Stanya ( स्तन्य ) & physiology of lactation.pptx

this ppt will help you to know about satnya(breast milk) in ayurveda and also help you to know about the physiology of lactation. process involved in initiation of milk secretion , maintenance of milk secretion , milk ejection process.
changes occuring in a women during lactational period. composition of breast milk with it's comparison to cow's milk .

importance of breast milk.


applied physiology related to mammary glands .
#ayurveda
#breastmilk
#stanya
#physiologylectures
#gyan

1. PRESENTED BY – DR. AMRIT KOUR KRIYA SHARIR DEPARTMENT R.G.G.P.G Ayurvedic College & Hospital Paprola Stanya ( स्तन्य ) & Physiology of Lactation

2. दोषधातुमलमूलं हि शरीरम्' (सु.सू. १५/३) "दोषधातुमल मूलं सदा देहस्य (अ.ह.सू. ११/१)  Roots of tree are very important for maintenance, stablity and growth of a tree, similarly Dosha , Dhatu and Mala are very important for maintaining human body. All these together keeps the body in balance.

3. Updhatu Meaning of Up is Sub, sub ordinate ,subsidiary, secondary and & Dhatu means tissue. supplementary support Definition Elements of the body which are derived from Dhatus and which are not further subjected to any transformation are called  Upadhatus .( Charakpani )

4. Substances that are present in the body which only perform Dharana Karma & do not provide nourishment like Dhatu is Updhatu . The main difference between Dhatu and Updhatu is that any changes or vitiation in Dhatu results in the effect in Uttar Dhatu but this can’t happen in case of  Updhatu

5. Food after digestion takes two forms viz. the Prasada part ( Annarasa ) and the Kitta part (Mala) From Prasadaja portion all the Dhatus are formed in progressive order.

6. Updhatus According to Acharay Charak रसात् स्तन्यं ततो रक्तमसृजः कण्डराः सिराः । मांसाद्वसा त्वचः षट् च मेदसः स्नायुसंभवः ।। (च.चि. १५/१७) 1.Stanya (breast milk) 2. Raja (menstrual fluid) 3.Kandaras (tendons) 4.Sira (blood vessels & nerves) 5.Vasa (muscle fat) 6. Twak (skin) 7. Snayu (nervous tissues & ligaments) DALHANA = SnayuSandi

7. Stanya as Updhatu Stanya is the updhatu (secondary tissue) of Rasa. स्तने जायति इति स्तन्यं । निरुक्ति breast milk is secreted in mammary gland therefore is called ' Stanya ‘ रसात् स्तन्यं । च.चि.१५ स्तन्यं क्षीरं रसस्य उपधातुः।शा.१.१५ आढमल Updhatu of Rasadhatu is breast milk.

8. स्तन्यं जीवनमिति बालजीवनम् । (सु.सू. १५/९ पर चक्रपाणि) For the nourishment of baby, the milk which is secreted in the mammary glands is called stanya .

9. Properties of Breast Milk यत् क्षीरमुदके क्षिप्तमेकीभवति पाण्डुरम् । मधुरं चाविवर्ण च प्रसन्नं तद्विनिर्दिशेत् ।। su.ni.10/26 Acharya Sushruta describes the qualities of Suddha Stanya as- Which mixes well with water immediately. White in colour . Sweet in taste and free from any discoloration . Is pleasant to look at .

10. स्तन्यमप्स परीक्षेत, तच्चेच्छीतलममलं तनु शङ्खावभासमप्सु न्यस्तमेकीभावं गच्छत्यफेनिलमतन्तुम, तेन कुमारस्यारोग्यं शरीरोपचयो बलवृद्धिश्चभवति ।। ३५।। Acharaya Sushruta aslo described qualities of suddha stanya in Sharir sthana 10 as- Examination of breast milk should be done in water. Suddha stanya should be cold, clean, thin. whitish yellow in colour like the colour of conch. It should be free from foam and fibers should disperse uniformaly in water,neither floats nor sinks. This kind of stanya provides a child with health & strength .

11. स्तन्यसंपत् तु प्रकृतवर्णगंधरसस्पर्शम् उदपात्रे अवदुह्यमानम् इयक व्येति प्रकृतिभूतत्वात् तत् पुष्टिकरम् आरोज्यकर चेति स्तन्यसंपत्। च.शा. ८.५५ Good quality breast milk is with physiological appearance of color, odor, taste, and touch and if dropped into water: assimilates in water due to its normal density. Such breast milk is nourishing to a baby and is called good quality breast milk. Good quality is realized by: Color : clear milk with milky white color Odor : typical milky odor. Taste : sweet. Touch : like water and of body temperature.

