (diuretic, anti- • Gotu kola (prevent seizure
inflammatory
• Shatavari (female tonic, anti inflammatory
See hypertension section re lowering BP reduction herbs to use as well.
Oil hands and feet with sesame oil to massage marma points - without over stimulating the woman.
Ayurvedic - Punanarva 1/2 tsp. daily (lowers BP, lowers swelling, rejuvenates kidneys and liver.
-Educate the client about this condition, significant symptoms to watch for, and why it is important that she cooperate
fully with the care interventions.
- Prenatals twice weekly if two or more symptoms are present.
- check for asymptomatic kidney/UTI infection which is sometimes implicated.
- Bedrest in left lateral position often, every day until symptoms disappear.
- Quiet, calm atmosphere.
- support the liver (western herbs:watercress, dandelion. and yellow dock) Raw beet juice may also help (4 oz daily)
- Fetal movement charts daily with the presence of two or more symptoms to watch fetal wellbeing .
Breech Position of Baby
Before 34 weeks a breech position is unremarkable- the baby has lots of room for somersaults. Premature babies are
more often breech because of this. Nearer term the child is likely to stay in a position due to less room to move. Usually
it is head down due to it being heavier than the baby’s pelvis. And if part of the baby descends in to the pelvic brim, it is
less likely to easily change. So babies with head down and down into the pelvis are unlikely to become breech – and
those breech and descended are less likely to spontaneously become head down.
Breech births can be as smooth as a vaginal birth – or not. Breech can be due to abnormalities of the baby or the
mother’s pelvic region, a short or wrapped cord that doesn’t allow the baby to move head down. Or it can be the way
the mother’s pelvis is shaped. The major risk is that obstetricians routinely do cesareans for breech and have lost their
skills to do a normal breech delivery. Home birth midwives have revived the skill although in Colorado it is illegal for a
midwife to knowingly deliver a breech baby at home.
According to ancient texts of Ayurveda, the common causes for abnormal presentation are related to instability of the
apana vayu:
• Sexual intercourse during pregnancy

• Riding on horseback, long walks, false step, a fall, running or a blow
• Pressure on the womb
• Sitting or lying down on uneven ground or in an uneven posture
• Fasting
• Voluntary repression of natural bodily urges
• Intake of extremely bitter, pungent or parchifying articles; inordinate amounts of leafy vegetables and alkaline
substances
• Affliction with diseases like diarrhea, dysentery, etc
• Use of emetics and purgatives
• Swinging in a swing or hammock
• Indigestion of the pregnant woman
• Use of medicines which produce labor pain and bring about miscarriage/abortion.
From Ayurveda for Mother & Child 1988 by Vaidya Bhagwan Dash
Besides calming the apana vayu – other measures to help turn the baby:
Breech tilt to pull baby out of pelvis(see below) Talking to the baby about turning
Maya Abdominal Therapy Homeopathic Pulsatilla 500x –see homeopath
Massage to release lower pelvis Chiropractic maneuvers
Swimming TCM for moxa treatment
Handstands in the water Manual version – in hospital due to danger


Amniotic Fluid Disorders
OLIGOHYDRAMNIOS
Oligohydramnios means that there is a reduced amount of amniotic fluid. Amounts listed vary for normal and
abnormal:
Normal Abnormal Source
800-1200 ml at term <300 ml or <500ml p.165 p442 Bobak & Jensen
_________________________
term=about 2 cups (480cc) below what is

normally found p183 Varney_______________
Cause: Most commonly due to placental insufficiency. More common when :

-congenital anomalies eg renal agenesis, Potter's syndrome
-intrauterine growth retardation
-early rupture of fetal membranes (24-26 wks)
-postmature syndrome
Concerns: Lung hypoplasia and limb deformities (when early in pregnancy-Williams)

Possibly due to obstruction of fetal urinary tract(may be correctable by fetal surgery) , renal problems or Potter's
syndrome
Restricts fetal movement, less constant body temperature, and not as much cushioning of baby from blows
against the uterus
More pressure on umbilical cord during labor, higher risk of fetal distress
Detection: Clinical signs & symptoms are:

-molding of their uterus around the fetus
-fetus easily outlined
-fetus not ballotable
By sonography:-1 cm or less of amniotic fluid; other sources consider a pocket of fluid < 2 cms significant -
Varney
Begin to suspect : begin to give Vidari Kanda to feed the placenta, be sure well hydrated
Management: refer to physician per Colo. Midwifery regs.

Workup to exclude congenital anomalies, iugr, and prom. Significant finding in diagnosing postmaturity
syndrome in a postdates pregnancy. -Varney
Sources:
Bobak & Jensen, Maternity & Gynecological Care 5th Ed.
Varney,Nurse Midwifery 2nd Ed.
Williams Obstetrics 16th Ed

POLYHYDRAMNIOS
Amniotic fluid volume normally increases gradually during pregnancy, reaching a peak of approximately 1 quart between
34 and 36 weeks of pregnancy.
Polyhydramnios is an excessive quantity of fluid. About 1 to7 per 1000 births are easily diagnosed; up to 1 in 62 births
may be milder cases.
• Signs & symptoms:
• dyspnea (difficulty breathing)
• Edema of the lower extremities
• Abdominal/ back pain
• Difficulty in hearing fht with fetascope
• Uterine size is greatly increased
• Uterine wall is very tense, difficult to palpate
• Baby’s presentation is more frequently unusual.
Other conditions causing similar signs are: twins, ovarian cyst, or tumors.
Associated factors are:
Congenital gastrointestinal or genitourinary obstruction in the baby
Prematurity
Twins
Placental Pathology
Diabetes
Potential complications include:
o Malformations of the baby o Preterm labor
o Abnormal presentation at birth o Prolapsed Cord
o PROM
Maternal complications at increased risk are:
o Premature placental separation
o Uterine dysfunction
o Postpartum hemorrhage
What to do:
• Evaluate for Preeclampsia, diabetes ,twins
• Ultrasound may give more information, including rule out congenital anomalies
• Educate client about the condition & discuss concerns
• During labor watch for prolapsed cord
• Needle bag instead of tearing it if AROM is necessary
• Watch for malpresentation, shoulder stalling & pp hemorrhage.
by Laine Gerritson, RN midwife

Antepartal Bleeding
Placenta Previa and placenta abruptio are major causes of late pregnancy bleeding. Another cause we've seen
is cervical polyp.
State of Colorado says we must refer out for bleeding after 20 weeks.
Placenta Previa: Implantation of the placenta low in the uterus so that it obstructs the presenting part of the
baby. It is characterized by painless bleeding in the second half of pregnancy (when the baby puts more
pressure on the lower uterine segment, thus pressure on the placenta) It usually occurs after the seventh
month, with peak incidence at 34 weeks. However, in about 10% of cases bleeding begins only with the onset
of labor, and in these situations a marginal placenta previa is more likely. As softening of the cervix occurs,
the placenta comes loose and blood which normally lies under the placenta escapes.
Problems for the mother are: bleeding and obstruction of labor. Problems for the baby are:
prematurity, and hypoxia with possibly no way out except cesarean. There are stories about babies being born
immediately after the birth of a placenta previa, but they are far in between.
Causes may include: malnutrition, smoking, and previous conditions which may have scarred the
uterus such as uterine infections, surgeries, frequent abortions or D&C's, or even multiparity. It may happen
sometimes that the blastocyst was almost miscarried and falls into the lower part of the uterus.
Diagnosis of placenta previa cannot be made early in pregnancy. Ultrasound has shown that up to 45%
of pregnant women will have a low lying placenta in the first trimester. But in 90% of the cases it resolves
itself as the pregnancy progresses and the uterus grows, pulling the placenta with it. A fundally located
placenta found in the second or third trimester is good indication this will not be a problem.
Prenatal Management:
****No vaginal exam by the midwife in the presence of bleeding more than spotting****
-Immediate consultation with a physician is essential. The physician will

most likely do a speculum exam and ultrasound.
- With a previa of less than 20% a safe vaginal birth at home is likely
-If the baby is preterm, hospitalization, home bedrest, or delivery will be
recommended (If threatened bleeding has occurred).
Perinatal Management:
-Without excessive bleeding, with good FHT's, second stage imminent and informed consent,
the midwife may attempt a home birth or transport by car.
- If increasing bleeding, FHT's worsen or slow progress, transport is required, preferably by ambulance.
Placenta Abruptio: This is when the placenta separates from the uterus before the birth of the baby is
completed. It rarely happens before labor, but can be caused by a trauma or blow to the stomach such as
falling or car accident. Exact cause is unknown.
Most Common Predisposing Factors:
-short umbilical cord

-trauma
-hypertension (40-60% of women with abruptio also have pre-eclampsia)
-precipitous labor
-uterine anomalies or tumors
-folic acid deficiency
-sudden decompression of the uterus
-compression of the inferior vena cava.
Signs & Symptoms:

- vaginal bleeding (in some cases it may be obscured)
-localized or generalized uterine tenderness, out of proportion to
palpation
-uterine irritability or hypertonicity
-absence of FHT"s in severe cases
-variable signs of maternal hypervolemia (from loss of blood)
The degree of problem for mother and baby is related to how much separation is occurring and how much
bleeding.
Management:
-Refer to physician immediately whenever this problem is suspected prenatally. The physician will
differentiate this from previa, polyps, or spontaneous abortion.
- During a homebirth, call an ambulance immediately. If the birth is imminent get the baby out! Then
treat the mother for Uterine Hemmorhage w/ bimanual compression & herbs to control hemorrhage and treat
her as necessary for shock:
-keep her warm
- place head lower than heart with legs raised
- Give oxygen
-monitor vitals
-Pray
Postdate Pregnancy and Fetal Evaluation by Laine Gerritson

I. Definitions:
A. Antenatal Terms
1.Postdate = a pregnancy that exceeds 42 weeks from LMP, assuming a 28 day cycle, or 40 weeks from
conception.
B. Postpartum Terms
1. Prolonged pregnancy = a pregnancy that really did go past the (correct) due date.
2. Post term baby = a product of a prolonged pregnancy, although not necessarily a unhealthy baby.
3 .Postmature Baby = a baby with postmaturity syndrome, i.e. an unhealthy product of a prolonged
pregnancy.
4. Dysmature Baby = a baby with defects caused by placental insufficiency, regardless of the
gestational age.

II. Incidence:
A. about 10% of all pregnancies go two weeks over their EDD. Studied have varied between 31/2%-14%.
B. About 50%-70% of all pregnancies thought to be prolonged end up not to be. This is most commonly due to
late ovulation.
C. Even of the babies that are really post term, over 42 weeks by gestational age, only 5%-22% have
postmaturity syndrome.
III. Predisposing Risk Factors: The following groups are more likely to go past 42 weeks:
-primigravidas
-over 26 years of age
-history of previous postdate pregnancy
-vaginal bleeding in the first twelve weeks
-multiparity
-beta strep carrier

IV. Possible Causes
A. Wrong due date
B. This mother takes longer to grow her babies
C. Unhealthy Uterus: perhaps the bleeding in early pregnancy caused or reflected an already weak
uterus/placenta
D. Congenital malformations; anencephalic fetuses and fetuses with low adrenal function do not
secrete enough steroids to get labor started. They also don't have enough steroids to withstand the stress of
labor very well.
E. Aspirin and Motrin inhibit prostaglandins that are needed to start labor.
F. Anxiety increases catecholamines which interfere with the steroids needed to start labor.
V. Antepartum Screening Tests:

A. Ultrasound. Various things are included in this, depending on the hospital. It can include looking at
fetal muscle tone, fetal movements, fetal breathing movements, placental grading, the ponderal index of the
fetus ( the relationship of length and weight), and amniotic fluid volume. The fetal biophysical profile is often
done in conjunction with FHT monitoring. This is the best indicator of fetal condition because it takes so amny
factors into account. Probably the single most important indicator is the presence of oligohydramnios.
Normal amniotic fluid volume is over 800 ml (31/2 cups): oligohydramnios exists if there is 400 ml or less. This
is usually measured by ultrasound by looking for a pocket of fluid that is over 1 cm large. It is hard to get an
accurate measure of oligohydramnios without ultrasound. Abdominal girth gives a rough measure; it's called
the Ballantyne-Runge sign if it decreases from a previous measurement, and that is a sign of decreasing
amniotic fluid. Oligohydramnios is difficult to diagnose clinically. Oligohydramnios is so important because if
the placenta and membranes can't make enough fluid, it indicates placental insufficiency. It also bodes poorly
for labor because there won't be as much cushion for the cord. It is associated with significantly more fetal
distress in labor, thick meconium, and SGA babies.
B.Amniocentesis: They used to do this to look for meconium, but too many healthy babies pass
meconium for this to be a reason to terminate pregnancy (11% have meconium in the waters at 39 weeks and
15% by 44 weeks) To some extent, it is a normal process with maturation. The other reason to do an amnio is
to check the clotting activity of the fluid. If the TAAF is less than 42, the baby is probably postmature.
Unfortunately, it takes ultrasound and amnio to find out this piece of info.
C.Hormone Assays: Estriol determinations are expensive and unreliable. HPL measures are also
unreliable. The estriol/creatinine ratio is better, but it still has too many false negatives and false positives.
D.Fetal Movement Counts: There hasn't been whole lot of research done on this, but it looks at least
as good as fetal heart rate testing. Less than 3 movements an hour is abnormal. You are generally considered
to have 48 hours to get the baby out before it stops moving.
E.Electronic Fetal Monitoring:
1. A reactive NST is good. To be reactive there must be good BTB variability and there must be 2
accelerations of at least 15 BPM, and no decelerations associated with movement. Unfortunately, there have
been quite a lot of deaths reported within a week of reactive NST's.
2. A negative CST/OCT is good. THere must be 3 palpable contractions within 10 minutes with
good variability and no decelerations. Nipple stimulation is often being used rather than pitocin now; 80% of
women can get the required number of contractions going if they are at 40 weeks or more. The CST is pretty
good at catching babies who aren't doing well, i.e. it has a low false negative rate, but about 30% of the time
when it says a baby is in trouble, the baby turns out to be just fine, so the false positive rate is llousy to go by.
VI. Management:

A. General considerations, there are undoubtedly fetuses who should be delivered at 40 weeks.
The problem is figuring out which ones. Routine delivery, regardless of gestation, causes more problems
(longer labors, more cesareans, more manipulative interventions) than it prevents, because most postdate
pregnancies do not have postmature babies. Routine delivery does not affect perinatal outcome as compared
to waiting for spontaneous labor. But mortality will double at 43 weeks and triple at 44 weeks.
B. Antepartum:
1 .Accurately determine due date. A more accurate rule than nagele's is to add 1 year to the
LMP, then subtract 2 months, 2 weeks for a primip, or 2 months, 2 1/2 weeks for a multip, then add or
subtract as many days as the usual cycle length varies from the 28 day pattern.
2. Screen for risk factors:
a.Women who had bleeding in the 1st trimester should be encouraged to drink red
raspberry tea and nettles tea throughout pregnancy and should start drinking 2 cups of squawvine tea daily
during the last 4-6 weeks. It can be made with leaves, or with 20-30 drops tincture (check this for the
woman’s constitution so as not to create imbalance energetically).
b. Primips and those with a history of prolonged pregnancy should have their cervix's
checked at 39 weeks and weekly thereafter. Assign a bishop score for ripeness. If the cervix is unripe,
recommend nipple stimulation 3 times daily up to 15 minutes each time, evening primrose oil capsules 3 daily,
and 2 cups blue cohosh and black cohosh tea daily. It can be made with leaves or with 10-15 drops of tincture.
3. Screen for Fetal compromise:
a.At 36 weeks, begin measuring abdominal girth. If it decreases, recommend ultrasound
to check for oligohydramnios.
b. at 40 weeks, begin daily fetal movement counts. Refer for NST/CST if movment falls
below minimum.
c. At 41 weeks, if the cervix is still unripe, recommend rubbing evening primrose oil
directly on the cervix, making love, and rubbing castor oil on the belly.
d. At 42 weeks, recommend ultrasound for amniotic fluid volume/biophysical profile,
and NST/NSCST twice weekly. If NST/NSCST indicates fetal compromise, it should ideally be checked by the
biophysical profile.
e.Delivery should be induced 1, if the pelvic score is over 5, dates are certain, and the
mother wishes it, or 2, if fetal compromise is indicated.
C. Intrapartum:
1. Recoginize that postdate pregnancies have higher risk of fetal distress, meconium staining,
dysfunctional labor, and labor that requires artificial stimulation.
2. The postdate pregnancy is already at increased risk. Any additional risk factors, such as
dysfunctional labor, should be grounds for transport.
3. Be vigilant for oligohydramnios and placental insufficiency, such as late decelerations. Either
is grounds for immediate transport.
4. Meconium staining is significamtly associated with abnormal labor progress, intrapartum
fetal distress, and lower 1 and 5 minute apgar scores in postdate pregnancies. It is important to know if
meconium is present as soon as possible in the labor; perform AROM if necessary. The presence of any
meconium over a trace is grounds for immediate transport. (Grade I = watery; Grade II = particulate; Grade III
= pea soup). Over 1/2 of infants born in MSF will have meconium in their trachea, and 1/3 of those will have
significant problems, such as pneumothorax or decreased artrial oxygen.
5.Avoid any sedation of the mother or fetus, and monitor more frequently and thoroughly than
usual.

6. Cut the cord immediately, since the postterm baby is at higher risk for polycythemia.
7. If there is a normal amount of clear amniotic fluid, with flecks of vernix present, and normal
labor pattern and normal FHR pattern, the birth can be traeted as any other low-risk birth.
D. Postpartum
1. Newborn complications associated with prolonged pregnancy include macrosomia (which
can lead to asphyxia, bracial palsy, etc.), SGA babies, hypoxia, acidosis, hypoglycemia, polycythemia (increased
hct and bilirubin), hydration, feeding problems, temperature instability, and jaundice.
2. Determine whether the baby is really "postmature". Remember that only 5-22% of postterm
babies have the postmaturity syndrome. The postmaturity syndrome (placental insufficiently syndrome) is
clinically recognized by the following symptoms: failure of growth; dehydration; development of dry cracked
skin, reduction of subcutaneous fat deposits; long thin arms and legs; advanced hardness of the skull; absence
of vernix and lanugo; and meconium staining.
a.Stage I- chronic placental insufficiency, skin signs, amlnutrition, alert and apprehensive look,
no meconium staining. Prognosis; 1 out of 3 infants will have mild respiratory distress, but normal course
after delivery.
b. Stage II-acute placental insufficiency: all the above signs plus green meconium staining of the
skin, membranes and cord. Prognosis: 2 out of 3 infants will have respiratory distress at birth; if they aspirate
the meconium, the mortality rate is 50%. 1 out of 3 infants will have some brain damage. Overall, mortality
rate is 35%.
c.Stage III-subacute placental insufficiency: the stage after survival of stage II (an additional
mortality rate of 15%, mostly due to respiratory distress and brain damage); all teh above signs except the
meconium staining has been present long enough to convert the green bile of the meconium into yellow
staining.
3. Genuinely postmature/dysmature infants should be checked by a pediatrician as early as possible.
Lots of follow-up is also required because these babies are less consolable and cuddly, have a poorer
orientation to their environment, and have decreased muscle tone and neurologic reflexes. At 4 months they
score lower on the DDST on personal-social items and have a low threshold for distractability and stimulation.
At 8 months, there have been more hospitalizations, more feeding and sleep disturbances, and they are less
cooperative babies.
Induction Methods:
Be aware of condition of baby and mom before considering any induction at home.
Check artava pulse and determine uterine condition and balance it
Midwife remedies:
-homeopathy, Acupuncture, Chiropractic adjustment
-Hot spicy foods; balsamic vinegar w/food;
-castor oil/MW cocktails with juice and vodka
-clary sage for belly massage 2x a day, circular clockwise strokes 5-10 minutes or a few drops to warm bath at
bedtime.
-massage of uterus; nipple stimulation (best with other therapies)
-sexual intercourse
Herbal induction protocol: In conjunction with Maya Abdominal Massage, intercourse, Acupuncture/chirop

Evening Primrose Oil bolus on cervix at bedtime. Try for good sleep.
early morning: Blue cohosh tincture every hour
Black cohost tincture every hour (repeat twice only)
Castor oil every hour (repeat twice only)
continue Blue Cohosh (may have short contractions, continue)
If not in labor by supper time, discontinue.
Rest for 1-3 days before trying again.
PRE-TERM LABOR
Definition: True labor, less than 37 weeks LMP
Chief concern: lung maturity in infant, infant can’t maintain temperature
Causes: SROM (due to infection), cervical incompetence, polyhydramnios, multip gestation, faulty
implantation, uterine abnormalities, maternal infection, severe or sudden stress, dehydration,
malnutrition.
Protocol: Colorado State regulation: Must transfer woman less than 37 weeks in labor
If woman and midwife are certain of dates, home delivery after 36 ½ weeks is okay.
*To help arrest a pre-term labor (Ayurvedic Herb useful for beginning of premature labor - anantamula)
1) Advise client of risks/treatment of premature babies. Advise client of medical help and
possibilities. Discuss with client their desires regarding possible premature baby.
2) Limit activity
3) Bed rest
4) Postural tilting to take pressure off cervix, pelvic rest
5) Alcohol, still drinks
6) Culture, check for vaginal infections especially GBS
7) Herbs (Chamomile, Hops, Skullcap, Blackhaw can stop irritated uterus, False Unicorn can stop
turning cervix, Lobelia relaxes uterus although watch for vomiting reaction, Homeopathic Sepia 5-7
mos.)
8) Tocolysis (meds to inhibit contractions). Woman must be at least 34 weeks gestation and less than
4 cm dilated. Most common medication is Terbutaline. Also used are Magnesium Sulfate,
Ritodine. All cause nervous irritability and nausea.
9) Drink lots of water
Sources: Davis, Varney
Symptoms of Pre-Term Labor
1. Any low backache, continual or rhythmic, that is different from what you’ve experienced in pregnancy so
far
2. Menstrual-like cramps
3. Intestinal cramps and/or diarrhea

4. Rhythmic pelvic pressure that feels different from what you’ve normally felt during your pregnancy
5. An increase in vaginal discharge, or change into a mucousy, watery, or blood-tinged discharge
Note: Because pre-term labor can begin without any obvious warning signs and because many of the early
symptoms of premature labor are hard to distinguish from the normal sensations and discomforts of
pregnancy, expectant mothers are urged to learn and use self-monitoring.
Source: The Premature Baby Book

Class 9 Notes - Childbirth

Section Six: Childbirth
Preparation for Childbirth per Ayurveda
• Apana vayu is mainly responsible for all activities relating to the delivery of a child. If it is in proper
condition, then delivery will not cause much pain & inconvenience, including malposition of the baby.
EVERY CARE SHOULD BE TAKEN TO ENSURE THE NORMALCY OF APANA VAYU, ESPECIALLY BEFORE, DURING,
AND AFTER THE DELIVERY.
Ways to Balance the Apana Prana in Preparation for Labor
Protecting and Correcting the Apana vata in Pregnancy
• Care of apana before pregnancy!!!

