FETAL
GROWTH AND DEVELOPMENT
Manu
identifies woman obviously responsible for the production of children, the
nurture of her progeny and as the best companion of man. He says: “The woman
and the man are the soil and seed. In some the seed is more distinguished and
in others the womb; but when both are of high quality the offspring is most
highly esteemed. On comparing the two the seed is more important since the
offspring is more marked by the characteristics of the seed. Whatever the seed
is sown that comes forth — not the other.” SUSHRUTA compares germination of
seed with that of conception and indicates the requirement of proper season and
water in addition to the fertile land (uterus) and potential seed of the man.
In Bundahis it is revealed that “The female seed is cold and moist and its flow
is from the loins i.e. it comes from either side of the uterus and the color is
white-red and yellow; while the male seed is hot and dry, its flow is from the
brain of the head; and the color is white and muddy. All the seed of the
females, which issues before hand takes a place within the womb and the seed of
the males will remain above it and will fill the space of the womb. Whatever
refrains there from becomes blood again, enters the veins of the female and at
the time when anyone is born it becomes milk and nourishes him as milk arises
from the seed of the males and the blood is that of the females.” “The sky,
metal, wind and fire are male and are never otherwise (not changed), the water,
earth, plants and fish are female and are never otherwise.” Thus Pahalavi works
obviously recognize male and female seeds to be hot and cold respectively while
Ayurvedic texts believe them to be cold and hot in the same order. Another obvious difference
is that Ayurveda believes in obstructed menstrual blood to be responsible for
placenta formation and to the secretion of milk while Pahalavi works attribute
it to the male seed. While Manu gives great importance for the seed of the
male, Pahalavi works indicate seed from both partners to come and unite in
uterus. Ayurveda believes in their relative dominance for sex differentiation.
The Y and X chromosomes, which represent male and female characters
respectively in different spermatozoa, determine the sex as per modern medicine.
Thus whatever their idea may be, they have imagined of the fertilization of the
ovum with spermatozoon and indicate proper environmental factors in uterus to
be essential for its nidation. The GARBHA or the zygote is defined as the
substance that is formed in uterus by the union of SHUKRA and SHONITA activated
to form Tanmatras for 8 Prakritis and 16 Vikaaraas in the presence of AATMA.
OJUS is said to be responsible for sustinance of life and a child born in 8th
month from SAMSKARA of the body by the OJUS shall be able to move with few
Jerky respirations like a cut snake or the cut piece of intestine in
laboratory experiments. Seeds germinate only upto certain period till OJUS is
present in them. Similarly the spermatozoa by virtue of the OJUS in them shall
be able to move for the time being in proper environmental conditions; but
after fertilization the CHETANA, TATVA or the conscience is continued only by
the AATMAN. The semen to which is due the body of the fetus chases the ovum out
of a sort of psychic affinity and is subsequently evolved out in the shape of a
child20. When this
GARBHA gets differentiated with various parts of the body like hands, fingers,
tongue, nose, genitals, etc. it is called as SHAREERA or the body complete.
The PURUSHA or human being consists of
the five MAHA BHOOTAS or the subtle elements (the AAKASHH, the VAYU, the AGNI,
the JALA and PRITHVI) and the AATMAN or the creative soul. These five elements get
nourished in the body by the DRAVYA, which is also PANCHA BHUTIKA in nature.
The genetic material of the fetus is brought about by four of the elements
(except the AAKASHH) derived from each of the four sources; the ovum (mother),
the sperm (father), the food (taken by mother during pregnancy) and the self
(the soul carrying with it the prints of its previous birth). The AATMAN or the
creative self first creates the AAKASH or the subtle eather into which the
other four elements grow. This process of growth and development of the
qualities of the five MAHABHOOTAS follow the same pattern of creation or
SRISTIKRAMA i.e. in the order of from AAKASHH the VAYU, from VAYU the Agni,
from AGNI the JALA, and from JALA the PRITHVI. The child develops maturity of
each of their functional qualities or the sense perceptions in the same order
after birth. A growing child first becomes satisfied and responds to sounds
(AAKASH GUNA); next attains satisfaction by way of touch (VAYUGUNA) through
handling and anointing, and later develops the sense of perceiving and
recognizing people. The sense of taste and smell are the last to be matured in
succession. A sleepy or unconscious man can be aroused by calling his name
rather than by stimulation of other senses. Hence the sense of hearing is the
first to come and the last to go in order; while the sense of smell is the last
to come and the first to wane off. Similarly the functional maturity of
KARMENDRIYAAS also emerge in order of VAAK, PAAYU, PAANI, PAADA and UPASTA and
the child thus undergoing the oral phase, anal phase, phase of locomotion and
finally sexual phase (Chavali’s concepts).