12. Breast development during pregnancy गृहीतगर्भाणामार्त्तववहानां स्रोतसां वर्मान्यवरुद्ध्यन्ते गर्भेण, तस्माद् गृहीतगर्भाणामार्त्तवं न दृश्यते, ततस्तदधः प्रतिहतमूर्ध्वमागतम अपरं चोपचीयमानमपरेत्यभिधीयते। शेषं चोर्ध्वतरमागतं पयोधरावभिप्रतिपद्यते, ततस्तदद्यः प्रतिह तस्मादगर्भिण्यः पीनोन्नतपयोधरा भवन्ति ।। (   Su.Sha.4/ २४ )

13. Sushruta Acharya - After Conception, orifices of artavavaha (reproductive) srotas of pregnant woman gets obstructed by the foetus and menstrual cycle is ceased hence artava cannot come out of vagina. Obstructed artava takes part in formation of placenta while remaining part travels in upward direction, reaches the breasts, helps development of lactiferous ducts of breasts and prepares them for the production of stanya . It also turns nipple into darker colour .

14. धमनीनां हृदिस्थानां विवृतत्वादनन्तरम् । चतुरात्रात्त्रिरात्राद्वा स्त्रीणां स्तन्यं प्रवर्तत । ( Su.Sha.10/16) Post partum, the excess of vata constricts the artavavaha srotas and dilates the lactiferous ducts of mammary glands and thus the actual secretion of milk takes place on third or fourth day.

15. Formation of Stanya (breast milk) रस प्रसादो मधुरः पक्वाहारनिमित्तजः । कृत्स्न देहात् स्तनौ प्राप्तः स्तन्यमित्यभिधीयते ।। (सु.नि. १०/१८) Excel part of Rasadhatu ,sweet ,generated from digested food after circulating in entire body when reaches two breasts,it is called “ Stanya ”

16. Ejection of breast milk आहाररसयोनित्वादेवं स्तन्यमपि स्त्रियाः । तदेवापत्यसंस्पर्शाद्दर्शनात् स्मरणादपि ।। ग्रहणाच्च शरीरस्य शुक्रवत् सम्प्रवर्त्तते । स्नेहो निरन्तरस्तत्र प्रत्रवे हेतुरुच्यते ।। (सु.नि. १०/२२,२३ )

17. When the mother feels baby's touch, or the mother sees her baby or picks the baby up; even its memory stimulates breast milk As Ahararasa circulates in entire body, these nutrients circulate in entire body before reaching its destination, breasts. Ceaseless love for the baby is supposed to be one of important factor for production of breast milk.

18. Time of breastfeeding according to different Acharyas - According to Acharay Charak – Dugdhapaan (breastfeeding) should be done on the 1 st day of postpartum period but before that Lehana with madhu & sarpani should be done. According to Acharay Sushruta & Vagabhaat - Dugdhapaan should be done on the 4 th day of postpartum period.

19. Benefits of Stanya - जीवनं वृंहणं सात्म्यं स्नेहनं मानुषं पयः । नावनं रक्तपित्ते च तर्पणं चाक्षिशूलिनाम् ।। (च.सू. २७/२२४)

20. As per Charak Acharya , Human milk is responsible for Jeevanam , Bhrahanam , Satmyam and  Snehanam . It is responsible for proper nourishment ,growth and proper strengthening of body constituents in infants. In Raktapitta , it is used for Nasya . It is used as Tarpana in Netra shoola .

21. प्रकृतिभूतत्वात्, तत् पुष्टिकरमारोग्यकरं चेति । (च.शा. ८/५४) Acharya charak has described milk as nourishing and healing by nature.

22. मातुरेव पिबेत्स्तन्यं तत्परं देहवृद्धये । (अ.हृ.उ. १/१५) Breast milk is responsible for deha - vriddhi (body growth) of infants.

23. नार्यास्तु मधुरं स्तन्यं कषायानुरसं हिमम् । नस्याश्योतनयोः पथ्यं जीवनं लघु दीपनम् ।। (सु.सू. ४५/५७ ) According to Acharaya Sushruta , milk of a woman is sweet in rasa. Anurasa is kasaya , beneficial for nasaya & aschyotan , pathya ( satamya ), jivniye , lagu (light)and enhance the digestive fire.

24. मानुषं वातपित्तासृगभिघाताक्षिरोगजित् । तर्पणाऽऽश्चोतनैर्नस्यैः. (अ.सं.सू.- ६/५९, अ.हृ.सू. ५/२६ ) According to acharya vagbhata , Woman’s milk is beneficial for Tarpana , Aschyotan & Nasya in akshiroga (eye disease), diseases due to Vata,Pitta , Rakhta and Abhigata (Trauma).

25. Physiological measure - द्वांजली तु स्तन्यस्य। अ.हृ.शा. ३.८२ Measure of normal secretion of breast milk is two anjali .

26. Stanya Kshaya – causes क्रोधशोकावात्सल्यादिभिश्च स्त्रियाः स्तन्यनाशो भवति । shu.sha.10/34 Causes – Anger, grief, lack of love for the child etc.

27. Stanya Kshaya – Lakshana स्तन्यक्षये स्तनयोम्र्लानता स्तन्यासम्भवोऽल्पता वा । तत्र श्लेष्मवर्धन द्रव्योपयोगः ।(सु.सू.१५/१६ ) Symptoms – looseness or wrinkles in the breasts, absence or less amount of milk in the breasts . Treatment – kapha enchanching substances.