• Daily walks
• Sattva and things that bring sattvic happiness help; sattvic liver herbs such as guduchi are indicated sometimes,
with hx of drugs of any kind allopathic or recreational, alchohol,
• Intercourse in first trimester and at 7 months per ayurveda to be generally avoided, except last few weeks when
the semen gives strength to baby . CHinese Taoist sexology advised similarly, except in those times just enough
activity to hold an erection with gentle coitus giving reproductive organ reflexology physical and emotional
treatment that is beneficial for both partners, and baby by honoring the gentle and love connection.
• More mushy foods, if needing fiber, hydrate it well first, in constipation during pregnancy. Tip – psyllium mixed
into a fruit juice splashed fruit bowl is a great way to take fiber; also oatmeal, cooked with more water. Less dry
foods and more dietary oleation is helpful for easy apana vayu without using laxatives. Soupy, creamy, healthy
sauces, cooked veggies for vatas especially the latter. Bedtime warm milk with ghee. Last month of pregnancy-
eat liquid food like gruel with ghee etc. and soup of deer meat.
• For late pregnancy and early labor to support good labor, both the Dhanwantari Institute and Vdya Bharat quote
classical use of small warm sesame oil or bala infused (Ysha would also use ashwagandha at this time) basti
rectally – about 1/3-1/2 cup max. An MD and Vaidya in the UK routinely advised alternate days small oil basti
anytime after 8.5 months. (Ref discussion on http://www.groups.yahoo.com/group/perinatalayurveda some
months ago . I don’t know who would want to do that many, which is probably a way to self regulate excess! But
she says makes for easy delivery with all her clients. All these ways help lubricate and soften tissues for
smoother birthing and better stretching of tissues.
• Avoid holding or forcing urination or bowel movements, including release of gas. Avoid constipation due to
inappropriate diet, dehydration, or lack of physical activity.
• Avoid jarring activities - snowboarding, falls, gymnastics, excessive jumping, jarring sexual activities.
• Both Ayurveda & Maya tradition suggest eat slippery foods for the end of pregnancy like okra, gruel with plenty
of ghee, and papaya --slippery foods to “grease the passage” before birth (another way of saying, having healthy
apana).
• Herbal choices in pregnancy, according to specific needs: bala, pinch of amalaki
• For late pregnancy and early labor to support good labor, both the Dhanwantari Institute and Vaidya Bharat
quote classical use of small warm sesame oil or bala or ashwagandha basti rectally – about 1/3-1/2 cup max. An
MD and Vaidya in the UK routinely advises on alternate days small oil basti anytime after 8.5 months. (Ref
discussion on http://www.groups.yahoo.com/group/perinatalayurveda some months ago . I don’t know who
would want to do that many, which is probably a way to self regulate excess! But she says makes for easy
delivery with all her clients. All these ways help lubricate and soften tissues for smoother birthing and better
stretching of tissues.)
• Dr Sarita Shrestha , Ayurvedic ob/gyn recommends a pichu or small clean gauze pad soaked in warm sesame oil
or bala oil vaginally at bedtime in the last month of pregnancy. Be sure there’s a thread to pull it out when it’s
time. Remove it after any toileting or in the morning.
• Therapies, according to time in pregnancy and specific needs: pelvic floor exercises, vata soothing diet and
lifestyle. Marma energy points below the waist help with balancing apana. After the 8th month only: apana
mudra https://www.youtube.com/watch?v=XYsQG6xGLb8 gentle basti, gentle yoni basti, pichu
Protecting and Correcting the Apana vata in Labor
• Care of apana during pregnancy. At end of pregnancy: herbal enema w/ bala, fennel, meat soup, milk, sesame
oil, honey & ghee; then oil enema sesame oil, milk and madhurani type herbs.
• Definitely in early labor – a full body warm oil abhyanga then basti is advised, to help apana vayu and relax into
nature’s rhythms with it. Even castor oil internally can be used in last few days when labor is delayed.
• Avoid vata disturbing influences - coldness(avoid icy drinks), dryness, overstimulation, too much movement,
excessive vaginal exams, lack of connection of the root chakra to the earth, injections and needles, pushing
without urges
Therapies, according to time in labor and specific needs: basti, pelvic floor exercises, vata soothing diet and lifestyle,
apana mudra https://www.youtube.com/watch?v=XYsQG6xGLb8
More Ayurvedic Preparation for Childbirth

o All types of abnormal presentations, fetal deformities and maternal diseases are mainly caused by the
vitiation of apana vayu. Moreover, pregnancy itself is a factor which causes instability in vayu. If there is
stability in the equilibrium of vayu the delivery will be without much discomfort or pain. So, take all steps for
maintenance of normal vayu during pregnancy, delivery, and thereafter.
o Bala is the choice of herb in this condition- it alleviates vayu and also has a tonic and nourishing action
on the genitor-urinary system. The root is most useful and usually the oil soluble fraction is used in the
therapy. Some other useful drugs may be added – recipe in Sushruta: Cikitsa 15: 15-18
o After 36 weeks, Use Asthapana type enema – can use bala,fennel, meat broth, milk, sesame oil, honey,
clarified butter. Follow this with anuvasana type enema with sesame oil, milk
o After 36 weeks, Dr Sarita recommends vaginal bastis (uttar basti) as well, using a rubber catheter and
25 ml syringe to gently insert the liquid in the vagina- use only about 50 ml – about 10 teaspoons full. Equal
parts bala & anise decoction with sesame seed oil is a recommended formula.
o After the ninth moon (36 week) up until labor should take liquid foods like gruel, etc with ghee etc. and
meat broth. These diets keep the vata in a normal condition.

o Practicing Ashwini mudra, along with Kegel exercises throughout pregnancy will help have healthy
apana prana ACY p.56
o Tamponing – Dr. Sarita recommends it to prevent tearing, softening the tissues for childbirth and
especially useful for prolapsed cases. Weekly, use a small amount of gauze in three layers. Soak it in Bala oil or
Dashmula oil. Then make it into a bolus by pulling the edges of the gauze together at the bottom, twist it so
that the middle of the gauze is like the bulge of a balloon. Slowly push it inside the vagina, with the end
hanging out. Leave it in 4-6 hours at bedtime is good. Take it out and throw away if urinate or BM.
o Massage of the perineum with licorice ghee helps soften the area
o Avoid suppression of natural urges – especially in the pelvic area, ie. urges for urination, defecation,
farting, and orgasm should not be suppressed to avoid vitiating apana vayu.
o Avoid other activities that imbalance the apana vayu : staying up late at night; eating before previous
meal is digested; speaking with a loud voice; physical exertion beyond capacity; leaping, jumping, jarring
activity(ie. gymnastics, snowboarding, mountain biking); riding on a bumpy road/in a jerky vehicle; long
travels; excessive worry, sex, fear, fasting, cold & grief.
• During pregnancy do stretching exercises and squatting to prepare for labor-squatting releases pelvic
floor.
• Choosing the birth attendant
o There should be up to four female attendants to look after the woman (acc. Sushruta). Important
qualities recommended include:
1-They should be elderly and mother of many children, thereby having enough of experience of the
techniques of delivery;
2-they should be sympathetic & affectionate towards the pregnant woman & of agreeable behavior;
3-They should be resourceful, kind-hearted by nature, cheerful & tolerant of hardships;
4-They should have the skill in the art of childbirth;
5-The pregnant woman should not have any feeling of delicacy with them; and
6-They should have got their nails pared.
• Breathing to increase relaxation during labor. Relaxation allows labor to progress naturally. Breath is
one way to increase relaxation. Warm water baths and showers may also help – guard against chills after
getting out of the warm water.
• Educated confident mother who trusts her body. Childbirth education may help ease the woman’s
fears. Encourage her to avoid “war stories” from other women that dwell on the negative. Focusing on what
she can do to allow birth to flow is most useful.
• Trusting her birth attendant contributes to easing the labor.
Ayurveda Recommendations for Labor Read ACY pp 51-54

Ayurvedic Texts on Childbirth
According to Charaka, Sushruta and Vagbhata, the woman should enter the maternity home before the
commencement of the ninth month of pregnancy with the blessings of Brahmins an seniors, because a normal
delivery may take place any time between ninth to twelfth month. Kasheppa recommends at the signs that
labor is beginning.
The maternity home must be free from obnoxious material like bones, sand and broken earthen vessels. The
soil under it should possess good color, taste and smell. It should be well build, according to Vastu rules. The
entrance and doors of compartments should face east or north. The room should be 16 feet by 8 feet and well
protected from unwanted and inauspicious men, animals, including germs and bacteria.
Herbs and other medicines, along with equipment shall be kept ready in the maternity home. There should
be a number of female attendants to look after the pregnant woman. Sushruta limited this number to four.
The woman is advised to sleep in supine position on a soft-bed and experienced women are advised to give
her psychological encouragement. Susruta and Vagbata have advised that after recitation of auspicious and
religious words, the woman hold fruit bearing masculine name; should be given oil massage, hot water bath
and diet that keeps vata in a normal condition.
Since the apana vayu is mainly responsible for all activities relating to the delivery of a child it is of utmost
importance to maintain it in a healthy state- before, during, and after delivery. Asthapana type enema
should be given, including badara, bala, atibala, fennel shatapushpa, palala (meat soup), milk, cream of curd,
sesame oil,saindhava salt, madana fruit, honey and ghee. After that she should be given anuvasana type of
enema prepared with sesame oil, milk and a decoction of drugs belonging to the madhuradi gana.
During first stage, the baby has descended some, mild urgings are advised. During intervals between
contractions she may be made to walk. However, strenuous pounding, etc is not advised, since the doshas and
dhatus are in a state of commotion and violent exercise may make it worse. Tepid sesame oil or castor oil
may be used to massage on the waist, sides, back and thighs. If the baby still isn’t engaging then she can inhale
frequently the powder of drugs like kustha, ela, langali, vaca, citraka, cirabilva and cavya.
When signs of imminent delivery appear she should be taken to the labor room with proper rites of
benediction. She should be anointed with oil and washed with warm water. Then she has some gruel and
thereafter, laid on her back on a soft and spacious bed spread on the ground. Her head should be on a pillow
and legs lightly flexed and drawn up. Charaka advised the birthing woman to sit on the bed till the head of
baby is engaged. The attendants should try to keep her mentally happy with comforting words and touches.

Second stage, when the head is engaged and coming out the birth canal, she should resort to deep urgings
until the completion of delivery. Resorting to deep urgings should be a gradual process and not sudden. Before
this stage she should be made to lie down on a bed.
When birth is imminent, the birth canal should be lubricated with unctuous substances like ghee, oil, etc. She
should be told not to strain herself if there is no real labour pain.
At the time of birth, the head of the baby is said to turn downwards by the uterine contractions caused by the
action of apana vayu. Therefore, the head appears first during a normal delivery.
Fall of Placenta – One attending woman should be keeping vigilance over the placenta after the baby’s birth.
If the placenta is not coming she may resort to pressure, tickling the woman’s throat with hair from her own
head; fumigated with various heard, oral hearbs, basti kriya with asthapana (white mustard seeds, kustha,
langali and the milky juice of snuhi mixed with suramanda) &/or anuvasana types. (Sometimes retention of
flatus, urine and feces obstruct the placenta. The enema helps them come uou and thus the placenta as well.).
It those measures fail then uttara basti or vaginal douching- mustard oil and asthapana herb s OR a tampon
soaked in oil prepared with shatapushpa, kustha, madana and hingu may be inserted in the vagina. Last resort
is manual removal of the placenta.
From Ayurveda for Mother and Child (1988) by Vaidya Bhagwan Dash pp 47-56
Labor Basics
Understanding of labor and birth:

Terra’s body-centered explanation:
• Long menstrual cycle:
Pregnancy is like a long menstrual cycle—after conception midcycle, that menses doesn’t come until the time of
birth. The month before giving birth is like the premenstrual period. Labor is like a really big menstrual period.
Early labor feels like menstrual cramps to many women.
• Labor experience= orgasm:
Labor is mediated by the hormone oxytocin, which is also what causes the uterine contractions of female
orgasm (and ejaculation). Labor contractions are like a very long, very hard orgasm.
• Pushing stage is like a bowel movement:
The same nerves that indicate fullness of the rectum before a bowel movement are activated in labor by the
pressure of the descending head of the baby. The urge to push naturally follows at the right time to push – thus,
Ayurvedic texts recommend no pushing without this urge. It also makes sense since the reflexive pushing of the

uterus is much stronger than the additional pressure a woman can consciously apply to pushing. It is more of a
letting go at its most functional.
How the Uterus Works in Labor

Pacemaker cells (similar to those in the heart) in the muscles allow for a coordinated contraction and relaxation
of all the uterine muscles. When they are not working together then contractions can’t work well to open up the cervix.
Contractions usually build up in a wave.
Kasheppa points out the difference between normal labor pains (avis) which come and go and the grahi-shula,
tetanic uterine contractions of an ineffectual, more painful labor. Ch V? V:30-31
Uterine muscles not only CONTRACT, they also RETRACT. When the muscle cells slide over each other to
shorten the muscle, during labor, this contraction is not fully released—gradually the uterine muscles actually get
shorter and shorter as labor progresses.
• This pulls on the more relaxed lower part of the uterus where the cervix is, thinning and opening the tubular
structure to about 10 centimeters, to allow the baby’s body to pass through.
• It also pushes the baby downward on the cervix, because the uterus is shrinking. Think of a toothpaste tube
being rolled downward, pushing the toothpaste out the opening.
Three Stages of Labor

First stage: beginning of labor until full dilation of cervix. Contractions usually get stronger & closer
together as first stage progresses.
Second stage: full dilation until after birth of baby. There’s often some pausing between first stage and
involuntary pushing. The pushing urge comes from pressure of the baby’s head on the posterior vagina/rectum.
Third stage: birth of baby until birth of placenta. Contractions again may pause after the baby birth.
They should start again after several minutes, but they are usually not as intense.
These stages are Followed by careful watching for 2 hours (normal protocol), or longer, if there have been
problems with mother or baby.
When Does Labor Begin? Labor & Warm-up Labor.

The question of when labor begins is not easy to answer, even though it may
sound simple. In observing labor as a phenomenon in itself I see labor as being a non-
discrete occurrence that actually begins with conception & gradually leads to the birth of the
baby.
What most people call labor is actually just a special part of the process. It
would be as if one said that making love consisted of only the moments of orgasm, when the
actual process of making love may have begun even months before with a flirtatious glance,
and gradually built up on physical, emotional, & spiritual levels over the whole time,

culminating in the physical embraces & orgasm itself. What happens before the orgasm is
not necessarily not making love & the orgasm is not necessarily the end or the goal or
product of the process. If one makes love & no orgasm occurs it does not mean it was not
making love.
Likewise, labor is building up throughout pregnancy. In the latter part of

pregnancy there are often several flirtatious episodes of what could lead up to the orgasm of
birthing, yet often they subside. Those "signs of impending labor" may come & go several
times in the weeks before birthing.
So does the labor start when the impending signs start? In this case many of
the women I assist have been in labor for weeks. Before I became more spacious in my
definition of the beginning of labor I believed & treated these women as though they were in
labor - and often ended up pushing their labors by various means including transporting
them to the hospital for exhaustion & "lack of progress".
I believe even the classic definition of labor - there is a progressive change in

the effacement, dilation of the cervix & the baby moves lower - is not a sign that the woman
is ready to give birth soon. Most midwives who do vaginal exams near term notice that some
women become quite dilated in the weeks before they have the baby all the way out - up to
4 centimeters. A woman who is having impending signs, having some mild contractions, goes
to the doctor or midwife to get checked will be told that she is in labor. Then the labor of
labor begins because when everyone believes she is in labor & she believes she is in labor,
that is when it actually begins. And if she was actually still in a flirtatious stage rather than
the culminating stage she may be pushed & dragged through labor by breaking her amniotic
bag, drugs, & mechanical assistance or c-section.
So I see the definition of the beginning of labor is very important to how we educate women
about labor & how we assist women in the process of giving birth. Currently I teach women
to ignore contractions as long as possible, warning them that they may start & stop many
times in the last weeks of pregnancy & that's just fine - preparation. This works well for
them. We also do not treat women as though they are in labor until they are well
established in a strong labor pattern, encouraging them to ignore it until they can't and then
spending time alone with their mate in a pleasant environment until they both decide it's
time for us to come. We educate them about delivering the baby themselves, discussing it a
lot to allow them to feel as comfortable as possible being alone for as much of the labor as
possible. This allows for the least interference possible with the natural laboring process.
Physiology of Uterine Contractions

The uterus is an incredible part of the woman's body. It is not only the seat of
her womanly energies, with the ability to nurture the growing child, but a specially powered

muscle with the capacity to grow & expand to hold the child to term & then to expel the child
from the inner womb of the mother to the outer womb of the family & tribe. The medical
explanations of this come more from the experimental realms than from the clinical realms of
medicine, and seem to be a bit less tinged with the dogma of medicine, maybe more objective.
See what seems true to you as you read the texts. I find most of this information fits into my
experience of what happens with various women in their pregnancy, birthing & postpartum.
You may want to review the anatomy & physiology of the reproductive system to have fuller
view.
Key points that I find useful to know:
•The uterus begins about the size of a fist and grows to the size of a small
watermelon. This growth of the uterus entails both the growing of the individual muscle cells
and the proliferation in number of cells. Most of the additional cells have grown by the 20th
week. This is why good nutrition throughout the pregnancy is a good assurance that the uterus
will work well - the muscle cells are growing & developing a great deal during the pregnancy.
The so-called "Braxton-Hicks" contractions which occur periodically during the pregnancy,
tightening & toning the uterus are a part of the development of the muscle fibers.
•An understanding of muscle tissue can be helpful in understanding both the

development & functioning of the uterus in labor. Review how muscles work in an anatomy &
physiology book, especially what they need for good functioning. Special features of uterine
muscle are : the muscles seem to function like the heart in that they contract rhythmically,
possibly with pacemakers like heart muscle to get the muscles to contract in a coordinated &
effective way; the uterine muscles do not just contract during labor - they retract, a special
feature only in the uterus. Retracting muscles work like contracting muscles in that the cells
get shorter during the contraction, but then, instead of totally relaxing back to their original
shape & size they remain a bit shorter with each contraction - this is the action which actually
pulls up the cervix and makes the uterus smaller & smaller, pushing the baby & placenta out &
preventing hemorrhage from the placental bed through tightening around the blood vessels.
•Recent studies have shown that the oxytocins which stimulate the
contractions of labor are not systemic but local to the uterus - who knows what the effect has
been on women of giving them systemic oxytocin? All these years they had assumed the
oxytocin came from the pituitary of the woman & thus was in her blood stream anyways.
Finally they did a blood test on laboring women & did not find it so! Oxytocins definitely play a
role in the labor contractions, as they do in orgasmic contractions & in the let-down reflex of
breastfeeding, but it may not be exactly what was imagined by the men of science.



The Four "P's" of Labor & the Higher Power.
I first read about the four "P's" of labor when I started studying midwifery. The
original three "P's" are:
1. the powers (strength & effectiveness of the uterine contractions)
2. the passage (openness of pelvis & soft tissues of pelvis)
3. the passenger (size & positioning of the baby)
the additional "p" recently added in nursing texts:
4. the psychology (of the mother & others around her)
I add another to the list:
5. the Higher Power (destiny, karma, cosmic needs, God's will)
These are the factors that come into play during labor, determining how quickly, how
easily, how smoothly the birth process goes for mother & baby. They can balance each other
out - very strong contractions can squeeze out a baby who is on the big side quickly or if a baby
is small it may fit through a slightly tighter passage or if a uterus is not having very strong
contractions the baby may come out easily if smaller & the passage is open.
This is why it is impossible to diagnose that a woman will not be able to get a
baby out of her pelvis at the beginning of labor, let alone at the beginning of pregnancy! Some
of these factors may be changed by time, by the progress of the labor progress, or by gentle
interventions. Much of the teaching we do with women in pregnancy about their health
impacts these factors -
1. a well-nourished, exercising woman will have a well-nourished uterus

which will tend to contract well;
2. perineal massage & butt massage help keep the passage relaxed &
open towards the end of pregnancy and a well-nourished woman will usually have proper
hormonal flows which soften the pelvic tissues at the end of the pregnancy;
3. a well-nourished woman may have a larger baby - some people are

afraid of that making the birth more difficult, but in my experience that well-nourished woman
will also have the added advantages of that nourishment that will balance out this size factor.
The position of the baby is something that can change even during labor. The use of movement
during labor, initiated for the most part by the woman herself, can bring the needed changes to
progress the downward movement of the baby through the pelvis.
4. through the preparation of women for labor & mothering by talking a

lot during pregnancy visits, by deprogramming negative messages about her body's ability to
give birth & her own ability to make decisions about caring for herself & her family; by showing
how what they are learning to do now will help them as a laborer & a mother; by having them
meet & talk with other mothers-to-be & mothers of newborns in an unstructured setting of the
birth lodge-seeing that women actually do go through it & come out the other side; and by

homebirth oriented preparation classes the woman is psychologically ready for the experience
as much as possible. The father is also prepared by sharing in the pregnancy experience as
much as possible, attending homebirth preparations classes & support groups for fathers, and
talking about the birth & parenting experience as much as possible at pregnancy visits. By
nurturing the relationship between the mates an important aspect of psychological
preparedness is added to the picture.
5. By encouraging the parents to connect to the Higher Power through their

own religious & spiritual ways they are prepared to call on guidance & understanding of the role
of this in labor; by the midwives also being open to this aspect it leaves more openness to
invoking the Higher Power & working with that flow.