These five subtle elements in-spite of
their opposing qualities exist by way of mutual adjustment for mutual benefit.
These five elements together with SATWA and SAATMYA contribute to the growth and
development of various organs and qualities in the fetus. The TEJO BHOOTA is
mainly responsible for the color of the body and eyes. In human body the humors
of VATA, PITTA and KAPHA are derived from these five elements; VATA
representing the AAKASHH and VAYU, the PITTA representing the AGNI, and the
SLESHMA exhibiting the qualities of JALA and PRITHVI.
Chavali believes VAYU to help in
transportation and PITTA for transformation of various substances in body. The
cohesive force of KAPHA helps for binding information of such substances.
The VAYU goes on dividing the GARBHA or
the zygote, AGNI brings about the metabolic changes, JALA moistens it thus
giving nutrition; while PRITHVI solidifies and gives it a shape. The AAKASH
then allows it to expand. Thus division, budding, branching and canalization,
resulting in growth take place along with metabolic changes in the presence of
proper nutrition.
FETAL CIRCULATION:
The impregnated zygote in its early
stage gets its nutrition by way of UPASNEHA and UPASWEDA from mother’s pool of
blood present all around it, in the uterus. But later on when it grows up it
receives its nutrition through the umbilical cord which becomes connected from
the NAABHI of the child to the APARA. The APARA or placenta is in turn pooled
around with a fine network of floating vessels (capillaries) where there is
constant liberation or oozing of RASA DHATU. Typical action of HRIDAYA i.e.
receiving and giving out something take place between the network of maternal
vessels and placenta or APARA by way of UPASNEHA and UPASWEDA. The word HRIDAYA
is not to be taken in its true sense as the mother’s heart. The pulsation in
the cord justifies one to understand its action similar to HRIDAYA. The words
UPASNEHA and UPASWEDA have been interpreted by Dr. (Kum) P.V. Tewari as
selective nutrition and osmosis respectively. Astanga Hridaya describes it as
KEDAARA KULYA like process where again selective absorption takes place. Thus
the selectively absorbed nutrients reach the NAABHI of the child through the
cord wherefrom the pulsating VAYU carries it to the JYOTISTHAANAM (SUSHRUTA).
Prof. Gaur describes JYOTISTHAANAM as the foetal liver, which is the main seat
of metabolic activity in the body. Astanga SAMGRAHA says that the absorbed nutrients
are subjected to the activity of he KAAYAAGNI of the child at the PAKWAASAYA.
The words NAABHI, JYOTSTHAANAM and PAKWAASAYA all refer to portal circulation
and however, the nutrients reach the foetal liver finally, where the substances
are broken down, modified and transformed in a befitting way as required for
the growth and development of the child. The pulsating VAYU is again
responsible for supplying the various nutrients to different parts of the body.
Apart from this Ayurveda believes in the child receiving nutrition partly
through the hair follicles, which is again a matter of dispute.