Birth Sutras By Terra Rafael
1. Entering fully into the altered state of childbirth allows a birthing woman to act in the best interests of healthy
birth for the baby & herself, just as being fully in the state of sexual arousal allows for orgasm to happen.
2. Seclusion & protection allow her to open gracefully with the guidance of her altered state. Do not distract her
from her labor.
3. Healthy downward energy in a balanced, nourished mother & baby leads to graceful birth.
4. The baby is an active participant in the birth process.
5. Maintaining the atmosphere of Love & Trust is of utmost importance for the spiritual welcoming of baby to the
world and woman to new motherhood.
6. The birthing woman is open energetically as well as physically and just as in menses & orgasm, she is both
powerful & vulnerable. Both aspects must be acknowledged.
7. Moving Downward energy of Birth – Be It. Uterus mind.
8. The contractions of childbirth are like long & very strong contractions of orgasm extended through time.
9. Normal labor pain is the discomfort of opening, not of injury. Healthy mothers’ bodies produce endorphins &
instinctual positioning to withstand it. These are promoted by a prepared, relaxed & confident mind and
uninterrupted, private, primarily non-verbal, & natural labor process.
10. Giving birth & breastfeeding is fulfillment of the physical capacity of womanhood.
11. Nature’s elements can support the birth process – the grounding of earth, water tubs & teardrops, fire of
warmth , air of breath, and ether of altered state
Helps for Labor -
Marma Points for Inducing Labor – See chart next page

Triku – tip of coccyx, use 2 thumbs – for cervix
Bhaga – midpoint of pubic bone –for vagina
Nabhi – navel points (vital energy points around the navel). – regulates apana prana in ovaries
Urvi – midpoint on posterior & anterior aspects of thigh – for ovaries
Rub the marma points in a circular movement with oil 12 times – clockwise for Vata & Kapha; counter clockwise for
Pitta. use Vadra oil if available; sesame oil, clary sage essential oil


Aromatherapy To induce labor: from Aromatherapy for Pregnancy & Childbirth by Margaret Fawcett:
CLARY SAGE belly massage twice each day, with gentle circular clockwise strokes for 5 - 10 minutes. Then add a few
drops of Clary Sage to a warm bath each evening.
Repeated vaginal exams are not best , increased risk of infection, as well as disturbing the downward movement
of the apana.
Dashamula Tea Basti – This tridoshic mixture of 10 roots balances the apana prana- should only be used in labor or pp –
not during pregnancy. Can be used at the beginning of labor to encourage a healthy process.
Understanding Pain in Labor and Relief Measures

The pain of labor is something women often fear. The cultural notion of pain is - if it hurts, take
something to make it go away. In the workings of the body pain is usually a signal of something being out of
balance or injured. Usually the first reaction to pain has to do with this - that there may be some danger
involved & determining what is going on. Pain can also be quite aversive in itself. Different people have
different pain thresholds - some of that dependent on attitude, some of it dependent on physical variable.
Gayle Petersen, well known for her work in birth psychology, said, "as a woman lives, so she gives birth." In
this respect you can see patterns of behavior regarding pain which will clue you in to what may happen in
labor - yet this could always be a surprise too.
Again what happens during the pregnancy can have a beneficial affect on the ability of a
woman to work with the pain of labor. I believe in building the woman to her utmost physically, emotionally,
psychologically & spiritually for the birth. By doing this her body is most likely to have the least tension & the
most reserves for the challenge of labor. It's important to talk about pain, fears about it, past experiences of
it, her resources regarding it, where it comes from in labor & that the pain of labor is not pain of injury but of
the opening up process that she was evolved as a woman to do. Instilling confidence in her body is important
in this aspect of labor as well. Practicing some technique for altering her state of consciousness on a regular
basis may assist her in dealing with the pain as well.
The pains of labor come from a variety of sources:
• the stretching open of the cervix

• the pulling on the ligaments when they contract with the contractions
• pressure of the baby against pelvic parts as it descends
• if circulation is poor between contractions-especially due to not moving or not
breathing enough or just plain tensing up to the pain- then a lack of O2 & the build up of lactic acid in the
uterine muscles can lead to more pain with contractions
• stretching of the muscles of the pelvic floor & perineum
The body does create its own type of opiate- like substances called endorphins when it is in a
physically challenged state, such as a marathon race or labor & birth. I believe that just as an individual's state
of being can be altered by these opiates,the degree that they can work can be effected by the activities &

environment on takes part in. If a woman is in a place where she feel totally safe and surrounded by people
who are willing to enter into her altered state rather than keep dragging her into a more intellectual, everyday
state of being I think these opiates work much better. She also can enter into the altered state much better if
she has practiced entering altered states & feels comfortable & good about doing so. Women who regularly
meditate, chant, do strenuous physical activity, have long sessions of lovemaking, drum or dance, or do any
such altering activities throughout pregnancy can use those activities in early labor to alter themselves more
easily to deal with the pain. All the better if her mate, who she is so connected to during this labor also can
enter altered state at will.
During labor there are a wide variety of more outward techniques which can also be used to
help the woman cope with the pain. Most of them do not necessarily get rid of the pain, since most of the
pain results from changes in her body necessary to the birthing process. Some common useful techniques for
preventing or alleviating excess pain :
warm/hot baths & showers focusing on the baby relaxed breathing
changing positions deep, relaxed vocalizing walking
breathing with someone remembering love
remembering why it's happening
back pressure or rubs pressure on special parts making out w/ mate
proper homeopathic remedy herbs for centering herbs-mild sedatives
keeping well nourished keeping well hydrated calm environment
going outside information about how labor is progressing & how baby is doing
voicing fears & getting more information letting out anything holding back
avoiding all unnecessary interaction or intervention keeping a sacred space
As you read the materials in the book & the handouts remember the Steps of Healing & begin
listing the techniques for dealing with the pain within the Steps of Healing to give you some way to gauge
when different techniques may be more appropriate.
Essential Oils for Labor

from the Complete Book on Aromatherapy & Essential Oils by Valerie Ann Worwood:
ROSE
o Uterine relaxant Slight analgesic effect
o Helps ligaments to soften, enabling the pelvic bones to expand; & regain their elasticity after birth
o Natural antiseptic
o Good cardiac tonic
NEROLI
o Works on the nervous system & facilitates easy breathing, especially during panting. Its calming effect
increases the O2 supply to the blood & brain & helps the woman avoid hyperventilation.
o In low dose (1-2 drops per day on a diffuser) it has a sedative & calming effect;
o in higher doses, it is a stimulant.
o Antiseptic; disinfectant
o Confidence; Antidepressant
LAVENDER
o Circulation stimulating
o Slight analgesic effect; Calming
o Antibiotic; antiseptic, disinfectant; slight antiviral properties; antiinflammatory
o Promotes healing of open wounds -- can be used instead of antiseptics
o Accepted by everyone—except Terra
o Good for headaches, fainting, & bringing around after shock
NUTMEG
o Analgesic;Calms the central nervous system; alleviates anxiety
o Increases circulation -- good for blood supply
CLARY-SAGE
o This essential oil must not be confused with sage. (Sage too toxic for baby) This is a milder version,
although still needs to be used with care.
o Helps respiratory, muscular & uterine systems.
o Mild analgesic
o Facilitates birth; uterine tonic
o Euphoric
o Helps breathing by calming the lower part of the spinal cord
GERANIUM
o Circulation-stimulating. One of best circulatory oils -- and if the cirulation is good, breathing will be
easier
o Good for uterus & endometrium
o Contractive effect -- pulls together dilated tissues, so excellent for after the birth
o Good for the whole female reproductivve system
o Antidepressant, known for its uplifting effects
from Aromatherapy for Women by Maggie Tisserand:
Labor Massage oil:
o 14 drops clary sage

o 5 drops rose
o 6 drops ylang ylang
o in 2 fluid oz vegetable oil.

or Clary Sage compress, warm, held just above pubic bone
from Aromatherapy for Pregnancy & Childbirth by Margaret Fawcett:
• CHAMOMILE to release inner tensions
• BERGAMOT OR MANDARIN to renew energy
• ROSE OR JASMINE to reassure & boost confidence
• CLARY SAGE tones muscles of the uterus, good especially if contractions are weak or irregular & progress
towards the birth is slow - same as above
• REMOVE ALL ESSENTIAL OILS BEFORE ENTERING THE BIRTHING TUB IF YOU INTEND TO HAVE A WATER BIRTH --
A QUICK SOAP & WATER SHOWER WILL DO.
• TO VAPORIZE THE ESSENTIAL OILS RAPIDLY INTO THE ROOM--ADD SEVERAL DROPS TO A BOWL OF HOT WATER-
OR ONTO THE SURFACE OF A WARM RADIATOR OR THE BULB OF A LAMP BEFORE SWITCHING IT ON
Easing the Pain of Labor with Ayurveda– see following chart

• Apply above techniques according to the doshic needs at the time
• Vata reducing therapies – warmth, oil, hydration, calm atmosphere, containment, rhythm
• Marma pts for pain in labor - use Jatamansi oil
Triku – tip of coccyx, use 2 thumbs (for kapha use Vacha oil)
Janu – central posteror aspect of knee joint and knee cap (for pitta use Khus oil)
Manibandha – midpoint of inner wrist – cervix (use Hinga oil for Vata)
Baga – midpoint of pubic bone – press for pain
• Herbs for extreme pain : Pushkarmula 300 mg, Anantamula 300 mg, Dashamula 300 mg – steeped in hot water;
safe to take every 2-3 hours –sedates the mother (watch for effects on baby, as always) – from Dr. Lad
• Medicinal oils for pain: Mahanaharana Tailam, Shilaha Tailam, Shodhana Tailam, Ropana Tailam
Vacha & Erendamoola (NOT Tagar because it will induce sleep) – from Dr Sarita Shresthra


Before Birth
At Delivery most MDs do episiotomy to avoid tears – a cut to the bottom of the yoni. This often extends and most very
servious tears happen after an episiotomy. Natural tears will tear more unevenly (harder to sew together) but will often
be smaller and tear in the place of weakness.
Licorice ghee to perineum & inside to avoid tearing- apply it with perineal massage strokes during end of pushing stage.
Recipe : 1 p licorice powder & 16 p water; boiled to ¼ original amt ; then add ghee , amt equal to concoction and cook
until all water evaporates; it will be aseptic if kept in sterilized jar & used just for time of delivery
Immediate Postpartum
Bonding of family and baby Humans are programmed to bond at the end of labor – especially mother & baby, with their
high oxytocin levels. High oxytocin levels predispose us to trust each other. Face-to-face of mother and child is one
aspect.
Initiating Breastfeeding –
Breastfeeding is an instinct for babies: Amazing video of baby crawling to nipple and beginning nursing shortly
after birth - must only stay out of way of disturbing the natural process during labor, birth & pp to allow for it –
First 3 days or so the milk has not come in yet – colostrums is there, a concentrated food source for the baby.
Early breastfeeding benefits baby : Bonding; colostrum helps clear meconium & has many antibody functions
that protect from infections (many traditional cultures don’t honor colostrom and avoid it); instinct of breastfeeding is
potentiated; frequent sucking on breast creates more milk.
Early breastfeeding benefits mother: Bonding; sucking on breast causes uterus to contract to expel placenta
and to prevent excess bleeding.
Watching for placental delivery –

the most dangerous time for mother if she bleeds large amounts.
How the placenta naturally comes loose: After baby is born the uterus may slow contractions for a bit to adjust
to extra space (vata); then it contracts again, continuing to shrink in size; this leads to placenta (which is NOT shrinking)
to peel loose from the inside of uterus . Bleeding from the bed of blood beneath the placental site is controlled by the
continuing contraction (and retraction) of the interwoven layer of uterine muscles—thus the crucial importance of
continued contractions postpartum and removing the placenta when it has loosened, so that it doesn’t obstruct uterine
contractions. Signs it is loose: cord lengthens as placenta loosens from top of uterus; separation gush of blood;
Normal blood loss pp 2 cups (500ml) Remember- excess pitta may be expelled through blood loss. Be sure
1)blood volume has expanded (physiological anemia 28-32 wks of pregnancy) 2) no longer anemic by labor
How a midwife usually handles placenta delivery- watches for signs of the placenta coming loose; allows
immediate breastfeeding and mother in an upright position; watches for sign that the placenta has loosened but

blocking the cervix, so that bleeding is happening behind the placenta; has the mother gently push as she uses gentle
cord traction to guide the placenta out of the vagina into a bowl. Carefully examine the placenta for any pieces missing,
which may be retained in the uterus and later cause infection &/or bleeding.
In hospital delivery – MD will usually aggressively manage placental delivery and use drug pitocin routinely to
contract the uterus and avoid bleeding.
Steps of Healing for Labor- Read ACY pp 52
Maintaining a state for the baby to stay connected or reconnect to Spirit.

If a woman has gone through her pregnancy creating a womb environment which is full of life, light & love then her
baby has remained in its Divine state throughout the pregnancy. The baby has not been distracted from the original
nature of Oneness with God/dess which the connection to mother through the placenta embodies.
The surprise of birth, the intense sensory input of the process & the emergence out into a bright & noisy world can
be a supreme distraction, pulling the child away from its heritage of divinity. When those present at the birth can
call themselves into their own divine, grounded, state of Oneness with God/dess it can allow that connection of the
baby to remain despite the outer dance or to be re-member, reconnected if it was disrupted.
I personally find it important to practice entering this state and do my best to maintain it at the birth as much as
possible. Of course I long for the day when I can live uninterruptedly in that state of Oneness and dedicate my life to
it. Yet I believe that grace grants us the ability to enter it more easily than usual at the time of birth, and therefore it
is an opportunity to be acknowledged & taken by all involved when possible.
The baby's experience of birthing is much more than the easily measurable physical effects. These more subtle
effects of the mind, emotions & relation to the spirit are the basis from which the baby will go forth & create its life.
There's more to it than just ensuring that the vehicle of the body is intact & functioning - that's just the most
minimal level of care & awareness.
Now, use your present knowledge & understanding to come up with a list of ways that you can prepare & maintain a
state most conducive to the baby remembering its divinity at birth. Feel free to discuss this with others, to read
what others say about this, to grow in your understanding of this as your experience increases.
Bonding.
My understanding of bonding is the formation of a strong attachment between beings. This attachment goes
beyond liking or not liking. To me it feel like a biological imperative. Through this attachment the chances of
survival of the baby are enhanced, since the baby is unable to attend to its own physical needs for many years.
Through bonding the parents are able to maintain their commitment to the child even when it seems too much to
handle, or they feel overwhelmingly angry, or they just don't want to move one more time to take care of the baby.

Encouraging bonding encourages stronger families, happier families. Most hospitals now brag about their family
oriented birth experiences. Most do now allow the baby to stay with the mother (only due to pressure from the
market, not necessarily out of caring for the families themselves.) I believe homebirth inherently is more family
centered & therefore inherently encourages bonding more than hospital birth.
This does not mean that midwives do not need to be aware of this process & work more to allow it to take place.
Some things I've done to encourage bonding:
-Mother/Father catching the baby
-Baby staying next to mother's skin to touch & smell, uninterruptedly for first hours - no one else holds baby
-Leaving the cord attached, placenta attached until the baby has totally finished with pulsating next to the
abdomen
-Leave the mother, father, & new baby & other siblings alone for an hour or so after the birth, reminding them
to leave the baby next to the mother to allow it to smell her & be in her aura
-During pregnancy encouraging the parents to relate to the baby as a person, with a pregnancy name, talking to
it, massaging it, playing with it
-After initial observation to assure normal adaptation, delay the newborn exam until the first day visit or do it
with the baby being held by the mother
-Avoid any procedures which separate mother & baby unless it's a dire situation. Even if resuscitation is needed,
do it on or next to the mother, keeping the cord intact. Suturing should be avoided when at all possible for the
distraction from the bonding
The cord & placenta.

The cord & placenta are usually left intact for the full time the baby is using them in our way. This means we do
not clamp or cut the cord until it has fully stopped pulsating right next to the baby's abdomen. The middle of the
cord seems to stop pulsating much sooner. The time is usually one - two hours for this cycle to end. After the
placenta is born we wrap it up in towels &/or underpads and put it next to the baby to be cradled by the mother
too.
It seems right to allow the baby to end its need for the placenta & cord rather than arbitrarily cutting it according to
a schedule. When we wait this long the blood between baby & placenta has clamped off within the baby and so we
do not need to clamp the cord to cut it. A teaspoon or so of blood comes out. We then pack the end of the cord
with goldenseal powder. We recommend that the baby is left open to the air as much as possible - not fully dressed
and diapered. This seems to let the cord dry up much faster. The baby can be on a diaper & wrapped with a blanket
for added warmth. The next day cord care continues with the stump being swabbed with alcohol about everytime a
diaper is changed. The remainder of the cord is cut off of the placenta and can be shaped on a piece of waxed paper
or such to dry into a heart or a spiral. It becomes dry & gnarly. I saved my children's cords to give them as a token
that they are grown up, a sort of cutting of the cord again at maturity.

The placentas are examined according to medical tradition, then washed thoroughly to get much of the blood out &
shown to the parents. After that they do according to their wishes with it - some bury it; freeze it for later burial;
make placenta cocktails from it; dry it in the oven & pulverize to make some medicine to strengthen the mother
with it.
Placenta cocktail: This nutritious & hormone filled drink is highly recommended for women who have bled extra
&/or had long, tiring labors. After washing the placenta cut out a chunk about as big as the baby's hand and blend it
in some juice with a blender. It'll be a bit frothy & fleshy but most women who do it find it highly appropriate at that
moment. Many women use V-8 juice or some other vegetable juice; some use apple or whatever is on hand.
Placenta medicine: I first learned this from a Chinese woman who happened to be an obstetrician. It is common
to use placenta as medicine there. She advised steaming the placenta after thoroughly washing out the blood; then
freezing it. When it's frozen solid cut it into very thin slices and spread them on a cookie sheet (it may get yucky).
Dry slowly in an oven at 250 degrees F. until it is so crispy you can powder it - be sure not to burn it. The time will be
dependent on how thin you slice it, your oven, etc. - usually it takes a couple of hours. Since that first time I've
known many people to just go from washing to freezing or even from washing to slicing (it's hard to slice thinly if it's
not frozen). Some people use a mortar & pestle to grind, others pound it while it's wrapped up to keep pieces from
flying. After it's powder you can either use it as a powder in juice or on food or take the time to put it in capsules.
Whatever the people do with their placenta be sure it is always treated with the utmost respect. If they want to
throw it away ask if you can have it. Bury it in the Earth with prayers.



Snapshots of V-P-K in Labor ACY pp 53-54
Prodromal or True Labor?

True Labor Prodromal Labor
- Contractions at regular intervals - Irregular Contractions
- Intervals gradually shorten - No change or irregular change
- Duration & strength increase > 45 seconds long - No change or uneven < 45 seconds
- Contraction starts in back, moves to front - Contraction mainly felt in front
- Walking increases intensity - No change or decreases
- Association between degree of uterine hardening - No relationship
and intensity of pain
- Bloody show often present - No bloody show
- Cervix effaced and dilated - No change in cervix
- Descent of presenting part - No descent
- Head fixed between pains - Head remains free
- Sedation does not stop it - Efficient sedation stops it
Resource: Human Labor & Birth, pp. 105
Ruptured Membranes without Labor

Colorado State Regulation: must refer is ROM > 12 hour without labor
Sterile Vaginal Exam req if ROM and head not engaged to R/O cord prolapse
While many people think of labor beginning with the rupture of membranes, the incidence is only about 12%.
Labor usually begins within 24 hours, especially for the term pregnancies for multiparas.
Possible causes include infection, malposition, malpresentation, malnutrition, smoking mother, fetal
anomalies, baby scratching or sucking bag, baby moving down in pelvis putting great pressure on forewaters.
All clients are instructed to call immediately if waters break
When a client calls with ruptured membranes ask:
- Was the fluid clear?

- What color was it?
- What did it smell like?
- Was it a leak or a gush?
- Was there any blood or tissue in the waters?

- Are there any symptoms of infection (vaginal, colds, flu, etc.)?
- Could the fluid have been bath or pool water or urine?
- Has the baby been moving since?
- Are you ready to have your baby?
Advise her:
- Put nothing in the vagina including tampons, fingers, penis, etc.