ORGANOGENESIS:
The five subtle elements with SATVA and
SAATMYA contribute for the growth and development of various organs and their
functional aspects. The male and female seeds have imprints for all the organs
and structures to be developed in future and any injury to these BEEJA BHAAGAAS
or the BEEJAAVAYAVAS bring forth defects in that particular organ that develops
later from them; thus giving rise to congenital malformations. Any of the genes
of different organs of the body may be involved. Thus the organogenesis is an
ongoing and continuous process, but not an event of any particular stage in the
fetus but only becomes more and more differentiated in course of time as the
fetus grows; and is present right from the beginning of zygote formation. This
is described by a simile stating that Choota phala and Vamsaamkura have all
parts in them even in a bud stage but get differentiated when grown. However,
there are two types of structures in the body; those that develop and appear
before birth and the other that develop and become obvious later after birth
like the teeth and seminal ejaculate etc. Thus though the male and female seeds
carry various imprints in the form of genes for future development of various
organs, a long list of structures, organs and functional aspects of the body
dependent and derived from the source of mother (ovum), father (sperm), AATMA,
mother’s diet, SAATMYA and SATVA are described. These include the following:
1) Organs
and tissues etc. derived from maternal genes: All soft tissues and parts of the
body including the TWAK, RAKTA, MAMSA, MEDAS, MAJJAA, NAABHI, HRIDAYA,
AMAASHAYA, GARBHASHAYA, YAKRITA, PLEEHA, KLOMA, AANTRA and GUDA, etc.
2) Organs
and tissues etc. derived from paternal genes:
All hard tissues and pats of the body including the hair, nails, bones,
SHUKRA, SIRA, SNAAYU and DHAMANI, etc.
3) Organs
and functional aspects derived from AATMA:
Birth of the individual from particular YONI, the mind, the sense
organs, the PRAANA and APAANA, the configuration of the body and its color, the
voice, all the mental drives including KAAMA, KRODHA, LOBHA, BHAYA, HARSHA,
DHARMA and ADHARMA SHEELATA; the BUDDHI, the SMRITI, ICHCHHAA, DWESHA,
PRAYATNA, AHANKAARA, SUKHA, DUKKHA, AAYU and AATMA – JNANA and derived from
Aatama.
4) Developmental
aspects derived from mother’s diet (RASA) during pregnancy: The actual growth
and development of the fetus including the differentiation of various tissues,
the TRIPTI, PUSHTI and UTSAAHA.
5) Developmental
aspects derive from SAATMYA to the fetus: The AAROGYAM, the ANAALASYAM,
ALOLUPATWAM, INDRIYA PRASAADAM, and the richness in SWARA, VARNA, BEEJA, OJUS
and HARSHA.
6) Things
derived from SATWA to the fetus: The SATWA is the mind in which float various
conflicts derived of RAJAS and the inherent conscious criticism of them by the
TAMAS. (See Patho-physiology of Psychic disturbances). Ultimately a man may be
RAJAS predominant, TAMAS dominant or pure SAATWIK. A SAATWIK man is pious and
highly intelligent with good memory. A RAAJASIK man is highly enrageous,
restless, irritable and excitable while a TAAMASIK man is more apathetic and
sleeps long.
Thus various sources of functional
aspects and anatomical genes of the body for its origin and development are
described. However, various physiological processes involved in the development
of different organs and systems of the body are described in detail in Astanga
SAMGRAHA and Agnipurana. The different organs of the body are made up of
innumerable minute particles, the cells, the binding of which is manifest by
VAYU, which acts in accordance to KARMA. The processes involved in development
of different organ systems are as follows:
1) SKIN:
Six layers (seven layers – SUSHRUTA) of skin are formed from the
blood
while undergoing metabolic activity similar to the layers of cream that form
while milk is boiled. Hence purity and right upkeep of skin favors in bringing
purity to blood. Applications over skin form an important aspect of treating
blood disorders and the skins represents the character of RASA DHATU in the
body as it is taken as one of the SAAKHAAS representing RASA. Hence CARAKA
gives stress on BAHIRMAARJAN, UTSAADAN and PARISHEKA in treating RAAJA YAKSHMAA.
The color of the skin is mainly dependent on the TEJOBHOOTA and various
theories for the color of the skin are given below:
i) PANCH MAHABHOOTAS:
TEJAS + JALA = GOURA VARNA
TEJAS
+ PRITHVI = KRISHNA VARNA
TEJAS
+ PRITHVI +
AAKASHHA = KRISHNA SHYAAMA VARNA
TEJAS
+ JALA +
AAKASHHA = GAURA SHYAAMA VARNA
ii) AAHARA: Sweet diet and moving in
water= GAURA VARNA
VIDAAHI substances
=KRISHNA VARNA
Mixed diet
=SHYAAMA VARNA
Whatever
the color of the food she eats the child acquires that color.
iii)
Character of SHUKRA:
White like effluent of ghee = GAURA VARNA
Oily = KRISHNA VARNA
Honey like = SHYAAMA VARNA
iv) Occupation of parents, the genes
and the land they live in also
influence the color of the skin.
2) KALAAS: The KLEDA that
remains between DHATU and AASAYA while undergoing metabolic changes results in
a membrane (layer) (like rings as seen in cut trunk of trees) representing the
essence of the tissue or DHATU and is called KALAA. Thus seven KALAAS are
formed in the body. The MAMSADHARA, the RAKTADHARAA, the MEDODHARAA, the
SLESHMADHARAA, the PURISHADHARAA, the PITTADHARAA and the SHUKRADHARAA.
3)
INDRIYAAS: The sense organs develop from the SROTAS in which
the KAPHA and RAKTA flow; where in the
essence of one of the
functional aspects of the five subtle
elements become lodged. Thus in a SROTAS in which the AAKASHH BHOOTA becomes
lodged that SROTAS or ear becomes capable of receiving sounds. In the SROTAS
where AGNI becomes settled it attains power in receiving the sense of vision in
the eyes. Similar is the rule with other sense organs also. However, the SUKLA
MANDALAM in the eye is paternal in nature and is formed of SLESHMA while the
KRISHNA MANDALAM is maternal and is formed of VATA (Agnipurana). The DRISTI
MANDALAM in between represents both the characters. The TEJO BHOOTA in the eyes
gets its energy recouped by the exterior light and remains untouched by the
SLESHMA all around it, just like a thunder amidst the clouds. If the TEJOBHOOTA
does not reach the DRISTIBHAAGA the child remains blind right from birth. The
TEJOBHOOTA when followed by RAKTA, PITTA, SLESHMA or VAYU gives rise to
RAKTAAKSHA, PINGAAKSHA, SUKLAAKSHA and VIKRITAAKSHA respectively.
4) KOSTANGAS: From the purest
part of the RAKTA which while undergoing metabolic change by the OOSHMA and
bowled from behind by the SAMAANA VAYU, emerge the YAKRIT and PLEEHA. The lungs
originate from the foam of the blood. From the waste part of RAKTA form the
UNDUKAM. Kidneys emerge from the purest parts of RAKTA and MEDA45.
Intestines develop from the purest parts of RAKTA and MAMSA. SUSHRUTA says that
canalization by VAYU of the RAKTA and SLESHMA while they undergo certain
metabolic changes give rise to the intestines, GUDA and VASTI. RAKTA by the
effect of VAYU gives rise to KAALIYAM, which is commented as trachea by
Atridevagupta (Sangrah Part – I, p. 302). The essence part of SLESHMA and RAKTA
give rise to HRIDAYAM. The testes arise from RAKTA, MAMSA, MEDA and KAPHA. Thus
probably from the maternal RASA DHATU emerge the rest DHATTOS like RAKTA, MAMSA
etc. in the fetus, and RAKTA forms the basis for different organs of the
abdomen and thorax.
5) SUPPORTIVE
STRUCTURES: The essence (SARA) parts of KAPHA, RAKTA and MAMSA give rise to
MAJJA just as a gold piece becomes purified (or a tree getting layers of SARA)
by repeated heating. This is something different from the DHATU PARINAAMA
SIDDHANTA. People were aware of some layers in MAJJA where form again the
tissues of RAKTA and MAMSA get replenished from time to time after birth. The
VAYU together with OOSHMA DIVIDE and make any of the structures patent
resulting in SROTAS formation; and the same by entering the MAMSA DHATU divide
it into different PESIS. Penetration by VAYU of the fat of MEDAS at different
stages of PAAKA; MRIDU and KHARA give rise to SIRA and SNAAYU respectively.