- Be meticulously clean about the perineal area: wipe very carefully so as not to contaminate vagina; change
pads frequently if they are worn; clean underpants, etc.
- No baths or swimming. Showers are okay if not water sprayed into vagina.
- If baby unengaged at last visit, advise her to be sure baby is moving and consider going to hear fetal heart
tones asap. Have her lying down until checked to rule out prolapse.
- Relax!!!! Go to sleep if it is night, sing a quiet song to yourself or read a boring book, have a partner
massage her or drink some skullcap tea; have a restful day if it is daytime. Be ready for labor to start in the
next 24 hours – meditate and pray in preparation for giving birth.
- During waking hours the client must:
- Take her temperature about every 2 hours
- Drink lots of fluids
- Take one dropperful of echinacea tincture or cup of tea every 2 hours
- Take 500 mg Vitamin C every 2 hours
- Keep client informed about the risk of infection to herself and the baby as the reason for care and limits.
- Some methods to determine if the Bag of Waters is ruptured:
- See if fluid is escaping from vagina spontaneously or by pressure on the fundus. Also try lifting baby up
from pelvis with woman in lying down position to see if any fluid escapes.
- Put sterile speculum in the vagina and see if fluid is coming out the cervix. Again, fundal pressure may
increase the amount.
- Look at fluid to see if there is meconium – if there is, it is amniotic fluid.
- During sterile speculum exam, insert nitrazine paper or stick into vagina to catch some of the fluid. The
vagina, normally acidic, becomes neutral or alkaline when wet with alkaline amniotic fluid. An alkaline
pH suggest the membranes are ruptured.
- The arborization test depends on the property of dried amniotic fluid to form crystals in an
arborization (branching) pattern. A few drops of vaginal fluid are aspirated from the vagina with a
sterile bulb syringe and placed on a clean, dry glass slide. After waiting 5-7 minutes for drying to occur,
the slide is examined under low power microscope for positive or negative identification or
arborization pattern.
- If time elapses without significant labor pattern, review pelvimetry findings, review EDB, assess for
prematurity, postmaturity, and CPD. Be watchful of signs of distress in mother or baby, infection in either
(increased pulse or fht, temperature in mother, increased WBC count (more than from echinacea),
increased respirations in mother). Temperature is a late sign, others more accurate earlier.
- If everything seems WNL expectant waiting guidelines are up to 12 hours for multips and 8 hours for
primips before assisting labor to begin. Evaluation of waiting longer includes: general health of the
mother; baby’s signs of health – fht, movements, clear amniotic fluid, term, AGA; mother’s present

condition; knowledge and respiratory level of mother and partner; hygiene conditions; intuition and signs
given; desires of parents; desires of midwife.
- Assisting labor to begin (see Induction of labor protocol also):

- brisk walks
- hot shower
- sleep
- early labor scenario of quiet, soft lighting, alone or with partner, calm peaceful
- energy balancing
- deep tissue work/massage
- nipple stimulation – 20 minutes every hour
- Homeopathics – commonly caulophyllm, other as appropriate
- orgasm using manual stimulation
- accupuncture
- chiropractic – special maneuver
- labor stimulating herbs – blue & black cohosh, others as indicated
- “magic tea” – 1 tablespoon castor oil, 1 tablespoon milk or magnesia in a cup of peppermint tea: drink
4x per day
- Transport needs to be considered when:
- labor does not begin within 24 hours
- labor is not progressing well within 24 hours
- any signs of infection in mother or baby
- CPD is present
- Any of other usual reasons to transport
Postpartum Care after ruptured membranes
- Watch both mother and baby for signs of infection. Take their temps and pulse for 10 days postpartum
- Mother takes 1000 mg Vitamin C per day and anti-infective herbs such as 1 dropperful echinacea tincture
or cup echinacea tea 3 times a day for 10 days pp
Induction of Labor (also see previous section on complications of pregnancy)
Evening Primrose Oil- Orally

Homeopathy – as indicated by condition
EPO Bolus on cervix – with cervical cap or diaphragm, or massaged on.
Begin Early morning: Blue Cohosh every hour
Black Cohosh every hour 2x
Castor Oil every hour 2x
Continue: Blue Cohosh (may have short contractions – continue)

If not in labor by suppertime, discontinue

Rest for 1-3 days before trying again
First Stage Lack of Progress

Lack of progress is a subjective term for a labor that just is not going anywhere. It is predisposed by : an
anxious primip; malnutrition in pregnancy and/or labor; tiredness and exhaustion at the beginning of labor;
unresolved “holding in” of mother; anemia; baby > 8 ½ pounds (relative to mom’s size); and malpresentation
or malposition.
BE SURE SHE IS REALLY IN LABOR!!! To encourage a good labor pattern to develop, be sure she has been well
nourished prenatally. Leave her alone or just with her mate until her ctx are well established – this does not
interfere with her hormones doing their thing without outside energy to deal with.
Causes are:
malposition or malpresentation CPD
Powers: hypertonic or hypotonic Cervical dystocia
Hypotonic contractions
This is infrequent ctx, of mild to moderate intensity and pain within normal limits – and the mother is already
exhausted/in psychological distress. One needs to be certain that the woman is truly in labor. Perhaps she is
in pre-labor and needs herbs or alcohol to help relax her enough to rest. Afterwards she may go into a
functional labor pattern – or wait a few more days to really be in labor.
Risks: maternal infection due to stress; pp hemorrhage due to insufficient uterine ctx; fetal distress due to
maternal exhaustion; mom too tired to effectively push baby out.
Helps: - Psychological interventions

- Oxytocic herbs – B&B tincture
- Homeopathics: caulophyllum or other appropriate
- Empty bladder
- Empty bowel – enema
- Amniotomy if 0 to +1 station
- Upright and moving positions
- Hydration and nutrition
- STRONG raspberry tea
- Sedation if needed for a rest before pushing starts
- Frequent assessment of ctx, mother and baby for exhaustion, distress, infection
- Keep vaginal exams to a minimum
- If no progress in 2-3 hours or if fetal distress transport and support
- Be cautious of possible prolonged 2nd stage or pph

Hypertonic Contractions
This is when resting tone of the uterus is high; frequency of ctx is usually increased but intensity of ctx may be
decreased. The ctx are painful but ineffective, possible due to anoxia of the uterus. “Very anxious nullipara at term or
post term is most common.”
Hypertonicity of uterus puts the baby at risk due to lack of uterine rest for placental perfusion. The mother is
also experiencing excessive pain with little or no progress to show for it.
Helps: - Bedrest
- Hydration and nutrition
- Monitor for ketones in urine
- Lateral position may correct it
- Massage may help her relax
- Help with coaching
- Centered Momma tincture 1 dropperful per hour, or lobelia, or skullcap 50 d/ half hour, or
alcohol/beer/wine to help her relax and rest; slow down the uterus.
- Energy balancing
- Psychological interventions
- If no progress after rest of 1-2 hours or any signs of fetal/maternal distress, transport and support
CephaloPelvic Disproportion
This baby will not fit through this pelvis with these ctx today and maybe not ever. It is a large baby with
borderline pelvis or a postdates baby with a hard head. It will show up with a prolonged labor with the baby
not descending. Ctx may be sufficient, but may dwindle due to exhaustion. She may progress to full
effacement but not past due to baby not descending. The cervix may be hanging without anything pressing on
it. It may be swelling by being trapped by the presenting part.
This woman needs to be transported and supported with preparation for a likely cesarean. Sometimes labor
augmented with pitocin will force the head to mold and fit through.
Rigid Cervix/Cervical Dystocia

This is lack of progress with maybe a very thin cervix. It may even feel fully dilated at first. It can be
predisposed by frequent cervical infections, scar tissue, or by failure of the presenting part to descend.
Another possible cause is long use of birth control pills.
Helps: - Evening primrose oil rubbed directly onto the cervix may soften it if it is a hormonal problem.
- Lobelia tincture about 150 drops as relaxant – watch mom and baby for any possible signs of
distress
- Slant board to take pressure off of cervix for a while, allow for shifting of head which might not be
applying pressure evenly.
- Explore psych holding pattern, instill letting go pattern.

- Keep mom well nourished, hydrated, peeing – watch for ketosis
- If no success, transport and support
Cervical Edema
Uncommon until late in labor, this is caused by pushing effort by the woman before fully dilated with the
cervix being trapped by the presenting part. It can also happen with cpd.
Helps: - Rule out cord

- Keep from pushing as possible
- Noninterference is usually sufficient
- Too edamatous to wait or an emergency – position her on her back; sterile speculum exam;
use sterile technique to make multiple punctures with a needle to release fluid.
- Homeopathy may help
- Slant board or side lying will relieve pressure and maybe that too early urge to push
- Have her keep arms up above head to take pressure off diaphragm
Malposition – OP
Malposition is determined by palpation of the baby through the belly or palpation of the baby’s head and
sutures/fontanelles to determine the head positioning. A dysfunctional labor pattern may be present, with
prolonged active stage. A stalling of dilation/descent may occur after it had been going along fine for a while.
Intense back labor, depression of the maternal abdomen above the symphysis, and fhts far laterally on the
abdomen are signs of occiput posterior.
Helps: - Try positional changes such as walking, side-lying, hands and knees, pelvic
rocking, modified knee-chest
- Consider manual rotation if not jammed, mother is cooperative, and the size of baby is fairly
certain to fit through the pelvis.
- Massage to loosen sacrum and relieve pain – do not fix it with constant counter-pressure –
it needs to be moveable to allow the baby to turn in there.
- Visualization
- Pulsatilla 200x to 1M
- Watch for prolonged 2nd stage if persistent OP
- Watch carefully for signs of distress
- Slant board may assist in un-jamming to allow turn
- Supportive labor measures
Prolonged Second Stage

Prolonged second stage is defined as > 2 hours for multips and > 3 hours for primips. Discrimination about
when second stage begins must be made. I have come to divide second stage into latent and active stages
and apply the definition to prolonged second stage only to the active stage. Latent second stage is when

dilation is complete and there is no urge to push – and there is nothing holding the baby such as
malpresentation, malposition or a full bladder. At this point allow the woman to choose to rest as long as the
vital signs of the baby are normal (ruling out cord problems and fetal distress). Active second stage is when
the woman is pushing in earnest and/or has the urge to push.
To encourage the expulsion of the baby:
- Assist the woman in dealing with any psychological reasons for the delay – worry about birth, parenting,
pain, last baby, birth revealing a secret, etc.
- Be sure bladder is empty
- Check position of baby and its head for malposition – if so, sue position changes, pulsatilla homeopathic,
possibly manipulation to assist correction
- If the mother is exhausted, try to help her rest during a latent phase and be sure she is well hydrated and
nourished.
- In the warm bath or shower or on toilet
- Monitor fht carefully to be sure cord isn’t handing up the baby and to reassure everyone
- Consider braking BOW if appropriate – some women seem to need this to go ahead and birth. It also lets
you know if there is any meconium.
- As long as progress is being made, no matter how slow and mom and baby show no distress you may
continue at home. Don’t psych her out with urgency if it is not necessary.
- For delay at the mid-pelvis – pelvic squeeze, position that opens her mid-pelvis, visualization, support
squat with outward pressure on sitz bones.
- For delay at outlet – position that opens her outlet; keep sacrum mobile; pubic stretch – scissors or
crowbar techniques; pelvic squeeze; break the coccyx if it is immobile.
Transport when medical help is needed – baby definitely not coming down; fetal or maternal
exhaustion/distress
After Postpartum Hemorrhage

Be sure to address this birth situation in the postpartum. If she hasn’t received blood volume expanders - she will be
dehydrated and needs fluid replacement. She will also need to rebuild her blood- see anemia protocol .
Remember that breast milk comes from the blood. If she is dehydrated, anemic, or had a hemorrhage she is at risk for
reduced milk supply. You must work to overcome this to ensure a successful breastfeeding experience.
Steps of Healing for Postpartum Self-Care

(Elaborated by Terra from the Steps for Wisewoman Healing by Susun Weed, see more at www.susunweed.com)
0. Do nothing; return to the creative void & do not interfere with the process as it unfolds.
• Meditate
• Look at your baby with adoration

1. Collect information; retrieve from your inner wisdom, ask people, consult oracles, read books.
• Check into your general state of well-being. Do you notice little symptoms that give a clue to the state of your doshas?
• Contemplate your amazing birth experience, and how it strengthened and/or wounded you
• Observe your baby & his/her activities and states
• Learn about normal newborn behavior - from books, friends, midwives, etc.
• Pay attention your family relationships - how are they going?
• Write down and contemplate any special dreams or omens.Use oracles - pendulum, tarot,astrology, other means to tap into suble
knowledge
• Observe your fears, joys, stresses, questions you need answered. Notice difference between fears and intuitions.
• If you received any advice from people, planets, or the unseen world, notice if it fits with your intuition.
2.Utilize energy or environment; engage elemental forces, walk, bathe, move, breathe.
• Spend time out-of-doors if weather permits, in peaceful nature, if possible... walking when it’s appropriate
• Be sure you have help (hopefully set up prenatally) so you can rest!
• Begin strengthening with deep breathing and other gentle abdominal work, along with Kegels. Lift nothing heavier than baby.
• Drink plenty of water and suitable herb teas for good hydration.
• Use deep breathing to control any stress or anxieties. Use natural means to control anxieties.
• Take relaxing warm baths & invigorating showers.
• Wrap your belly to give containment to Vata and your organs
• Vaginal steam after 3 days (with practitioner approval);Healing herbal sitz baths for yoni healing
• Stay cozy and warm - avoid chills from air or cold foods and drinks.
• Enjoy a peaceful environment and people - Avoid over stimulation, including from electronics
3. Nourish & tone; nourish mother & baby optimally, open to compassion
• Get plenty of hugs & snuggles.
• Drink appropriate nourishing herbal infusions daily
• Take some alone time daily
• Nourish your nervous system with gentle herbs like oatstraw and brahmi
• Rest/sleep when the baby sleeps
• Receive massage, energy work as you can, self massage if other isn’t possible
• Is your digestion good? Follow digestive guidelines.
• Are you eating appropriate,nourishing postpartum foods? Are you eating enough? Nutritional needs for postpartum and
breastfeeding are GREATER than for pregnancy!
• Support breastfeeding - digestion, nutrition, rest, relaxation, baby skin-to-skin time, correct latch
4. Stimulate & sedate; use herbs to facilitate desired effect, initiate and move forward, slow down and reset the clock.
• Use herbs to help you relax or sleep: skullcap; jatamansi
• Herbs to support digestion: ginger, agni kindler
5. Use drugs; vitamin & mineral supplement; immediate results.

• Use over-the-counter or prescription drugs; strong medicinal herbs, essential oils, and processed vitamins & minerals
sparingly during this delicate time; be sure they are safe for breastfeeding and baby as well
6. Break & enter; use invasive technology that forcefully enters the physical, emotional or energetic body
• In this delicate time of change, strong, invasive techniques are inappropriate, except for in an emergency.
PREPARING FOR BREASTFEEDING
FOUR BASIC FUNCTIONS of Lactation

1. Breastfeeding provides specialized, highly adapted food for each newborn mammal
2. Breastfeeding provides immune support for the baby

3. Lactation produces hormones that work as natural contraception, ensuring that a mother’s births are spaced
adequately apart.
4. Breastfeeding provides a “window of learning” in which young mammals can focus on acquiring sills rather than
desperately seeking food.
Breastfeeding has "proved" itself to the medical profession as superior to artificial feeding and yet again the medical
model runs counter to the consciousness & process necessary for fully functioning breastfeeding. The crucial beginning
of breastfeeding requires the instinctual state of consciousness so difficult to maintain in a fearsome, interrupted,
intellectual or overly observant situation. The culture does not support breastfeeding in its expectations that women
must earn money outside the home even if they have little ones; in its view of breasts as sexual objects; or in its view of
women as faulty. They wonder why so many women do not breastfeed past the first few weeks of the baby's life!
So in effect, successful prolonged breastfeeding requires either an extraordinarily centered individual &/or a supportive
tribe of breastfeeding around the woman to encourage & give her helpful information along the way. We can only do so
much - if we can get women to breastfeed even for a few weeks it's better for the child than nothing. At the same time
some women are not rebels and don't have a breastfeeding tribe, so they may not get what it takes to continue.
There are also some cases (few but very real) where the physical situation of the baby &/or mother makes full,
prolonged breastfeeding only a dream if the nutritional needs of the child are to be met. THE BABY MUST BE FED, NO
MATTER WHAT IT TAKES!! Better adding formula than starving a baby! Some La Leche League meetings make women
feel so self conscious & bad about even considering that they might have to give their babies a bottle that they can't get
needed information to overcome difficulties! Don't even dare mention formula supplementation!
BREASTFEEDING FACTS
Breastfeeding is a natural function of the adult female human & of all adult female mammals. An outstanding
characteristic which defines being a mammal is the mammary glands-the breasts. And breastfeeding is similar to the
natural function of giving birth in that it can be interrupted or altered by meddling on an intellectual level or fears from
an emotional level, besides purely physical causes of difficulties which may arise.
Breastfeeding is natural - but not always easy or intuitive. Babies may know more than mothers how to breastfeed, since
their instincts are usually less impaired (Terra’s note) . Mothers used to learn how to breastfeed by observation and
advice from their mothers and aunts, their friends and neighbors, all who used to breastfeed. Social transmission of
breastfeeding has been disrupted. Experts are sometimes needed now - lactation consultant. About 80% of newly
lactating mothers have sore nipples, and many of them quit at the first sign of discomfort.
There has always been some women who can’t or won’t breastfeed for physiological or cultural reasons. Some gave
other milks or foods. Others had wet-nurses - very fashionable in upper classes of many societies thru most of recorded
history, perhaps because it increases the fertility rate of the mother. (prolactin suppresses ovulation) EVEN NOW A child
born in a developing country less than two years after an older sibling is almost twice as likely to die as a child born after
a longer spread.

Humans are the only primates who wean their young long before they can forage on their own. Most humans in
foraging cultures weaned their young at about 30 months, “a pattern known to be optimal for growth and
development.” Daniel W. Sellen, Canada Research Cair in Human Ecology and Public Health Nutrition, University of
Toronto, author interview in Breasts: a natural and unnatural history, October 2010. But there were also societies
where the norm was much longer or much shorter. Early weaning is sometimes ok from a nutritional perspective, but
less so from an immunological one, especially globally.
History of Modern Breastfeeding - In the 1600-1800’s Foundling hospitals wet nurses fed dozens of infants, nursing as
often as 34 times a day. As many as 90% of those babies died. Even for urban middle and working classes who sent their
babies out to wet nurses in the country, mortality rates of babies reached 50%.
o dry feeding -resort to some sort of mash as a milk supplement or replacement. Many didn’t survive or
had nutrient deficiency diseases.
o end of 1800’s - MDs started prescribing formulas to replace dry feeding
o Germ fears - 1920 only 20% of women gave birth in hospitals; by 1950 over 80% did. Scientific mothering
arose and science did not look favorably on breast-feeding. Mothers weren’t allowed to nurse on
demand - schedules, night feedings with formula
o Breastfeeding rates had been declining steadily since the postwar baby boom, falling by half from 1946 -
1956.
o 1956 - La Leche League began
o Now, about 70% initiate breast-feeding only 33% nurse longer than 6 months and only 13% fulfill the
year . In Australia and Sweden the initiation rates are over 90%. Canada’s is 87%. Brazil is 95%
The World Health Organization recommends breast-feeding for 2 years. The American Academy of Pediatrics
recommends it for 1 year.
Early days are critical for the long-term success of nursing. In Ghana only 4% of women experience delayed lactation; in
Sacramento, 44% do. No one knows why. Possible reasons: obesity, older, spinal anesthesia, C-sections, environmental
exposures, tight bras.
Breast-feeding benefits are less in our culture where most babies are healthy compared to in third world countries. Still -
formula confers the same average loss in IQ points - 4 = as high childhood lead levels. This led to bans on lead in gasoline
and paint in the 1970s.
Pumping - allows mothers and babies to decouple supply and demand - leading to confusion of the breast production
and infant nipple confusion from bottle feeding. Useful in some other ways.
While a woman is lactating, the metabolic energy required to feed her infant is 30% of her total output - or the energy
equivalent of walking 7 miles every day. A male baby requires almost 1,000 megajoules of energy the first year of life.
That is the equivalent of the kinetic energy of one thousand light trucks moving one hundred miles per hour. (T: if
women haven’t gained enough weight during pregnancy or lose to much too fast during breastfeeding or if nutritional
needs of the lactating mother are not met, the mother’s body can suffer.