Though
the activity of all the five subtle elements derived from different sources,
nourished in turn by mother’s food and modified by SAATMYA and SATVA is at work
in differentiating various structures together with organogenesis, gross
macro-scopical and functional changes taking place in the growing fetus are
described monthwise46. Harita gives a more detailed description. The
KALALAM or the zygote that forms the first day acquires a bubble like shape in
10 days. This becomes solidified in 15 days and looks like a fleshy lump in 20
days. All the 5 subtle elements take their proper abode in 25 days and the
fetus acquires the qualities of all 5 elements by one month.
Thus
the fetus during the first month remains in a semisolid state the KALALAM,
which becomes firm and hard during second month giving rise to globular,
elongated, or long and round shaped masses indicating early its sex, the male,
the female or the hermaphrodite respectively. During third month (by 50
days-Harita) five buds appear one for the head and the other for four limbs.
These buds contain various parts of that respective limb or head in a minute
form which becomes more differentiated during fourth month. However, Harita
finds the head to be well differentiated by 3 ½ months. The mind starts
functioning from fourth month as HRIDAYA the seat of mind also becomes
differentiated by this time along with the development of sense organs and so
is able to perceive pain and pleasure and expresses its longings through the
mother. Good antenatal care consists in fulfilling her desires lest the fetus
becomes insulted and thus may bring forth fetal developmental abnormalities.
Modern medicine believes in emotional dissatisfaction during first year as the
root of life-long personality disorders, while Ayurveda has gone still ahead
and warns of the put coming disabilities if the child is insulted even when it
is in its fetal state. Agnipurana describes development of skin, muscular and
body tissue during 4th month only. According to Harita even the
hairs appears during 4th month. The fetus becomes firm and fixed
during 4th month and hence from this time onwards any expulsion will
be called GARBHAPATA instead of GARBHASTRAVA as is to be called before. The
muscular tissue that starts during 4th month becomes obvious by 5th
month and hence SUSHRUTA rightly advocated meat soup during 4th
month of antenatal care. The mind becomes more active during 5th
month along with the experience of quickening by the mother (Harita) and BUDDHI
(sense of perception) is added in 6th month. VAGBHATA describes
development of bodily and scalp hairs, the nails, the bones and ligaments
during 6th month while Agnipurana describes development of bones during 4th
month and of the hairs in 5th month. However, deposition of calcium in the
growing bones of the fetus occurs from 6th month onwards reaching the maximum
by 8th and 9th months. Hence GHRITAAS (the best source of Vitamin-D for
absorption and deposition of calcium) prepared of diuretics probably to combat
toxemias of pregnancy are prescribed from 6th month onwards. By 7th month all
the pats and organs of the body having grown in all dimensions become well
differentiated and the child becomes viable. In 8th month the OJUS moves about
from fetus to the mother and vice versa. Hence the child born in 8th month has
little chance to survive depending on the presence or absence of OJUS in it. It
is still difficult to explain this unless and until the question of what the
OJUS is, in the present sense of our knowledge is understood. Harita describes
the gastric juices (AGNI) to develop during 8th month. The child is viable when
born in 9th, 10th, 11th and 12th months (SUSHRUTA); but, however, CARAKA says
that the delivery takes place during 9th or 10th month. SUSHRUTA might have
calculated according to lunar, months; otherwise the child remaining long in
uterus undergoes post maturity and suffers the risk of placental dysfunction
syndrome. Harita says that the child with the short experience of foetal life
becomes indifferent to wordly pleasure.
SAMSAKARS IN PREGNANT
WOMEN
About twelve SAMSKARAS are known to be
performed in a pregnant woman, including the PUMSAVAN, but, however,
SEEMANTONNAYANA is the most important without performing of which no woman
should be allowed to deliver. However, the SAMSKARAS of pregnancy
are of great importance to an Obstetrician who follows the health of the
pregnant woman. Thus they are probably important milestones in antenatal follow
up and are of Obstetrician’s concern; while the SAMSKARAS to the child after
birth form an essential subject matter to a pediatrician and should be done as
and when the child becomes physically and mentally fit to accept that newly
introduced refined activity.
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