Breastfeeding is a form of matrotropy: eating one’s mother.” ecologist and writer Sandra Steingraber. Sore nipples,
mastitis, inconvenience all go against the continuance of breastfeeding. The love hormone of oxytocin, released with
suckling , the nutritional and immunological advantages for the baby, the emotional rewards many women experience,
and the lowering of some disease risk for mom urge lactation to continue
The baby forms a strong suction with her lips and it’s when she releases the nipple that milk flows down her throat -
they used to think the infant squeezed the nipple with her tongue, rhythmically releasing milk through this peristaltic
action.
Humans do not produce milk at full capacity, like a dairy cow. They down-regulate to match the baby’s appetite. Each
breast of the average new mother produces approx 454 grams or 16 oz every 24 hours.
o Each breast can store about half of that and both actions are determined by the demand of the infant.
o Even after fifteen months of lactation, each breast can still make 208 grams of milk, even though the the
breast has returned to its pre-pregnancy size.The breast becomes more efficient
What Breastfeeding Mothers Need
• Why? Newborn’s diet must supply nutrients to meet the rapid rate of growth (physical/mental) and development.
• Calories needed by Mom:
o 105-110 kcal/kg/day
o 50-55 kcal/lb/day
o Divided into protein, fat and carbohydrates
• Water requirements are high also
Human Breast MILK

Ingredients - 100% of the recommended daily allowance of virtually everything a baby needs to grow and extras to ward
of a lifetime of disease. around 200 components - fats, sugars, proteins, and enzymes. Sugars - oligosaccharides- long
chins of complex sugars; 140 identified with about 200 total. Oligosaccharides - in our bodies, they ride on our cells
attached to proteins and lipids but free or unattached ones are in breast milk. They are NOT DIGESTIBLE by infants - but
feed many types of beneficial bacteria and prevent bad bugs from sticking to the gut.
Types of Breast Milk

o Colostrum -yellowish, creamy, thick- contains high levels of immunoglobulins-lasts for first 2-3 days
o Transitional milk-elevated levels of fats, calories, lactose and vitamins-2 weeks
o Mature milk-10% solids(protein, carbohydrates & fats) 90% water
o Foremilk(water,protein) & hindmilk(fats) Nursing long enough on each breast ensures the baby gets enough fat and
calories to thrive and have good brain growth
Composition of Breast Milk

o Composition varies with:
▪ Stage of lactation
▪ Time during the feeding
▪ Maternal nutrition

▪ Gestational age of newborn at birth
• Whether a male or female baby
• Whether baby is healthy or ill
Immunologic Advantages of Breast Milk

o Varying degrees of protection against:
• Respiratory infections
• Gastrointestinal infections
• Otitis Media
• Meningitis
• Sepsis
• Allergies
Nutritional Advantages of Breast Milk

o Breast Milk is composed of substances that facilitate its digestion, absorption and full use
o Helps myelination process and neurologic development
o May protect infant against cardiovascular disease
o Suited to preterm infants
o Prebiotics and immune help the baby be healthy now and in the future
Psychosocial Advantages of Breastfeeding

o Promotes maternal-infant attachment
o Increased oxytocin=more even moods
o Direct skin contact improves infant’s sense of touch
o Communicates warmth, closeness and comfort
o Empowers mother. Breastfeeding increases confidence in a woman’s ability to be a mother.
o Women who breast feed lose more pregnancy weight than mothers who don’t, but the data is inconsistent.
o Women who didn’t breastfeed were 10% more likely to suffer cardiovascular disease and type 2 diabetes later on.
o Those who breastfed for just 3 months had a threefold lower risk of aortic or arterial calcification after adjusting for
other lifestyle and economic factors
Contraindications or Complications to Breastfeeding
• Breast cancer
• AIDs
• Medications (Cocaine) or Illegal drugs
Possible Psychological Blocks
• Mother may feel negative about it
• Father may feel left out
• Mother may not be keeping baby

Immunity: It was thought previously that breastmilk was sterile, but it is more like cultured yogurt, with lots of live
bacteria - inoculating the infant gut; identified 800 species of bacteria living there; an individual milk sample has
anywhere from 100-600 species of bacteria- most are new to science.
Premature infants do remarkably better on breast milk than on formula. Prevents necrotizing enterocolitis
which can hit 10% of preemies (and 1/4th of those will die from it) reduces the rat of NEC 77% lower.
Another oligosaccharide fights amoebiasis, which kills 100, 000 people a year.
The initial microbiome is very important. Preemie, C-section, not breast fed babies are then getting bacteria
from hospital that will live in them the rest of their life. Normally the mother hands down bacteria to infant. One C-
section can break the chain. Researcher wishes every baby who doesn’t get breast milk would get a dose of Bifidus
infantis at birth.
Tests to diagnose the microbiome are not yet available. Changing the microflora is even harder.
Although breast milk is the world’s best source of prebiotics for humans, they are also found in Jerusalem
artichoke, Belgian endive, onions, asparagus and some other plants.
GLOBALLY - 1.4 million children under five DIE EACH YEAR from diarrheal illnesses. 20% of the world’s
population doesn’t use any sort of toilet; nearly a billion people don’t live near clean drinking water. HUMAN MILK IS
SO EFFECTIVE AT FIGHTING INFECTIONS THAT IF ALL CHILDREN WERE EXCLUSIVELY BREAST FED THE FIRST SIX
MONTHS OF LIFE, ONE IN FIVE CHILDHOOD DEATHS COULD BE PREVENTED.
Human milk inhibits the transmission of HIV
Remember lactation likely evolved from the immune system- most of the cells in milk are macrophages, which
disable viruses, fungi and bacteria.
FAT - The lactating breast communicates not only with the mother but also with the infant. The breast knows if the
infant is a boy or a girl (at least in rhesus monkeys- fattier milk for sons, letting him go away from her more and longer
but more milk for daughters, more frequent feedings keeping her nearby.) When the baby is older than one year, the
milk contains more fat and cholesterol to match the baby’s energy needs.
When a baby is born prematurely, the mother’s milk contains more protein and caloric density for that tiny
tummy.
Endocannabinoids - entice infants to eat and regulate appetite so infants feel very full by the end of a feed and
so don’t eat too much. Formula lacks that - giving them a notoriously higher caloric intake, possibly contributing to
obesity.
Stress can cause the mother to hold back her output of milk. It also sends more cortisol into the milk, which appears to
affect the long-term personality of sons (but not necessarily daughter), making them more exploratory or hypervigilant
for a difficult environment.

Cells in the breast communicate with cells in the mother’s bones, telling how much calcium to release for milk
production and when to start guarding it again. A mother loses up to 6% of her calcium for her baby but it fully
replenishes within a few months after weaning in well nourished mothers.
Breastfeeding helps the mother recover from gestation and delivery by tweaking her metabolism and protecting her
heart.
Which drugs are contraindicated during breastfeeding?

ANSWER: {according to western medicine} Only a few drugs pose a clinically significant risk to breastfed babies. In
general, antineoplastics, drugs of abuse, some anticonvulsants, ergot alkaloids, and radiopharmaceuticals should not
be taken, and levels of amiodarone, cyclosporine, and lithium should be monitored.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2145042 /
https://www.slideshare.net/10Preeti/breastfeeding-ppt
TOXINS IN BREAST MILK
Toxins in breast milk have been associated with lower IQ, compromised immunity, behavioral problems, and cancer.
Common toxins contribute to earlier puberty in girls- which leads to greater risk of breast cancer later in life.
While breast-fed infants and toddlers have considerably higher levels of chemicals in their bodies, their formula-fed
peers catch up by mid-childhood - crawling, sucking and orally exploring the world leads to this.
Some studies have found that breast-fed babies develop better despite the additional chemicals in breast milk, which is
why it is still recommended as good for babies.
On a body weight basis, the dietary doses our babies get are much higher than the does we get - they are smaller and
our milk has more concentrated contaminants through biomagnifications.
Toxins show up in virtually every animal and human tested around the globe. The levels in American women are
considerably higher than in anyone else, maybe high enough to affect our health and our children’s health. We cannot
hide from toxins no matter how carefully we shop, eat, and vacuum.
Nursing a baby, ironically, is the ultimate detox diet. Recent studies show that lactating mothers off-load about 2-
3% of their total PBDE body burden per month to their babies or about 30% if they nurse for a year. For some other
chemicals, the dump rate is even higher, up to 14% per month for dioxins and up to 8% per month for PCBs. In one year
also download 90% of their body burden of Perflourinated compounds ( from manufacturing products such a
scotchgard, gore-tex and Teflon. - found globally and never break down in the environment - one type is likely to be
carcinogenic in humans.)
Managing Toxins-
o It’s strongly recommended that women not lose weight during nursing because that further mobilizes
contaminants in her fat which go in her milk.

o Reduce exposure to toxins throughout life - house dust is the major source of exposures to PDBEs (except for bf
babies who get more in breast milk) is full of flame retardants because they don’t bond to material and easily
inhaled or ingested
o There is only so much an individual can do - a better solution would be regulatory - use the precautionary
approach to chemicals that show persistence, toxicity, and easy transportability. The US has a poor track record
for banning chemicals.
Becoming educated about breastfeeding - La Leche League, on-line
Go to a La Leche League series to see what they have to say, remember your own breastfeeding experiences or talk with
other women about them. Prepare yourself to give help here that once mothers & grandmothers passed on to their own
daughters. Maybe someday again specialists will only be necessary for the few serious problems & otherwise the local
community would all share in common their knowledge & experiences about breastfeeding
While education is helpful, for some women, especially Vata or anxious women, too much information or knowing what
could possibly go wrong can add to tension and anxiety which may end up creating a problem. Know yourself and your
clients in this regard.
INITIATING BREASTFEEDING - BREASTFEEDING PRACTICE

The crucial beginning of breastfeeding requires the instinctual state of consciousness so difficult to maintain in a
fearsome, interrupted, intellectual or overly observant situation.
Breastfeeding is an instinct for babies: Amazing video of baby crawling to nipple and beginning nursing shortly
after birth - must only stay out of way of disturbing the natural process during labor, birth & pp to allow for it –
https://youtu.be/a9SH55UzCSo Breast crawl long https://youtu.be/tNCKd-og3YY Breast crawl shorter
https://youtu.be/lEjM2TkVmK8 Breast crawl shortest
First 3 days or so the milk has not come in yet – colostrums is there, a concentrated food source for the baby.
Early breastfeeding benefits baby : Bonding; colostrum helps clear meconium & has many antibody functions
that protect from infections (many traditional cultures don’t honor colostrom and avoid it); instinct of breastfeeding is
potentiated; frequent sucking on breast creates more milk.
Early breastfeeding benefits mother: Bonding; sucking on breast causes uterus to contract to expel placenta
and to prevent excess bleeding.
Latching
For many women the latching can be a natural happening, and one that is anxiety-free. To much education can inhibit
the instinctual mind which best works for allowing a let down. Best to only focus on latching when problems such as
nipple soreness indicate that it may not be happening naturally.

Women’s Health With Ayurveda, Yoga Veda Institute
Terra Rafael, Certified Ayurveda Practitioner, WiseWomanhood
Class 10 - Menopause and Ayurveda

Menopause, the Result of Perimenopause
Terminology is slippery around the topic of menopause. Medical terminology has defined the time of
shifting menstrual cycles to be the perimenopause, while menopause is official 13 months after the last
menstrual bleed.
Perimenopause varies greatly from one woman to the next. The average duration is three to four years,
although it can last just a few months or extend as long as a decade. Some women feel buffeted by hot
flashes and wiped out by heavy periods; many have no bothersome symptoms. Periods may end more
or less abruptly for some, while others may menstruate erratically for years. Fortunately, as knowledge
about reproductive aging has grown, so have the options for treating some of its more distressing
features.
Dance of the hormones

The physical changes of perimenopause are rooted in hormonal alterations, particularly variations in the
level of circulating estrogen.
The three major naturally occurring estrogens in women are estrone (E1), estradiol (E2), and estriol (E3).
They make up 10-20%, 10-30%, and 60-80% of circulating estrogens, respectively.[citation needed]
wisewomanhood@gmail.com www.wisewomanhood.com © WiseWomanhood LLC Page 1

Though estriol is the most plentiful of the three estrogens it is also the weakest, whereas estradiol is the
strongest with a potency of approximately 80x that of estriol. Thus, estradiol is the most important
estrogen in non-pregnant females who are between the menarche and menopause stages of life.
However, during pregnancy this role shifts to estriol, and in postmenopausal women estrone becomes
the primary form of estrogen in the body. Another type of estrogen called estetrol (E4) is produced only
during pregnancy. All of the different forms of estrogen are synthesized from androgens, specifically
testosterone and androstenedione, by the enzyme aromatase.
During our peak reproductive years, the amount of estrogen in circulation rises and falls fairly
predictably throughout the menstrual cycle. Estrogen levels are largely controlled by two hormones,
follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH stimulates the follicles — the fluid-
filled sacs in the ovaries that contain the eggs — to produce estrogen. When estrogen reaches a certain
level, the brain signals the pituitary to turn off the FSH and produce a surge of LH. This in turn stimulates
the ovary to release the egg from its follicle (ovulation). The leftover follicle produces progesterone, in
addition to estrogen, in preparation for pregnancy. As these hormone levels rise, the levels of FSH and
LH drop. If pregnancy doesn’t occur, progesterone falls, menstruation takes place, and the cycle begins
again.
By our late 30s, we don’t produce as much progesterone. The number and quality of follicles also
diminishes, causing a decline in estrogen production and fewer ovulations. As a result, by our 40s, cycle
length and menstrual flow may vary and periods may become irregular. Estrogen may drop precipitously
or spike higher than normal. Over time, FSH levels rise in a vain attempt to prod the ovaries into
producing more estrogen.
Although a high FSH can be a sign that perimenopause has begun, a single FSH reading isn’t a reliable
indicator because day-to-day hormone levels can fluctuate dramatically (see graphic, below).
Ovaries secrete estrone for several years after menopause, dwindling with time. Alternate sources of
estrone: fatty tissues and adrenal glands.
NOTE: The Premenstrual time is similar to the Late Perimenopausal time – the hormones are dropping
in both phases. Women who learn to navigate premenstrually will be better equipped to deal with
perimenopause.

By comparison with the regularity of hormone levels before perimenopause (top graph) and their relative
quiescence after it (bottom graph), the course of one perimenopausal woman’s hormones over a six-month
period (middle graph) looks like Mr. Toad’s Wild Ride. Not all women’s hormones are so adventurous.

General Natural Helps for Menopause by Susun S. Weed, herbalist

You can have symptoms down the line if you don’t provide your body with the building blocks for
hormones:
1. Fat: we need a lot more fat in our diets and on our bodies. It is important to put aside vegetable
oils and eat organic animal fats & olive oil. Olive oil is not a vegetable oil, it is from a fruit, as are
coconut oil and avocado oil. Greek women eating more olive oil have the lowest rates of breast
cancer in the world. Butter & Ghee can be used for cooking also. Flax oil
is “cancer in a can” according to lipid chemists—it is rancid 5 minutes after being pressed. Why sold
refrigerated??? Freshly ground flax seed, on the other hand, reduces tumors. Eat immediately after
grinding—put in oatmeal, on other hot foods. Or take fish oil. (Some people don’t have the
pathways to transform the flax or hemp oil to Omega 3 – especially those whose ancestors were big
fish eaters.)
2. Minerals: Lots of minerals in hormones. Eat sea vegetables. If you don’t get minerals in your diet,
you pull them from your bones. So far the need for minerals in the menopausal years exceeds
anything anyone has told you. Pump minerals big time! Herbal Infusions are a good source of
minerals:
Four Herbs for Infusions (Simples):
1. Nettles—Urtica PK-V+

Strengthens adrenals. Making hormones taxes the adrenals. Menopause is exhausting. Going
to sleep usually no problem, it’s the wakefulness. A fight-or-flight response causes vasoconstriction
then vasodilation. Dilation causes heat. A night sweat is an adrenal-mediated hot flash. You wake
up hot, sweat profusely, then you have to go pee immediately.
2. Red Clover—Trifolium PK-V+

Anticancer reputation. “Everything you thought soy would be but better.” There are 4 types of
isoflavones. They can be problematic. The ones in red clover counter cancer. One quart per week
as a preventative. The problem—it increases fertility enormously.
3. Oats—Avena VP-K+
Great for the heart and nervous system. “Herbal viagra” for sowing your wild oats.
4. Comfrey leaf—Symphytum PK-V+

Knitbone. Prevents osteoporosis and spinal compression. Every MD says estrogen does not
prevent spinal compression. You must stretch your spine backwards, not just forwards, to maintain
flexibility. Comfrey has special amino acids that are used by short-term memory cells. “Remember
comfrey.”
Comfrey will grow like a weed and is a beautiful green plant with big leaves. Collect anytime
there is a flower stalk. Cut off stalk and dry: no PA’s and high in allantoin. When first up in spring it
has small amount of PA’s. Avoid long-term use of the ROOT. (Pyrrolizidine alkaloids~liver poison.)
Any excess of leaves can be used as compost to make fertile soil.
Other Natural Helps

• Rose water spritzer and cooling breath for relieving hot flashws
• Organic Rose Petal Jam https://www.sacredwindowstudies.com/product/organic-rose-
petal-jam/
• Phytoestrogens to ease excess estrogens & gently add when needed (see notes below)
• TIME AWAY
• Support system
• Exercise
• Meditation
• Creative expression
Phytoestrogen Foods - eat several per day

• Whole grains & edible seeds
▪ Lignans – most in rye, buckwheat, millet, sesame, flax & sunflower seeds
▪ Resorcylic Acid Lactones – most in oats, barley, rye, wheat, corn, rice & sesame

▪ Isoflavones – significant amounts in all whole grains
• Beans Isoflavones-genistein & daidzein – virtually every edible bean

▪ BEANS MUST BE cooked or fermented to remove anit-nutritional substances.
Tofu & soy “milk” are not recommended
• Leafy greens
▪ Isoflavones, & other phytoestrogens – best sources cooked parsley, nettle,
cabbage, broccoli, kale, mustard green,s, collards, lambs’quarter, seaweed, and
rhubarb stalks.
• Fruits & berries – fresh, dried, frozen or cooked – isoflavones, lignans, & other phytoestrogens.
– Cherries, grapes, apples, pears, peaches, plums,strawberrieds, black berries, raspberries,
hawthornberries, salmonberries, apricots, crab apples, quinces, rosehips, & blue berries are best
soures.
• Oils from edible seeds – phytoesterols – especially corn, rice bran,sesame, & wheatgerm oils.
OLIVE OIL IS BEST.
• Olives are excellent source of phytoestrogenic coumestans
• Roots- beets, carrots, sweet potatoes, potatoes, burdock, dandelion, sunchokes, & parsnips
• Garlic, onions, chives & leeks are hormone-rich & heart healthy
• Pomegranate- there are about 1.7 milligrams of the “weak” estrogen estrone in 100 grams of
pomegranate seeds. Olive oil in which ground pomegrante seeds are infused for six weeks and
then strained, acts as a hormemade “estrogen cream” to counter vaginal dryness.
Phytoestrogenic Food-like Herbs - take 2-3 per day

• Citrus peel (may be found in orange marmalade)
• Dandelion, rich in –plant hormones & nourishes liver- any part of plant regularly used can be
helpful Tincture 10-25 drops before meals, at least twice a day.. for bones- used dandelion
vinegars
• Fenugreek – tea or food seasoning caution- promotes fertility – For tea- 1 tablespoonful steep
for no more than 15 minutes in a cup of hot water
• Flax seeds – fabulous source when freshly ground – oil is rancid within 5 minutes (refrigerating
doesn’t help) – 75-800 times more lignans than other foods & up to 5 times as much omega-3
fatty acids. – shrinks tumors
• Green tea- blocks estrogen at tumor sites daily dose is 6-10 cups ( but hard on adrenals???)
• Hops – relieves water retention, helps sleep & phytoestrogens – strong tea of dried female
flowers sipped cold through the day or 5 –15 drops fresh female flower tincture just before bed.
Home brew or non-alcoholic beer also works
• Nettles – regular use of tea- avoid capsule or tinctures forms (very little benefit in those)
• Red clover – 10 times more phytoestrogens than soy and more minerals. Infusions or vinegar-
avoid tinctures or capsules

• Red wine – best post menopausal since alcohol can increase hot flashes
• Seasoning seeds like cumin, coriander, celery & caraway – use liberally in cooking or drink as tea
1 tablespoon per cup, 3-43 cups/day
• Seaweeds – second only to flax in lignans
Phytosterolic, Phytoestrogenic Herbs - take for symptomatic use only,

check doshas for best fit to client
• Agave – ¼-1 teaspoon several times a day to relieve uterine prolapse
• Alfalfa (can thin the blood so avoid while still bleeding)
• Black cohosh PK-V+ (V+ in excess) – becoming rare – tincture of fresh root 10-60 drops / day
(dried root products more likely to cause side effects)
• Black currant – nourishes adrenals & ovaries, - prevents vascular disturbances (including hot
flashes) glycerite or alcohol tincture of fresh leaf buds or berries , 10-50 drops/day
• Black Haw KV-P+ – ok if bleed heavily during menses- counters cramps &hemorrhage; ease
palpitations. Infusion of the root bark sipped frequently up to a cup/day or use tincture of fresh
root bark, 1-25 drops a day
• Chaste berry or Vitex KV-P+ – esp. good if menopause through induced means. Consistent use
increase progesterone & LH in blood. Good for beginning of change—great deal of LH later in
blood so may not be helpful
• Cramp bark KV-P+ similar to black haw but weaker. Considered safe for those who flood. 2-3
cups of root bark infusion or 20-40 drops tincture daily
• Dong quai – use cautiously-can promote hemorrhage. Can promote cancer in petri dishes (in
humans??) Better for early change or post menopause than at climax. Dose is usually 10-40
drops fresh or dried root tincture (traditionally combined with poria and peony root tinctures to
balance) or up to one cup of dried root infusion
• Devils club – 5-20 drops tincture of fresh or dried root or a cup infusion of dried root bark
• False unicorn VPK= (K+ in excess) – rare plant, especially good for those who flood. Take in very
small doses- 2-5 drops of tincture of fresh or dried root , several times a day.
• Ginseng ( Panax) VPK+ (VPK+ in excess) heart healthy & phytoestrogenic chew on small piece
of root or 5-40 drops of tincture
• Liferoot – liver strengthening & hormonal. 5-10 drops fresh flower tincture, once a day only.
• Motherwort PK-V= (V+ in excess) – heart, PMS, cramps, moderates hot flashes & night sweats
& emotional swings. The more you use it the less you need it – tincture of fresh flowering tops
10-30 drops 1-4 times a day – watch out if tendency to flooding or get addicted to substances!
• Raspberry PK-V= (V+ in excess) – infusion of dried leaves at least a cup a day
• Rose family VPK=– any part; cooling female rejuvenative good for all doshas and rasa, and mind.
• Sagef PK-V+ – garden sage not the wild “sage”-- night sweats, depression, trembling & dizziness-
promotes estrogen & may lower FSH & LH surges during the melt-down years. Use infusion but
dilute it by at least a third with water before drinking and sip slowing a cup or two each day.
Sage vinegar is better tasting than tea. Short term use only!

• Shatavari VP-K+ - use as tea, milk, oil or ghee - 1 tablespoon per day – nourishing tonic &
rejuvenative
shatavari is building :. avoid if there is cancer in the family
“What Is A Healthy Menopause? By Alakananda Ma

In an ideally healthy menopause process, a woman of the age of forty five or over will begin
skipping menstrual periods. She may notice some hot flashes or night sweats, particularly if she
is Pitta. Gradually her flow will become lighter, number of days of menstrual bleeding will
diminish, menstrual periods will space out and eventually will cease. Once a woman has not
experienced menstrual bleeding for a full year, she is said to have attained menopause.
Although this picture of the menopause process is one of health rather that disease, we should
still note that menopause is termed in common speech “the Change.” In other words, for even
the healthiest woman, it is a Vata process. Indeed, the menopause process announces the
transition between the Pitta and Vata time of life. Typical Vata symptoms include vagina
dryness, indecisiveness, insomnia and a sudden onset of age-related mental decline—the
famous “senior moment.”
Supporting a Healthy Menopause
Support of a healthy menopause includes gentle rejuvenation of artava dhatu, the female
reproductive system, as well as lifestyle measures for Vata management. Women’s Support is a
good all-round formula that can be of value to women of any Prakruti type. In addition, Vata
can be managed by self-massage using the indicated oil for the woman’s constitution—Vata,
Pitta or Kapha Massage Oil. A weekly bath using dry ginger powder and baking soda will also
help calm vata. Cumin-coriander-fennel tea contains natural phyto-estrogens that support
healthy hormonal balance, while tea made from organic Tulsi will relieve the tendency to
‘senior moments,’ stress and indecisiveness. For vaginal dryness she can use a ghee medicated
with organic Shatavari, which can be applied locally to enhance lubrication. A gentle Vata
soothing yoga practice is also of help. A woman going through menopause should be advised to
shift her diet to focus on foods that provide positive nourishment. In general, there are three
kinds of food we can put in our bodies, those that are good for us, those that are not harmful
but not positively good and those that are bad for us. A menopausal or post-menopausal
woman can be counseled to focus on high quality nutrition, emphasizing foods and teas that
are positively beneficial. Perhaps the greatest support of all can be derived from women circling
together to support and understand their body’s process of change. Since ancient times, New
Moon has been an occasion for women to gather to honor the cycles and seasons of their
bodies. A women’s menopause support group, accompanied by Ayurvedic teas and sesame
snacks laced with Shatavari, would be a wonderful addition to any Ayurveda practice. “ –
Alakananda Devi (Alakananda Ma) is director of Alandi Ayurvedic Clinic in Boulder, Colorado, and principal teacher
of Alandi School of Ayurveda, a traditional ayurvedic school and apprenticeship program. She can be reached at
303-786-7437 or by email at: info@alandiashram.org.

In the language of Ayurveda, during the menopausal change, the energy of the woman shifts
from the downward energy of the apana more towards the upward energy of udana. If she has
imbalances in the samana vayu or ranjaka pitta these will move into other areas causing hot
flashes, cholesterol problems, sleep disturbances.
There are also the effects of general aging and years of toxic build-up (if not controlled by
proper diet & cleansings). Elder people will show the wear & tear of years of their lifestyle at
this time—it may have not much to do with menopause itself. Disease tendencies have often
progressed to a stage recognized as disease by the conventional medical profession.
In addition, the elder age is naturally more Vata—meaning it tends towards dryness, spaciness,
expansiveness, and creativity from the heart. If one becomes too Vata this lends to the
problems of osteoporosis, memory loss, joint problems, and sleep disturbances. By
understanding root causes, rather than treating symptoms only, Ayurveda offers a truly holistic
approach to menopause.
Menopause is influenced by the constitution & balance of each individual. By keeping in

balance one may avoid unnecessary discomforts & complications of the menopausal years.
Women who follow Ayurvedic self care, get regular advise from an Ayurvedic practitioner, and
do hatha yoga may experience less disruption.
These examples are of typical doshic tendencies—remember that people are often of mixed
tendencies.
In allopathic medicine today, menopause is seen as a deficiency disease and is typically treated
with “hormone replacement therapy,” a phraseology indicating the pathologizing of this natural
process. This can prolong imbalances and postpone the change, unless a woman plans to
continue the hormones the rest of her life.
Common Patterns of Climeractic – Peak of Perimenopause

Cycles the same and then stop suddenly. Kapha type
Cycles vary in length, long or short. Vata type
Cycles shorten for a few years, then lengthen before stopping *** Most Common Pitta then Vata
Kapha menopausal tendencies:

delayed menopause; chubby, heavy, lethargic, sleepy, very psychic, with out –of –body
experiences; edema; emotionally –happy & unbothered, gets sense of maturity; water
retention; fibrocystic breasts; excessive urination
Treatments for Kapha women & Kapha Imbalances
o Kapha pacifying diet

o Essential oils: clary sage, cypress (stimulating)
o Herbs: bibhitaki, ½ tsp on empty stomach before bed and punanarva 5 parts & chitrak 2
parts & kutka 1 part – mix – take ¼ tsp twice daily after food
o Daily exercise is essential and is particularly useful during the kapha time of morning—a
good time for yoga, as well as the kapha time of night, when a brisk walk is in order.
o Stimulating pranayamas, like Kapalabati and breath of fire
o Nutritional counselling is essential for any kapha woman over forty, for weight once
gained will be hard to remove. Most essential is avoidance of starchy foods during the
Kapha time of the evening, with dinner consisting of soup, vegetables or salad. To make
this work, a good lunch is needed, although even at lunch, kapha must understand that
a portion of rice or other starchy foods is half a cup. Refined sugars should also be
avoided, and a kapha soothing diet implemented.
o Women’s Support (Banyan Botanicals) helps maintain hormonal balance while Trim
Support (Banyan Botanicals) will enhance the thyroid function.
o For swollen, painful breasts or fibrocystic changes, it is helpful to do daily breast
massage with appropriately medicated oil.
Pitta menopausal tendencies:
earlier menopause; menopausal flooding; hot flashes; inflammation; emotionally -

doubtful, cautious, watchful. Jealous of mate. Irritability, anger, judgmental, critical; emotional
upset. Hives & rashes; sensitive nipples & tender breasts; insomnia (pitta time of night= 10 pm
–2 am)
Treatments for Pitta women & Pitta Imbalances
o Pitta pacifying diet, avoiding acidic foods like tomato sauce and eggplant
o Sunflower oil massage
o Rose water or cucumber water spritzes or rose, sandalwood, jasmine, ylang ylang
essential oils/incense
o Use a sandalwood fan or rose water spritzes when hot flashing
o Cooling breath pranayama
o Baking soda baths, not too hot

o Wearing pearls
o Gem elixir : pearl, coral, essential oils/flower remedy: rose, lotus
o Herbs: shatavari 5 parts & guduchi 3 parts & brahmi 2 parts mixed – take ¼ tsp twice
daily before food and amalaki or triphala powder 1 tsp w/ water daily on empty
stomach 1hr before bed
o As soon as a Pitta woman notices indications of the onset of menopausal changes, she
would be well advised to start using both Women’s Support and Shatavari Kalpa. Roast
an ounce of Shatavari with one or two tablespoons ghee in a cast iron pan until light
brown and add two tablespoons of sucanat, rapadura or turbinado sugar, two pinches
saffron and a pinch of cardamom, and eat a teaspoon three times daily.
o Pitta soothing yoga such as forward bends, shoulder stand and shivasana will also be
supportive.
o For anger and irritability Brahmi tea can be taken three times daily, one teaspoon per
cup.
o It can also be tremendously helpful for a woman in pitta-imbalanced menopause to
have her own room to sleep in, especially if her moods are putting a stress on her life-
partnership. During Pitta menopause she may well be up during the pitta time of night,
both because of hot flashes and because of flashes of inspiration that lead her to
journal, draw and write poetry. It is helpful to have the space to follow her own altered
rhythms at this time.
o For excess menstrual bleeding, a good home remedy is Hibiscus tea with a little
Cinnamon. Ashoka is a star herb in any formula for excess menstrual bleeding, since it is
astringent, cooling and pitta soothing, with excellent action to stop menorrhagia. It is
also essential to give supplemental iron in menorrhagia, since low serum iron causes the
blood vessels in the uterus to lose their capacity to constrict, further increasing
menstrual bleeding. One method for supplementing iron is to make a paste from half a
teaspoon of Triphala and to place it overnight in a cast iron vessel, where it will absorb
the iron. Triphala in turn will support iron absorption in the gastro-intestinal tract.
o Rose petal jam may be very helpful Organic Rose Petal Jam
https://www.sacredwindowstudies.com/product/organic-rose-petal-jam/
Vata menopausal tendencies:
o A woman whose menopause is affected by Vata imbalance may also experience earlier
onset of menopause (before age forty-five), clinically significant insomnia, adrenal
fatigue, impaired short term memory and emotional lability well as osteoporosis or
osteopenia. dryness of skin or vagina; Feels useless to mate, that she is losing
womanhood. Constipation; distention of abdomen; pain; fatigue.

Treatments for Vata women & Vata Imbalances
o Vata pacifying diet and should be moist, well-cooked and regular

o Daily abhyanga with Sesame/vata soothing oil– I use Queen’s Oil – by Heather Baines -
o Calming breaths – deep belly breathing, alternate nostril breath
o Essential oils: clary sage, cypress
o Gem elixirs : yellow sapphire, tourmaline, ruby
o Herbs- haritaki: ½ tsp , 1 hr before bed on an empty stomach and yogarj guggulu 2 pills
or ½ tsp powder twice daily and dashmula herbal enemas as needed
o regular basti using Dashamoola tea will also help alleviate Vata symptoms.
o Other herbs use either Women’s Support (banyan botanicals) or a formula that
contains Vidari. For adrenal stress, impaired short term memory and indecisiveness, a
tea made from equal parts Tulsi and Brahmi can be very beneficial, as can Mental
Clarity (banyan botanicals). For insomnia, a teaspoon of Ashwagandha in a cup of warm
milk at bed time will help ensure sound sleep. The soles of the feet can be massaged
with Brahmi oil at bed time..
Massage Therapist Using Ayurveda for Menopause by Bhanu Kapil Rider
Ayurveda, the natural medicine of India, regards menopause as a “dark gate.” A woman passing through
this gate is at risk of standing too long at a threshold that is very exposed to the wind. Energetically,
Ayurvedic medicine, like traditional Chinese medicine, regards wind as toxic. Excess air is an imbalance of
the “vata dosha,” a particular problem at menopause. Physically and emotionally, a woman who does not
pass swiftly through the dark gate may suffer the depleting effects of depression, anxiety attacks, and night-
time wakefulness.
Excess vata may be brought into balance with the use of massage,
herbs, oils, and incense. The women on my mother’s side - - north
Indian Punjabis - - start drinking a special tea early in their forties, to
fortify themselves against the negative vatic effects of menopause.
Black cardamom pods and gingerroot are boiled, then simmered, then
strained for a delicious, nourishing tea that is sipped all day long.
As an additional tonic, the herb “ashwaganda” is taken in powdered

form, with a teaspoon of iron-rich, melted “gur,” a sort of molasses.
(“Ashwa,” a Sanskrit word, means “kora” in Hindi and “bitter” in
English. In general, bitter foods benefit excess vata.) In my practice, I
might offer a cup of this tea to a client before a massage treatment
begins. Bhanu Kapil Rider and her mother
As soon as the client arrives, I start to heat specific oils in a jar that I
place in a crockpot. In the summer, I use almond oil; in winter, mustard seed oil is more protective against
over-abundant vata. (However, I have discovered that mustard seed oil is sometimes too pungent for clients
returning to work after a massage - - for these clients, a very light olive oil is more appropriate.)
In addition to these oils, an Ayurvedic treatment may include the application of various herbs as pastes to
parts of the body considered most vulnerable to being invaded by wind energy. In India, these pastes would

be left to dry on the ears, mouth and throat - - with the directive not to wash them off until tomorrow
morning’s bath! For American clients, this is a bit extreme.
Thus, in my practice, I use my herbs - - most commonly, arjuna and comfrey root - - as a decoction I keep
very warm in a crockpot next to my massage table. During a massage, I soak towels in this earthy, slightly
bitter tea, then apply the towels to the face and throat and upper chest. If my client is experiencing any
anxiety-related digestive disorder, I also make an application of fresh aloe to the abdomen. When it has
dried, I wipe it off with a warm, herb-soaked towel. For those clients who experience their anxiety in a more
mentally constrictive way, I complete a massage by anointing the forehead and sub-occipitals with neroli, an
essential oil that swiftly generates a feeling of well-being.
Finally, Ayurveda is also concerned with the way in which an individual re-integrates with her environment.
The qualities of friendship, especially that of sharing food with a friend, are thought to be very restful for a
woman experiencing excess vata during menopause. Keeping this in mind, a self-care suggestion for such a
client would be to cook a dish that calms vata, such as rice with saffron, and to share it with friends. Or,
more simply, a practitioner might offer a bowl of this rice to a client as they rest after a massage.
My mother recently arrived from India to visit in me in Colorado for the summer. She is reading this article
over my shoulder as I type it into the computer, and she just said: “Don’t forget to tell them about the
sandal!” By sandal, she doesn’t mean a type of footwear, but, rather, sandalwood incense. She’s right.
Sandalwood reduces vata and raises the spirits. I don’t like to burn incense during a massage, but perhaps,
in the future, I’ll hand a stick of sandal to a client as she leaves. Later, at home, breathing in the fragrant,
protective smoke, may she pass, let’s imagine, with greater ease through her “dark gate.”
Bhanu Kapil Rider offers massage therapy and Ayurvedic treatments to her clients in Loveland, Colorado.
She also writes poetry and prose inspired by the rituals of working with the body. Her book, The Vertical
Interrogation of Strangers, was published by Kelsey Street Press in 2001. She can be reached at
bhanukapilrider@yahoo.com
Common Discomforts of Menopause & Ayurveda
Discomforts of menopause need to be treated in regards to the doshas of the woman having
the symptoms, as well as symptomatically, to avoid creating energetic imbalances which will
manifest in other ways. The wisewoman tradition recommends beginning with gentle
treatments which may help such as diet, lifestyle, energetic interventions, and nutritional herbs
& concentrated food supplements. Medicinal herbs may be the next step used and if they fail to
bring desired results then one may resort to treatments of drugs & surgeries.
Doing regular care with an Ayurvedic practitioner will ensure a personalized plan that suits the
individual needs of a given woman, addressing all her concerns in a holistic way. This is
especially important because of the changing nature of the menopausal change – what works
at one point may not work later. It will usually include a once or twice yearly Ayurvedic cleanse
& rejuvenation.
-Aching joints: This can be a Vata, Pitta or Kapha problem and treated with herbs. It indicates
toxins in the joints which need to be reduced before too much damage happens to the joints. If

joint are popping (V) massaging with warm castor oil or using a castor oil compress can help.
Also using just a teaspoon of castor oil daily in hot tea can be useful for joints (it is P when taken
internally).
Bladder
Incontinence: A vata problem This can be worked with by doing the Kegel exercises regularly,
vata soothing diet & herbs, and yoga postures – Vajrasana, Forward Ben, Shoulder Stand and
Plow pose . Weekly sesame oil basti (enema) will help calm the apana. Maya Abdominal
Therapy™ may help, especially if the uterus is prolapsing and exerting pressure on the
bladder. It will also improve circulation, which can support all the organs.
Increased risk of bladder infection: Plenty of water, healthy diet, wiping front to back, and
urinating after intercourse can help prevent infection. By watching for signs of infection &
treating as soon as possible allows for using herbs rather than antibiotics in most cases. I
recommend usnea tincture/ uva ursi tincture (don’t use this longer than 7 days ), unsweetened
cranberry or pomegranate juice,
Heart
High Cholesterol & risk of heart disease: Cholesterol does increase—with healthy diet &
Ayurvedic herbs it may be kept within limits. One simple remedy is to drink 1 cup of hot water
with 1 tsp. Honey and 1 tsp lime juice or 10 drops apple cider vinegar – this will scrape fat from
your system & reduce cholesterol. This is a Kapha problem and requires dietary changes &
regular exercise. Cardiotone by Ayush Herbs, shilajit, and other herbs for cardio health can be
supportive.
HOT FLASHES / CHILLS
This is a most common symptom associated with menopause. Simple cases may need only
Pitta reduction others have both Vata & Pitta aspects for some, with treatment being more
complex.
Most women don’t expect to have hot flashes until menopause, so it can be a big surprise
when they show up earlier, during perimenopause. Hot flashes — sometimes called hot flushes
and given the scientific name of vasomotor symptoms — are the most commonly reported
symptom of perimenopause. They’re also a regular feature of sudden menopause due to
surgery or treatment with certain medications, such as chemotherapy drugs.

An estimated 35%–50% of perimenopausal women suffer sudden waves of body heat with
sweating and flushing that last 5–10 minutes, often at night as well as during the day. They
typically begin in the scalp, face, neck, or chest and can differ dramatically among women who
have them; some women feel only slightly warm, while others end up wringing wet. Hot flash
frequency varies widely. Some women have a few over the course of a week; others may
experience 10 or more in the daytime, plus some at night. Hot flashes often continue for a year
or two after menopause. In up to 10% of women, they persist for years beyond that.
The Study of Women’s Health Across the Nation, which surveyed almost 15,000 women in the
United States, found that, on average, African American women had more hot flashes than
white women, and Asian women had the fewest of all ethnic groups surveyed. Research has
also found that hot flashes are associated with greater body weight, smoking, and stress.
Hot flashes tend to come on rapidly and can last from one to five minutes. They range in
severity from a fleeting sense of warmth to a feeling of being consumed by fire “from the inside
out.” A major hot flash can induce facial and upper-body flushing, sweating, chills, and
sometimes confusion. Having one of these at an inconvenient time (such as during a speech,
job interview, or romantic interlude) can be quite disconcerting.
Most American women have hot flashes around the time of menopause, but studies of other
cultures suggest this experience is not universal. Far fewer Japanese, Korean, and Southeast
Asian women report having hot flashes. In Mexico’s Yucatan peninsula, women appear not to
have any at all. These differences may reflect cultural variations in perceptions, semantics, and
lifestyle factors, such as diet.
Although the physiology of hot flashes has been studied for more than 30 years, no one is
certain why or how they occur. Estrogen is involved — if it weren’t, estrogen therapy wouldn’t
relieve vasomotor symptoms as well as it does — but it’s not the whole story. For example,
researchers have found no differences in estrogen levels in women who have hot flash
symptoms and those who don’t. A better understanding of the causes of hot flashes could open
the way to new, nonhormonal treatments.
One line of inquiry has focused on why some women have hot flashes and others don’t. An
intriguing explanation has emerged, thanks largely to research led by Wayne State University
School of Medicine scientist Robert R. Freedman, who has studied hot flashes for 25 years. He
and his colleagues have measured skin temperature, blood flow, and skin conductance (an
electrical measure of sweating) in menopausal women before, during, and after hot flashes.
They’ve asked subjects to wear monitors to collect hot flash data, swallow radiotelemetry pills
to measure core body temperatures, and spend nights in a sleep laboratory to have their hot
flashes tracked.

Freedman has found that women who have hot flashes have a lower tolerance for small
increases in the body’s core (innermost) temperature than women who don’t have hot
flashes. The body tries to maintain its core temperature within a comfortable “thermoneutral
zone.” When our core temperature rises above the zone’s upper threshold, we sweat; when it
drops below the lower threshold, we shiver. Women who don’t have hot flashes have a
thermoneutral zone of several tenths of a degree centigrade. But in women with hot flashes,
this thermoneutral zone is so narrow, it’s “virtually nonexistent,” says Freedman. As a result,
small variations in core body temperature — by as little as one-tenth of a degree centigrade —
that don’t trouble some women trigger hot flashes (and chills) in others.(Source: Adapted from
Freedman, RR. Seminars in Reproductive Medicine 2005; 23 (2): 117–125.)
What causes the thermoneutral zone to narrow? One idea is that elevated levels of the brain
chemical norepinephrine are involved. Norepinephrine has been shown to reduce the
thermoneutral zone in animals. Conversely, the drug clonidine, which lowers norepinephrine,
widens the zone in women with hot flashes. So do estrogen and certain antidepressants,
though scientists still don’t understand all the mechanisms.
Because hot flashes are triggered by elevations in core body temperature, the first-line strategy
for avoiding them is keeping cool:
o Drink cold beverages and avoid hot ones, use fans and air conditioners, and dress in
layers.
o Another nondrug technique is paced respiration. In controlled studies, Dr. Freedman
has shown that paced respiration can reduce hot flash frequency by about 50%. Women
in these studies were trained to take slow, deep, full breaths — expanding and
contracting the abdomen gently while inhaling and exhaling — at a rate of about six to
eight breaths per minute. One of the best ways to learn paced respiration is by taking a
yoga class, then practicing this technique twice a day for 15 minutes. You can also use
paced respiration whenever you feel a hot flash coming on.
MENSTRUAL PROBLEMS
-Menstrual irregularities, Cessation of menses, Menstrual cramps before or at beginning of

bleeding: these are Vata imbalances in general & are addressed by vata soothing
-Menstrual flooding, Spotting, Menstrual cramps during heavy bleeding: these are Pitta
imbalances which may also involve vata imbalance, helped by balancing Pitta or both Vata &
Pitta

-Fibroids: remember- fibroids will subside after menopause, so don’t go for surgery if you can
wait. There are different types of fibroids caused by the different doshas—treatment by a
practitioner is indicated.
-PMS symptoms may increase at this time:
• water retention: Kapha symptom—balance restored herbally

• sore breasts: fibrocystic breasts may be Vata or Kapha; premenstrual tenderness
without cysts is Pitta. Breast Massage on a regular basis will help diminish both
types.
• digestive distresses: may be V, P or K—this area is a specialty of ayurveda
• emotional uproar: Hormonal and role changes at this time lead to emotional
instability. It can be helped by drinking Brahmi tea daily and treating doshas
involved. Meditation and pranayama can also help stabilize.
• sore all over: This is related to toxins in the body being moved by Vata. Requires
cleansing and balancing.
OSTEOPOROSIS
Vata disorder of the bones—natural calcium supplementation (with shankabhasma,

dashamoola and lime water and a handful of white sesame seeds each morning) and exercise
are supplemented by bone breathing and general Vata reduction methods. Alakananda Ma
recommends for osteoporosis or osteopenia, a teaspoon of Arjun in a cup of warm milk twice a
day in the morning and evening can help restore normal bone density. Dr Lad recommends:
shatavari 5 parts, vidari 3 parts, wild yam 2 parts, shanka bhasma 1/8 part & kama dudha 1/8
part. Take ¼ tsp of this mixture twice a day with warm milk (cow’s, goat’s or oatstraw/almond
milk) as a daily maintenance dose indefinitely. Terra recommends Oat straw 5 parts, Comfrey
leaf 4 parts, shatavari 4 parts, and arjun 4 parts- use as a tea.
Stress is ever an enemy to women’s health and continues in osteoporosis. A Danish study
looked at perceived stress and fracture risk. Not only did the study find that high-stressed
participants had a 68% increased risk of hip fracture and a 37% increased risk of any
osteoporotic fracture. The research also suggests that it’s not just the stress itself, but our
perception of that stress that’s important.
The study determined this with nearly 8,000 Danish adults age 55+ who were categorized
according to their self-perceived level of stress. Note that the researchers didn’t try to measure
the level or type of stress itself! Instead, they asked the individual participants to describe what
their level of stress was — then watched to see who in the cohort experienced an osteoporotic
fracture over the next five years.

The one-fourth of people who reported a “high” level of perceived stress had the significantly
increased risk of fractures – again, a 68% increased risk of hip fracture and a 37% increased risk
of any osteoporotic fracture – compared to those who reported “low” perceived stress.
“Bone Breathing Practice (from https://www.tao-yoga.com/en/articles/bone-breathing.html )
1. Position – Sit comfortably and place the extended arms on your lap. The palms of the
hands are open and the fingers relaxed. Inhale gently through the nose in the direction
of the abdomen and then exhale deeply all the way from the abdomen. Do this several
times, mentally letting go of tension with each exhale. Bring your attention to the tip of
the index finger of the left hand.
2. Breathing into your fingers, hands and arms - The next time you take your normal
breath, simply let your attention run slowly from the tip to the base of that index finger.
As you exhale normally through the nose, let the energy stay in the finger and retune
your attention to the tip of the finger. Repeat the procedure again with the next breath.
As a sensation of heaviness or warmth develops in that finger compare it with the right
index finger where you have not done any breathing yet. This will help develop the
ability to feel more deeply and identify the sensation bone breathing brings. As the left
index finger becomes warmer or heavier, continue the same bone breathing procedure
with the rest of the fingers of the left hand, either one by one or all at the same time.
As the left hand becomes warmer and heavier, compare it with the right hand, where no
practice has been done yet. When you decide to incorporate the right hand into the
practice just reproduce the feeling in the left hand into the right OR start once again,
finger by finger. Once both hands are feeling heavy continue the same practice, but
higher and higher in the arms until the same feeling extends up to the shoulders.
3. Breathing with your toes, feet, and legs – it is best to remove the shoes and socks.
Guide your awareness up the toes, either singly or together up to the ankle, then
continue up the legs, as with the fingers and arms. Develop that feeling of warmth or
heaviness as with the fingers and arms.
4. Breathing up your spine – Begin at the tip of the sacrum (the tailbone) and run your
awareness up the spine, higher and higher, until you reach the base of the neck with the
same feeling of warmth or heaviness developed. As the practice progresses” and the
body relaxes, the gross breath through the nose may become more and more subtle. Do
not try to force back to gross, rather let it stay subtle and calm.
5. Breathing with the whole body – Continue to guide your attention up the bones
Eventually it is possible to have the whole skeleton doing bone breathing, including the
teeth. As practice develops, try to breath through the whole body at once, like a sponge.
If more specific knowledge of the bones is desired then it is advisable to work with an
anatomical chart of the skeleton to guide the energy with more precision.”
Bone density may decrease in the time just after menopause, but can increase again, with
proper nutrition and exercise, in the following years.

Osteoporosis:Asthi Kshaya
By Alakananda Ma on March 4, 2012
Image via Wikipedia
Dosha dhatu mala mulam hi shariram (1). Doshas, dhatus and malas
are the foundations of the body.
Osteoporosis is a common condition affecting as many as ten million

Americans, with an additional 34 million suffering from osteopenia. It
occurs most commonly in post-menopausal white women but may affect
all ages, sexes and ethnicities. Many older women either come to see an Ayurvedic practitioner
because they are concerned to prevent or treat osteoporosis, or list this condition as an additional
concern alongside their main complaint. In this article we will examine the Ayurvedic approach
to osteoporosis and its treatment.
Within bone, the trimurti functions of Brahma, creator, Vishnu, preserver and Shiva, destroyer
are clearly seen. Osteoblasts are the Brahma force, building bone, making collagen and
hydroxyapatite. Osteocytes, buried within the bone matrix, are the Vishnu force, maintaining
bone and preventing bone resorption. Osteoclasts are the Shiva force, dissolving and breaking
down bone (3).
The function of asthi dhatu is dharana, support of the body, along with nourishing majja (4).
When it is deficient (asthi kshaya) it gives rise to pain in the bone, breaking of teeth and nails
and dryness (5). Osteopenia is the puravarupa and osteoporosis is the full-blown rupa (6).
Vagbhat points out that, " In asthi resides vayu" (7). Asthi and vayu in the bones are in an
inverse relationship, so that factors that increase vata decrease bone mineral density (7). As with
any dhatu, there are several factors that can lead to dhatu kshay. If jatharagni is affected there
will be lack of poshana (nutrition) to asthi dhatu, leading to asthi kshay. For example,
undiagnosed celiac disease can lead to osteoporosis (8). If bhutagni is disturbed, particularly
parthiva agni, calcium and phosphate metabolism in the body will be affected. Again, there will
be lack of poshana of asthi, leading to ostepenia and osteoporosis (6). If asthi dhatu agni is
increased, there will be excess resorption of bone, or excess osteoclast activity, again leading to
asthi kshaya (6). And if asthi dhatu agni is diminished, there may be decreased bone formation or
diminished activity of osteoblasts in building bone.
Osteoporosis is particularly common in the elderly population--affecting men as well as women.

This is the vata time of life, and as we have mentioned, there is an inverse relationship between
vata and asthi. Furthermore, it is more difficult for geriatric patients to build the dhatus. Sa
evannaraso vriddhanam jaraparipakwa shariratwat aprinano bhavati--The essence of food will
not be able to build the tissues of elderly patients by nourishing them because these tissues are
over-matured due to age (9). Osteoporosis due to old age is known as Type II or senile

osteoporosis, and affects both men and women over the age of 70. Postmenopausal osteoporosis
due to estrogen deficiency is known as Type I osteoporosis and affects women age 50-65 (2).
Type I osteoporosis mainly affects trabecular bone. Fractures of the distal forearm such as Colles
fracture are quite common in this cohort, as are vertebral fractures (10, 2). Type II osteoporosis
affects both cortical and trabecular bone. Hip fractures are common among elderly patients with
osteoporosis, as well as wrist and vertebral fractures (2). In addition to these primary types of
osteoporosis, secondary osteoporosis may occur due to diseases which affect jathar agni,
bhutagni or asthi dhatu agni. Many individual patients may have a combination of primary and
secondary causes, leading to a complex clinical picture of multifactorial disease (2).
Causes of secondary osteoporosis include genetic disorders such as cystic fibrosis, Ehrler Danlos
Disease, glycogen storage disease, Gaucher disease, hemochromatosis, Marfan syndrome and
hypophosphatasia. Hypogonadal conditions can also cause osteoporosis; these include anorexia
nervosa, bulimia, female athlete triad (eating disorder, amenorrhea and osteoporosis in female
athletes participating in sports that emphasize thinness), hyperprolactinemia, premature
menopause, Turner syndrome (XO) and Klinefelter syndrome (XXY). Endocrine disorders such
as adrenal insufficiency, Cushing syndrome, Diabetes, hyperparathyroidism and hyperthyroidism
are causes of secondary osteoporosis, and the hormonal changes of pregnancy can also trigger
osteoporosis in susceptible individuals (2). Deficiencies of calcium, magnesium, protein and
vitamin D are causes, as are inflammatory conditions including inflammatory bowel disease,
Rheumatoid Arthritis, Ankylosis Spondylitis and Systemic Lupus Erythematosus. Leukemia,
lymphoma, metastatic cancer and multiple myeloma should also be considered in osteoporosis.
Symptoms of osteoporosis may be the first warning of an illness such a multiple myeloma. Note
that many medications are implicated in the causation of osteoporosis, including several that are
taken long term such as anti-convulsants, anti-retrovirals (AIDS medications), antipsychotics and
excess thyroxine (2). Additional causes of secondary osteoprosis include alcoholism, congestive
cardiac failure, depression, HIV and chronic liver disease.
Maria is a fifty eight year old white post-menopausal woman suffering from hepatitis C and HIV
co-infection. For the last fifteen years, she has had an alcohol problem. She has been clinically
depressed since taking Interferon for hepatitis C. She currently takes anti-retrovirals for HIV and
has done so for several years. Recently she suffered a severe Colles fracture requiring surgery. It
is easy to infer that Maria has significant osteoporosis but more difficult to pin down a cause. As
a post-menopausal woman, she is a candidate for primary type I osteoporosis. But possible
contributing secondary causes include HIV, hepatitis C, depression, alcoholism, and
antiretrovirals. Some causes cannot be removed. For example, her anti-retroviral medication is
obligatory. Therefore, vigorous effort should be made to remove treatable co-factors such as
alcoholism, lack of exercise and poor diet. It would be valuable to assess her vitamin D levels.
She should also be checked for non-Hodgkins lymphoma, common in HIV patients.
Treatment of asthi kshaya falls into four stages
1. Hetu viparita chikitsa: removal of the cause
2. Agni deepan: Treat the affected agnis
3. Vata shamak: Pacify vata
4. Dahtu rasayana: Build bone

Hetu viparita chikitsa
Since osteoporosis is multifactorial in so many cases, begin with a hetu (causation) worksheet. Is
the condition primary, secondary, or both simultaneously, as in the case of Maria? List all the
secondary factors: prajanaparadh, diet, lifestyle, genetic, inflammatory, iatrogenic etc. Now note
which of those factors can be removed. For example, Maria had the option of going sober and
removing one cause of her osteoporosis completely, or a patient of celiac disease could go off
gluten completely. Next note causes which may not be able to be removed completely but could
be modified. For example, the patient could discuss with their MD any possible changes to their
medication schedule, for greater bone health. By removing or modifying any aspects of hetu that
are amenable to being addressed, an optimal outcome can be obtained.
Agni Deepan
Next, use an agni worksheet to think carefully through all the agnis involved. Again, in a
multifactorial situation, several agnis may be involved. If jatharagni is involved, it may be
rehabilitated using suitable teas, herbs and spice blends, as well as home remedies such as grated
fresh ginger marinaded in lemon juice with a little rock salt. If bhutagnis are involved, herbs that
target the liver, such as guduchi, neem or kalmegh, along with anupans such as aloe vera may be
helpful. Be careful not to provoke vata. If asthi dhatu agni is involved, guggulu can be used to
balance asthi dhatu agni.
Vata Shamak
The patient with osteoporosis requires pacification of vata, because of the inverse relationship
between vata and asthi. This will include use of vata pratyanika herbs such as ashwagandha and
vidari, vata pacifying diet, daily self-abhyanga and lifestyle modifications. Basti treatments will
be extremely helpful, alternating matra (oil) basti using sesame oil with niruha (decoction) bastis
using dashamooal tea.
Dhatu Rasayana
'For decrease of dhatus, counter-measures are this foods and substances that cause their increase'
(11). Traditionally this is accompliashed by use of bhashmas of similar composition to bone,
such as shankha bhasma (conch shell ash), praval panchamrit (combination of conch, coral,
pearl, mother-of-pearl and cowrie). Nowadays, there are issues of both sustainability and
mercury contamination in using marine bhasmas. Therefore it may be safer and simpler to select
other substance endowed with the properties of asthi i.e. "guru (heavy), kathina(hard), khara
(rough), sthula (bulk), sthira (remains for a long time) and murtimad (having shape)" (6). This
includes milk, ghee, tikta ghee (tikta adds the khara property), turmeric milk (turmeric adds the
khara property), urad dal, red rice, and for non-vegetarians, chicken soup. Yogaraj guggulu can
be used to kindle asthi-dhatu agni and heal bony pain. Arjun is high in calcium and very good for
healing bone and is traditionally used for fractures and osteoporosis in the form of kshirapak or
medicated milk. Ashawagandha kshirapak may also be used. Ayurveda has its own methodology

for providing Vitamin D in the form of early morning sunbaths. However, it should be
considered that as people age, their ability to manufacture vitamin D from sunlight diminishes
(12). Therefore Vitamin D3 supplementation is also advisable. Eating unhulled sesame seeds is
recommended as a calcium supplement (13).
Using these four steps of Ayurvedic treatment, the multifactorial condition, asthi kshay or
osteoporosis can be prevented, controlled or effectively managed for best outcomes.
1. Sushrut, Sutrasthana 15/3

2. Dana Jacobs-Kosmin Osteoporosis http://emedicine.medscape.com/article/330598-overview#a0156 accessed
27 Nov 2011.
3. Buckwalter JA, Cooper RR Bone structure and function.Instr Course Lect. 1987;36:27-48
4. Sushrut sutrasthana 15/6
5. ibid v 9
6. Kadlimatti SM, Maheshwari KS, Chandola HM, Critical Analysis of the Concept of Asthi Kshaya vis-à-vis
Osteoporosis Ayu-Vol. 30, No. 4 (October-December) 2009, Pp. 447-458
7 .Vagbhat, sutrasthana 11/26-27.
8. Kemppainen T.; Kroger H.; et al Osteoporosis in adult patients with celiac disease - Frequent
clinical onset during pregnancy or the puerperium Bone, Volume 24, Number 3, March 1999 ,
pp. 249-255(7)
9. Sushruta, sutrasthana, 14/19
10. S.A. Earnshaw, S.A. Cawte Colles' Fracture of the Wrist as an Indicator of Underlying Osteoporosis in
Postmenopausal Women: A Prospective Study of Bone Mineral Density and Bone Turnover Rate Osteoporosis
International Volume 8, Number 1, 53-60, DOI: 10.1007/s001980050048
11. Sushrut, Sutrasthana 15/10

12. John H. Lee, MD*, James H. O'Keefe, et al Vitamin D Deficiency
An Important, Common, and Easily Treatable Cardiovascular Risk Factor?
J Am Coll Cardiol, 2008; 52:1949-1956, doi:10.1016/j.jacc.2008.08.050
13. http://whfoods.org/genpage.php?tname=dailytip&dbid=74 accessed 30 Nov 11
WEIGHT GAIN
Some weight gain (about 10 lbs) can be healthy for menopausal years because the fat tissue
helps with estrone production after menopause. Weight gain occurs due to slowing of
metabolism—excess weight gain may be due to thyroid dysfunction as well. Excess weight is a
risk factor for many diseases as well a disability due to joint problems.
Bright Line Eating (for details go to www.BrightLineEating.com – The four bright lines to keep to
control eating problems.
1. No sugars (any kind)

2. No flours (any kind)

3. Only three meals a day

4. Measured quantities of protein, carb, veg, fruit, and fat in each meal
Following these rules helps lose weight and then, titration of amounts, maintains weight loss.
The Maintenance diet is created by you, step by step, when you reach your goal body.It is
based on scientific understanding of not only being overweight, but of brain chemical changes
due to eating habits. . A quiz determines your “Susceptibility Scale” (
https://foodfreedomquiz.com) score, how much you may be a food addict. Bright Line Eating:
) Studies have shown this program effective for any age, male or female. Even weight loss of
100-200 lbs is common in BLE. Special support is there for bulimic and other restricted eating
disorders as well. Social support is an important part of this program, similar to 12 step
programs for other addictions.
Adaptable for all doshas. Since many obese people have abused food in ways that has
compromised their agni, addressing agni is an important Ayurvedic consideration.
The only problem with their standard plan with Ayurveda is that eating fruits at meals can be
ama producing for some people, although the option of eating more vegetables instead of fruits
is given.
I have personally followed this eating program 2 ½ years, lost 40+ lbs and on maintenance
since April 8, 2020 . Let me know if you want more information.
STRONG MOOD CHANGES
• Mood symptoms. Estimates put the number of women who experience mood symptoms during
perimenopause at 10%–20%. Some studies have linked estrogen to depression during the
menopausal transition, but there’s no proof that depression in women at midlife reflects
declining hormone levels. In fact, women actually have a lower rate of depression after age 45
than before. Menopause-related hormone changes are also unlikely to make women anxious or
chronically irritable, although the unpredictability of perimenopause can be stressful and
provoke some episodes of irritability. Also, some women may be more vulnerable than others to
hormone-related mood changes. The 2005 NIH conference concluded that the best predictors of
mood symptoms at midlife are life stress, poor overall health, and a history of depression.
Depression/ Anxiety/ Fear/ Extreme Nervousness: Vata symptoms call for calming of nerves,
warming, and oiling. Brahmi tea is indicated as well as flower essences and aromatherapy for
specific cases. My go-to formula which I adapt to individual needs is: Brahmi, Bacopa,
Shankapushpi, Shatavari &/or Ashwaganda, plus a digestive herb. I give as tea or powder with
ghee

Rage / Oversensitivity / Irritability: Pitta symptoms call for cooling of temper and irritability
with pitta reducing lifestyle & herbs as well as Brahmi tea. Sandalwood oil in belly button.
Cooling breaths. Deep breathing.
BRAIN FUNCTION
Many women complain of short-term memory problems and difficulty concentrating during the
menopausal transition. Although estrogen and progesterone are players in maintaining brain
function, there’s too little information to separate the effects of aging and psychosocial factors from
those related to hormone changes. Again – my go-to formula for nervous system is Brahmi, Bacopa,
Shankapushpi, with Shatavari &/or Ashwaganda and a digestive herb – as a daily tea or powder with
ghee.
SLEEP DISTURBANCES
Data presented at a March 2005 NIH conference on managing menopausal symptoms suggest that
about 40% of perimenopausal women have sleep problems. Some studies have shown a relationship
between night sweats and disrupted sleep; others have not. The problem is too complex to blame
on hormone oscillations alone. Sleep cycles change as we age, and insomnia is a common age-
related complaint in both sexes.
In my practice, treating perimenopause problems, Vata or Pitta problems and adrenals (if Vata) can
help. Sleep hygiene is basic – cool, quiet, dark room; stop electronics a couple of hours before bed;
eat the last meal several hours before bedtime. I use “Deep Stress” tincture before bed or when
wake too early and want to sleep more. This helps some. Remind them about the changeable
nature of menopause.
UTERINE PROLAPSE
“Uterine prolapse is when the womb (uterus) slides from its normal position into the vaginal
area. There are four stages of uterine prolapse. First degree uterine prolapse is when the
cervix drops into the vagina. Second degree is when the cervix sticks out of the opening of the
vagina. Third degree is when the cervix is outside of the vagina and fourth degree is when the
entire uterus is outside the vagina. Here is a quick video that demonstrates a uterine prolapse,
I can’t be held responsible for what videos show up after this one has played. ; )
Cystocele is when part of the bladder bulges into the vagina. Rectocele is when the rectum
bulges into the lower rear vaginal wall. This can make bowel movements difficult and women
may need to push on the inside rear wall of the vagina with their fingers to empty the bowel.
Enterocele is when a portion of the small intestine bulges into the vagina through a herniation
in the rear upper portion of the upper rear vaginal wall.

Prolapse is a result of a weakness in the supporting structures of the organs such as muscles,
ligaments and fascia. The weakness can be caused from lack of proper alignment of the skeletal
muscles, traumatic falls or accidents, emotional component/trauma, spleen qi deficiency,
kidney yang deficiency, and from using the valsalva maneuver. Valsalva is when you take in a
breath, seal it off and push to get things like poop, babies and snot out. Excessive pushing
(valsalva) causes unnecessary intra-abdominal pressure and can lead to damage of the
supporting tissues.
“The human body has great equipment for expelling various items. Smooth muscle creates
wave-like motions that move items through the body (like food through your digestive tract,
or particles up through your sinuses). Specialty muscles like the diaphragm (generating
upward forces for coughing and vomiting) and the uterus (vaginal delivery) are well-
designed and can really get the job done for you,” Katy Bowman-bio-mechanical scientist.
Read more here about the over-developed habits that we have created that work against
our natural expelling mechanics, making elimination of all types more difficult.
Symptoms of prolapse:
• Heaviness in the pelvis

• Pelvic pain
• Constipation
• Urinary Incontinence
• Urinary frequency and urgency
• Lower back pain
• Difficulty walking
• Protrusion of tissue
• Difficulty urinating
• Difficult or painful intercourse
• May feel like you are sitting on a ball
Help my uterus is falling out:
Remember, it is easier to prevent than to cure especially if you are experiencing stage three and
four prolapse.
1. Stop sucking in - When you pull your stomach muscles in and do lots of core work WITHOUT
also strengthening your pelvic floor you can be actually forcing the uterus downwards.
3. Stop straining during bowel movements. Also, using correct bathroom posture will help
reduce need for straining - squatting on toilet or using a stool under feet to simulate a squat.

4. Learn the self-care massage called Arvigo Techniques of Maya Abdominal Therapy™
(ATMAT). The technique is a non invasion external technique designed to lift and center the
uterus. The uterus is supported by ligaments and ligaments have a fraction of the blood supply
that muscles do, so they take longer to heal. So doing your self-care massage two times a day is
very important because every time you do the massage you bring fresh blood supply and
nutrients to the tissues to speed healing as you guide the uterus back up to the natural
centered position. A certified ATMAT practitioner will teach you the self-care massage during
your first session. When at home you will do the massage on a slant board (about 45 degrees)
or pillow that puts your hips in a posterior tilt (pubic bone slightly higher than the ASIS when
laying on your back). The massage is done everyday except when you are menstruating, five
days before menses, if you think you may be pregnant, or have an infection or cancer present.
The self-care massage takes about five minutes each time.
5. It is ideal to see your Arvigo Techniques of Maya Abdominal Therapy™ practitioner one to
three sessions a month for three months depending on your situation. There is posterior work
that we can do to help correct pelvic alignment, increase abdominal blood flow and lift the
uterus. Best results have been seen with women who have stage one and two prolapse, with
moderate improvement in stage three prolapse with diligent self care massage and alignment
awareness.
6. Wear a faja. A faja is a a cloth worn by Central American women to support their uteri. You
can make your own faja or purchase one from a ATMAT practitioner for about $7. To make one
cut a strip of cotton muslin cloth about 12 inches wide and three to four yards long. It should
be long enough to wrap around your pelvis twice with room to tie a knot in the ends. A shawl
or old cotton sheet may also work well. https://www.youtube.com/watch?v=EsmEyrrCpcA
7. No lifting over 10 pounds while you are healing if you are not able to lift without the valsalva
maneuver (creating internal pressure).
8. Nourish uterine ligaments- “A disturbance in the balance of Calc. fluor. or Calcium Fluoride
in any of the body tissues, can cause a chronically relaxed condition of any of the associated
tissues,” from the Natural Health DOC website. There is a homeopathic suppository remedy
for prolapse, homeopathy can be very specific to the individual, so best to see someone who
specializes in this.
9. Uterine meditation/visualize the uterus lifting
10. Ask for help when needed. Many women with prolapses report that they lack adequate
support from their loved ones or coworkers. Remember some people may not know you need
help unless you ask.
11. In Belize some midwives use Vicks Vapor Rub on a tampon to make the uterus “jump” back
into position. Vicks was an inexpensive and easy to acquire product for them to use. I would

NOT recommend using Vicks in the vagina. However some practitioners use Ashwaganda/Bala
oil on a tampon at bedtime. “This vata-pacifying oil can be used to nourish and strengthen the
muscles. Useful for athletes and those weakened by debility due to old age or illness. Literally
meaning “strength”, bala builds muscle mass and provides energy,” from the Banyan Botanicals
website. (Terra’s note: this is an apana problem - treat it so - this picchu can help balance the
apana - but look at the earlier apana balancing protocols for more things you can do as well!)
12. Yoga students may do daily inversions except 3-5 days before menses and during bleeding-
shoulder stands, head stands, hand stands.
13. Acupuncture, moxa or acupressure to certain points to raise the organ qi or treat
deficiency. GV20 is perhaps the point most well-known for the treatment of prolapse. Located
five cun within the anterior hairline on the governing vessel channel, it has the ability to raise
the yang. A cun is the distance between the distal and proximal inter-phalangeal joints of the
middle finger and is used as a measuring tool to find acupuncture points. Prolapse can have
several sources, so see a qualified acupuncturist for treatments and learn self-care pressure
points.
14. Stop wearing positive heeled shoes. High heeled shoes are bad for the pelvic floor, here is
why.
15. Manage your general health, including alternative modalities and using conventional health
care when needed. In some cases, especially stage four prolapse, a pessary may be used. A
pessary is a small plastic or silicone medical device which is inserted into the vagina and acts as
a support. Posted by Barbara Loomis, LMT, RES on Feb 16th, 2012
Terra also includes:
• Vaginal steams to balance the apana - since there is no longer much pitta in the area -
unless there’s an infection. It also increases pelvic circulation, which decreases
dramatically in the menopausal time.
• Kegels on a slant board
• Calc Flor tissue salt or Bioplasma tissue salt to feed the ligaments.
• Marma points - for the uterus and vagina
• Be sure you have your phytoestrogens support as outlined - this helps tissues stay
elastic.
YONI SYMPTOMS
Vaginal tissues start to age with lack of estrogens and greatly reduced blood flow in the area.
This can lead to both vaginal discomfort and a lower libido.
Vaginal dryness, itching, dyspareunia - treatment suggestions

• Phytoestrogens in diet
• Be sure you’re well hydrated! Rasa & rakta play a big role in vaginal health and sexual
excitement fluids come mostly from moisture from yoni lining.
• Shatavari ghee pichu or use as sexual lubricant - be sure to use a lubricant – I
recommend Yoni Luscious by Heather Baines –
heather@RootsOfWellnessAyurveda.com
• Shatavari decoction for yoni basti (douche) weekly
• Maya abdominal therapy and kegels to increase circulation
• Sexual excitement increases circulation and keeps area alive - at least weekly - use it or
lose it!
Lack of Sexual Desire -

• Be sure you are in a loving relationship - with another &/or YOURSELF
• Kegel exercises greatly increase circulation in the pelvic area, necessary for arousal, and
also contribute to larger orgasmic response. General health of the area is enhanced.
• Maya Abdominal Massage increases circulation, decreases tension which might inhibit
sexual feelings.
• Saltwater foot baths, hot water bottles to the lower abdomen &/or feet stimulate
circulation in the area.
• What turns you on? If nothing does now—what used to turn you one? Pay more
attention to this. Do it. Fantasize about it. Talk about it with your partner.
• Higher estrogen means more circulation to the pelvis-. If you reduce excess estrogen
for health reasons with drugs or DIM, this may be a side effect. Use other ways to
increase the circulation, if needed.
• Testosterone peaks at ovulation and just before and during menstruation. It seems to
effect desire but it isn't clearly shown for all women—it seems more important in men.
Stress and lack of exercise diminish testosterone levels, although very strenuous
exercise can also diminish it. Make sure that you are getting enough saturated fat &
cholesterol to make hormones-- 1 tablespoon of butter, ghee or coconut oil daily if you
need to supplement. Stephen Buhner, herbalist, reports that pine pollen is exceedingly
high in testosterone. Ingestion of the pollen itself, or the tincture of the pollen in
dropperful doses, seems to gradually increase libido in those susceptible to its action.
• Reduce tension and stress. They create fight or flight hormones, made for emergency.
Relaxation allows for the “feed and breed” hormones, supportive of digestion AND
sexual pleasure. What conditions do you need to get comfortable and relaxed enough
to make love with your partner? How do you create those conditions more frequently?
• Herbs for increasing desire-
• Jasmine V+excess, PK- emmenagogue, cleanse uterus, aphrodesiac
• Vitex berries (Agnus castus)--The berries are considered to be an aphrodisiac,tincture is
a convenient way to take this- a tonic so may take a month or two to work
• Aphrodesiac formula for women – p 107 from Sex, Love and Health by Brigitte Mars
o 2 parts damiana herb

o 2 parts schizandra berry

o 11/2 parts rosemary leaves
o 11/2 parts organic rose flower
o 1 part clove bud
o 3 cups water
1. Combine all the herbs
2. Place 3 tablespoons of herbs in a Mason jar. Add 3 cups boiling water. Cover and let sit
overnight.
3. Strain infused tea from spent herbs. Drink 1 cup of the tea before each meal during the
day.
4. Continue this daily program for one-two months.
Alzheimer's Disease
Within Ayurveda, every aspect of life is governed by the interplay of the three doshas (body
humors), vata, pitta, and kapha. Throughout the hours of the day and the seasons of the year,
these doshas predominate in a rhythmic and cyclical manner. Similarly, throughout an
individual's lifetime, each dosha has its time of predominance. Kapha governs childhood; pitta,
maturity; and vata, old age. Thus, during the latter years of life, there is a tendency towards vata
imbalances, such as memory loss, disorientation, paranoia, tremors, rigidity, cracked and
quaking voice and stooped spine. The condition known to Western medicine as Alzheimer's
disease constitutes, according to Ayurveda, a drastic and accelerated form of this vata
provocation of old age.
In Alzheimer's disease, the vata is severely provoked in the majja dhatu, the tissue layer which
includes the central nervous system and all other tissues which are contained within bone. The
vata dries and thus degenerates the brain. In addition, the vata passes from the majja dhatu to the
mano vaha srotas, or "mind-carrying channels," causing thought disorders such as paranoia and
delusions as well as memory loss and confusion.
The causes of this severe vata provocation within majja dhatu and mano vaha srotas are both
hereditary and acquired. Susceptible people are those who have a hereditary weakness of the
majja dhatu. Once vata is provoked, it follows the line of least resistance, moving into the
weakest tissue layer, in this case, the majja dhatu. Acquired causes are those which serve to
aggravate the vata dosha sufficiently to bring about the onset of the disease in susceptible
subjects. Unfortunately, our stressful, fast-paced, coffee-driven lifestyle provides abundant
opportunities for such provocation. In addition, we are exposed to a number of environmental
toxins which specifically weaken the majja dhatu, causing greatly increased susceptibility to
Alzheimer's disease. Aluminum, pesticides, herbicides, agent orange, lead, and other toxins have
a specific action in weakening the majja dhatu agni, the metabolic fire of the central nervous
system.

One particularly important factor in the causation of Alzheimer's disease is the increased rate of
change and increased population mobility. A person born before the first World War has
witnessed changes more rapid than those experienced previously by many generations. Change
provokes vata, as does movement. Relocation, movement of family members, and other such
shifts present a much more vata-provoking situation than does the old village life, where people
were born and died in the same house, surrounded by familiar family members.
Prevention, mitigation, and treatment of Alzheimer's disease requires that we create more stable,
calming, vata-soothing lifestyles for ourselves and our elders. Regular routines, calm family
mealtimes, daily rituals, and a slower pace of life will help to reduce the vata-provoking effects
of our exponentially increasing rate of technological change. The old tribal or extended family
systems must be replaced by stable and committed support networks. This is particularly
important since, according to Ayurveda, a person with Alzheimer's disease is best nursed at
home whenever possible. Relocation to the unfamiliar environment of a nursing home is
drastically vata-provoking. However, homecare cannot realistically be provided by a single care
giver, and is possible only when a solid and reliable support network is available.
From an Ayurvedic standpoint, it is recommended that health departments and health insurance
companies focus on providing in-home services for patients with Alzheimer's disease, rather than
nursing home care, since patients have a much greater chance of retaining a higher level of
functioning when as little change as possible is made in their way of life.
Treatment
General and Specific
General vata pacifying measures should be introduced as soon as the onset of symptoms appears,
or, better still, as soon as susceptibility is suspected. These include daily oil massage (or self
massage) before taking a warm shower; taking a vata-soothing diet; and drinking, at bedtime, a
cup of warm milk with a teaspoon of ashwaganda (Withania somnifera) and a half a teaspoon of
ghee (clarified butter). If the cholesterol level is high, the ghee can be omitted, and skim milk can
be used.
When older people live alone, they may consume an inadequate diet consisting of, for example,
bread and coffee or frozen dinners. As much as possible, caffeine, frozen foods, and dry foods
should be eliminated from the diet to prevent the development of vata provocation. In severe or
advanced cases of Alzheimer's disease, a khichari diet could be given. This consists of Basmati
rice, mung dal, well-cooked vegetables, and mild digestive spices such as cumin, coriander,
fennel, turmeric, and ginger. At bedtime, the soles of the feet should be massaged with warm
sesame oil.
In younger patients and in milder or earlier stages of the disease, cleansing practices may be
indicated. These are svedan (sweating), basti (Ayurvedic enema), and nasya (nasal medication).
Sweating is applied after oiling with sesame oil. A simple form of sweat that can be done at
home consists of taking a bath at a comfortable temperature with one-third of a cup of dry ginger

powder and one third cup baking soda in the tub. The ginger will promote sweating, so that after
taking the tub, and remaining in a warm place, sweating should occur.
Basti
Madhu tail basti
1 1/2 pint pure water

1 oz. anise seeds
1 oz. ashwaganda (Withania somnifera)
1 oz. brahmi (Bacopa monniera)
Simmer, with lid on, for 20 minutes, then add:

2 oz honey
2 oz sesame oil
1 t salt
Strain and cool to slightly above blood heat and use as enema.
Vata-soothing basti
Indicated in severe vata provocation; contraindicated in pitta provocation

Equal parts:
Mustard seed decoction
Whey
Soured rice gruel
Cow's urine
Use as an enema.
In the case of unavailability of certain ingredients (e.g., organic cow's urine), mustard seed
decoction alone may be used with good effect.
Oil basti
3-4 oz warm sesame oil, retained if possible for about half an hour.
Basti treatment should not be used with very old or very frail people, although a 2- oz oil basti
may still be used if constipation is a significant issue.

Nasya Treatment
Indicated nasyas for Alzheimer's disease:
Brahmi (Bacopa monniera), ghee nasya -- best if there is any pitta provocation
Vacha oil nasya (Acorus calamus) in sesame oil -- best for severe vata provocation without any
concurrent pitta provocation.
Nasya should not be used in very old, very frail or severely confused subjects, but only for those
who are capable of understanding how to use the nasya correctly.
Specific treatment for Alzheimer's disease consists of the use of herbs which act upon the majja
dhatu and mano vaha srotas. Chiefly, these are brahmi, vacha, jatamansi (Nardostachys
jatamansi; ssp: grandiflorum), and Akar karabha (Anacyclus pyrethrum). Generally, the most
useful remedy for Alzheimer's disease is sarasvati churna, which is highly effective in presenting
and enhancing memory and intellect. Sarasvati churna can be taken in doses of one quarter to
one-half teaspoon twice daily after meals. In severe cases, it can be taken three times daily. In
cases where there is a bleeding disorder, ulcer, or bleeding hemorrhoids, brahmi and jatamansi
may be used, but vacha should be omitted completely, since it is contraindicated in bleeding
disorder.
Akar karabha, which contains the active ingredient anacycline, is extremely important in the
treatment of Alzheimer's disease. Unfortunately, it is currently unavailable outside India. It may
be used as a medicated milk:
1/2 teaspoon Akar karabha

1/2 teaspoon Brahmi
I cup milk
Boil together and drink at bedtime. It may also be used as a tea, using 1/2 teaspoon Akar karabha
and 1/2 teaspoon shankapushpi (Evolvulus alsinoides). Steep 10 minutes in I cup boiling water
and drink 2-3 times daily.
Despite the great usefulness of these general and specific measures in the treatment of
Alzheimer's disease, regularity and stability remain the most important factors in treating this
condition. Meals and remedies must be given at regular times, treatments such as oil massage
must be administered according to a fixed schedule, whilst familiar faces and familiar
surroundings are also of great importance. Any conditions that are haphazard, irregular or
unexpected will serve only to provoke the vata still more. To be useful at all, Ayurvedic
treatment of this condition must be both regular and prolonged.
Peer-reviewed article first published in the Protocol Journal of Botanical Medicine.
Alakananda Ma M.B., B.S. (Lond.) is an Ayurvedic Doctor (NAMA) and graduate of a top
London medical school. She is co-founder of Alandi Ayurveda Clinic and Alandi Ayurveda

Gurukula in Boulder Colorado, as well as a spiritual mother, teacher, flower essence maker and
storyteller. Alakananda is a well known and highly respected practitioner in the Ayurveda
community both nationally and internationally.
Sources & for more information:
-Notes from lecture of Dr. Lad on Ayurvedic Gynecology

- The Complete Book of Ayurvedic Home Remedies, Dr Vasant Lad
-Lecture, Alakananda Devi, Menopause journey
-Wise Woman Ways for the Menopausal Years by Susun Weed
-Balance Your Hormones, Balance Your Life by Dr. Claudia Welch, MSOM

Final Exam – Classes 6-10 Women’s Health Yoga Veda Institute,
Terra Rafael, Instructor – wisewomanhood@gmail.com www.wisewomanhood.com
FEMALE FERTILITY CONCERNS

1. Eve’s cycles have a short luteal phase (between ovulation & menses). What would you
recommend to help her normalize, to become pregnant?
a. Feed her ovaries with Vidari herb and dosha appropriate diet
b. Use CoQ10 supplement to support corpus luteum mitochondria
c. Suggest Vitex tincture to increase progesterone
d. All of above
2. Pancha karma with rejuvenation before pregnancy is ideal & highly recommended for both
women and their male partner
a. True
b. False
3. Eve’s friend Judy heard you’re great at helping women with fertility. After she charts her
cycles you see that her temperatures are very erratic, no pattern.
a. Suspect that she is not ovulating
b. Suspect she has a thyroid problem
c. It’s possible she isn’t following best practices in taking temperatures
d. All of above
4. Karen is 27 years old and wants to get pregnant. She was on Birth Control pills for 10 years
and stopped 3 months ago. She just got her first period since stopping. What is one concern
you know is indicated with this information?
a. Start CoQ10 supplement
b. Her thyroid
c. Recommend liver cleanse / Pancha Karma
d. All of above
5. Nancy is 35 year old, high energy business woman who wants to get pregnant. She is V2 P3 K1
with vikruti of V3 (pushing) P4 K1. She went off Birth control pills 3 years ago and has tried to
get pregnant but has excessive bleeding with periods. What would you definitely include in
her plan?
a. Stress reducing techniques
b. Check her thyroid
c. Increase her exercise regime
d. All of above
PREGNANCY
6. When in-utero babies are most susceptible to teratogens.
a. Preconception
b. 1st Trimester
c. 2nd Trimester
d. 3rd Trimester
7. The 8th month of pregnancy is significant for mother and baby according to Ayurveda because:
a. That’s when the soul enters the body.
b. She must do special ceremonies to ensure a safe birth.
c. The ojas moves between the mother and baby and needs to be supported.
d. If the mother is too sad then, her child will have breathing problems.
8. Main functions of the placenta

a. O2/ CO2 transport
b. Nutritional transport
c. Removal of Waste products
d. All of above
9. Which subdosha is most important for fetal development and positioning during pregnancy?
a. Apana Vata
b. Sadhaka Pitta
c. Sleshaka Kapha
d. Samana Vata
10. Which Ayurvedic procedure is allowed in pregnancy according to ancient texts.

a. Nasya
b. Massage after the first trimester
c. Head-evacuation
d. Sudation - heat therapy
11. Signs of Vata excess in pregnancy.

a. Changeable appetite, irregular eating habits
b. Swelling
c. Bleeding gums
d. All of above
12. Which are Vata soothing measures for pregnancy?
a. Self massage with warm sesame or almond oil can be very soothing after the first
trimester- especially the feet and the head
b. Use gentle speech and focus on positive languaging, avoiding comments that might
scare her
c. Encourage routine in her life, especially for eating, sleeping, BM
d. All of above
13. Which are ways to maintain or restore apana balance during pregnancy
a. Take Triphala to balance the apana.
b. Avoid jarring activities - snowboarding, falls, gymnastics, excessive jumping, jarring
sexual activities.
c. Massage of the third eye chakra.
d. All of the above
14. Signs of Pitta excess in pregnancy

a. Changeable appetite, irregular eating habits
b. Bleeding gums
c. Swelling
d. All of above
15. Signs of Kapha excess in pregnancy

a. Swelling
b. Over exercise
c. Changeable appetite, irregular eating habits
d. All of above
PREGNANCY CONCERNS
16. Which of these is not a Danger Sign Of Pregnancy
a. Swelling hands, feet & face
b. Indigestion
c. Blurry vision
d. Pain not relieved by BM
17. Apana vata imbalance can cause

a. Miscarriage
b. Malposition of the baby
c. Developmental mistakes of the baby
d. All of the above
18. Tammy is a healthy Kapha woman who is 3 months pregnant. She’s been craving dairy and
eating lots of it. She has a yeast infection now. Which is most relevant advice?
a. Eat a Kapha reducing diet, avoiding sugar and dairy
b. Avoid eating bread due to the yeast in it.
c. Get more exercise.
d. None of above
19. Which measures can support post miscarriage recovery with Ayurveda
a. Using sanitary pads instead of tampons
b. Trifala to support apana normalization
c. Therapeutic enemas
d. All of the above
20. Nancy is now 37 weeks pregnant, in for an Ayurveda check-in with you and showing signs of:
blood pressure above normal and swelling in her hands and face. What is highest priority?
a. Recommend she immediately check in with her midwife or OB
b. Tell her its normal to swell in pregnancy
c. Check her reflexes
d. Recommend a liver cleanse
LABOR AND BIRTH
21. Your sister is going to be in labor soon. She’s V3 P2 K1. She asks you for a couple of simple
helps from “that Ayurveda thing” you’ve been studying. Which of these would be appropriate
general helps to recommend:
a. Keep cool during labor.
b. Take castor oil on the due date.
c. Massage in early labor with warm bala oil.
d. Write down every contraction, and its duration as soon as they start.
22. Judy (V3P2K1) is in labor. She gained 20 lbs eating a healthy diet. She has been excited and
up all night but now is only 2 centimeters. Her baby is in a high transverse position.
a. Have her jump on a rebounder to bring the baby head down.
b. Massage her with warm bala oil and encourage her to sleep on the side the baby’s head
is on.
c. Get her to walk up and down the stairs to increase contractions.
d. None of the above
23. June ( V2P2K3) is in labor. She is smiling and relaxed even though 7 centimeters after a long,
slow laboring time.
a. Be sure someone checks that the baby’s heart is showing signs of health and stamina.
b. Massage her with warm coconut oil.
c. Make sure she keeps from over exerting herself.
d. Give her warm shatavari milk to build her stamina.
24. Postpartum is predominantly Vata phase because:

a. The uterus has become empty
b. Her hormones have shifted
c. She is overwhelmed after the work of labor
d. All of above
MENOPAUSE
25. Sylvia (V2P3K2) is 48 yrs old. After years of regular, 28 day cycles,now they are heavy periods,
happening every 21 days . Her doctor ruled out fibroids. She has trouble going to sleep at
night. She wonders if she’s in menopause. She’s at what stage of her process?
a. Reproductive phase
b. Early Perimenopause
c. Late Perimenopause
d. Menopause
26. A Vata perimenopause menstrual pattern is commonly:

a. Stop suddenly and be done
b. Get heavier, closer together then stop
c. Get lighter, further apart then stop
d. Get heavy, then light, then heavy until stops
27. Why are phytoestrogens helpful support during perimenopause?

a. Prevent progesterone dominance
b. Adaptogenic action on estrogen receptors
c. Offset Hormone Replacement Therapy
d. None of above
28. Emergency stopping of flooding during perimenopause can be through:

a. Arjun
b. Yarrow tincture
c. Tulsi
d. All of above
29. There is a natural increase of _______ in every woman going forward from menopause.
a. Vata
b. Pitta
c. Kapha
d. Vata and Kapha
30. Osteoporosis is not treatable by Ayurveda.

a. True
b. False

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Course TItle Women’s Health

Course Instructor Terra Rafael

Class Time Wednesdays, 12:00 - 2:00 pm EST (excluding school holidays)

Contact Info. terra@wisewomanhood.com

Class One - July 7, 2021

Class Two - July 14, 2021

Class Three - July 21, 2021

Class Four - July 28, 2021

Class Five - August 4, 2021

Q & A before Midterm Exam

Terra Rafael, Wise Womanhood Practice & School terra@wisewomanhood.com www.wisewomanhood.com

Class Seven - July 18, 2021

Class Eight - July 25, 2021

Class Nine - September 1, 2021

Class Ten - September 15, 2021

Q & A before Final Exam

Terra Rafael, Wise Womanhood Practice & School terra@wisewomanhood.com www.wisewomanhood.com

Review of Reproductive Anatomy and Physiology - Western and

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Doshas In Menstrual Cycle - Varying interpretations

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Monthly Egg Cycle

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The Uterus changes in Size and Weight at different times in the

Review of Female Anatomy per Ayurveda regarding Female

Causes of vitiation of Vata (and so apana):

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Dhatu Sub - dhatu (created at same Waste Materials

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COMMON HEALTH CONCERNS OF FEMALES

“O, thou with the beautiful face, may the child

Reared on your milk, attain a long life, like

The gods made immortal with drinks of nectar.”

Evolution of Lactation & Breasts

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Evolution of Fatty Breasts

The Varieties Of Breasts

- From pp 240-243, Textbook of Ayurveda, Vol 2, Vasant Lad

Breast Development & Changes Over A Woman’s Life

When Does Breast Development Begin?

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What Breast Changes Happen At Puberty?

Beginning Puberty Happens Early in the USA

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Causes of Early Puberty

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Phase 2: They’re softer and smaller

Phase 3: They’re perky