28. Stanya vriddhi lakshana - ✓ स्तन्यं स्तनयोरापीनत्वं मुहुर्मुहुः प्रवृत्तिं तोदं च । (सु.सू. १५/२१ ) Symptoms – heaviness of breasts Engorgement in the breasts Needle pricking pain

29. Disorders and effects of unfit breast milk- Breast milk when gets vitiated by Dosha is not fit to feed the baby. Tests are given to diagnose such milk.

30. Charak expained 8 types of abnormalities in breast milk ( ksheer Dosha ) based on the dosha promience .

31. Types of Stanya dusti with their clinical features - VATAJA STANYA DUSHTI - 1. VAIRASYA – karshya (emaciation) in child, Swadate na-stanya – (breast milk does not taste good) Kruchhrena vardhate – delayed growth of the child.

32. 2 . PHEN-SANGHATA – Kricchra pravartana ( difficulty in expression of breast milk) Kshamaswarata (dull voice) Purisha – mutra graha ( retention of feces & urine) Causes vataj shiroroga ( headache) Peenasa ( sinusitis) 3. RAUKSHYA – Balahrasa ( weakness)

33. Pittaj Stanya Dushti - 4 . VAIVARNYA – Discolouration of Stanya , Gatravaivarnaya – discolouration of body parts. Swedana – Adhikya ( excessive perspiration) Trishna – Adhikya (excessive thirst) 5. DURGANDHYA – Occurance of Pandu & Kamala in the child .

34. KAPHAJA STANYA DUSHTI 6. Ati - SNIGDHA – Chardana (vomiting) Kunthana ( discomfort or pain ) Lalastrava ( excessive salivation ) Strotas Rodha ( obstruction of body channels ) Nidra ( sleepiness ) Klma ( lethargy)

35. 7. PAICHILLYA – Lalastrava ( Salivation) kshunakshi vaktrayada - ( inflammation in the buccal cavity , eyes ) 8 . GAURAVA – Hridroga (heart disorders )

36. Stanya vitiated By Dosha ------ VAGBHATA When vitiated Vata affects milk, it floats on water, When vitiated Pitta affects milk, it creates yellow streaks in water. When vitiated Kapha affects milk, it sinks in water.

37. Diseases in neonates due to abnormal breast milk Ashtang Sangraha explains the variety of diseases like jwara (fever), kasa (cough), chhardi (nausea, vomiting, gastric disturbance) commonly observed in the paediatric population. Ksheeralasaka and Parigarbhika are two most common diseases observed in neonates. Ksheeralasaka is a condition involving the vitiation of all the three dosha resulting in symptoms like diarrhoea , malaise, fever, vomiting, nausea etc. the child. chronic indigestion and disturbed gastro-intestinal functioning, which is commonly observed in breast fed infants.

38. Parigarbhika = malnutrition related disorders. It has been explained as an important factor resulting from the abnormal breast milk. Similarly, other conditions like kukunaka ( opthalmia neonatarum ) and ahiputana (napkin rash), [Su. Sa. Chikitsa Sthana 20/57] charmadala (skin disorders) (K. S. Khila Sthana 15/10), utfullika (H. S .3.54.9-13), visarpa (herpetic rash) (K.S Khila Sthana 14/10-15) also result from vitiated stanya leading to the occurrence of range of disorders in the paediatric population.

39. Aversion of the infant towards breast feeding ( stanya dwesha ) is considered a sign of graha dushti e.g. skanda , skandapasmara , andhaputana . [Su. Sa. Shareera Sthana 10/51, A.H. Uttar Tantra 3/5]. It is also observed in conditions like mukha roga , kantha roga , trishna , udarashool .

40. Substitute breast feeding - 1. Chhaga paya (goats milk) 2. Gavya paya (cow milk)  3. Laghu - panchamula siddha ksheera with sitopala

41. PHYSIOLOGY OF LACTATION

42. Structure of Breast - Breasts have mammary glands which are modified sweat glands involved in lactation or production of milk. Breast arises from the surface epithelium as solid column of cells which gradually is hollowed out to become ducts. These ducts branch to give rise to terminal ductules which is turn lead to alveoli. Myoepithelium – Elongated branching striated cells . cover the external surface of epithelium of the alveoli and ducts .

43. It consists of- 1. Skin – nipple, areola . 2. Parenchyma / Glandular tissue / mammary gland .- secrete milk to feed newborn baby. 3. Stroma – cooper’s ligament . cover the breast.

44. Nipple- central protruding part of breast. Consists of Smooth muscle fivers. Areola – pigmented skin area that surround the nipple . It consists of numerous sebaceous sweat glands – which enlarge during pregnancy and secrete oily substance to lubricate the nipple.– Montgomery’s glands.

45. Breasts have mammary glands/glandular tissues/ Parenchyma . Each Breast consists of about 15- 20 lobes which are further divided into lobules (produce milk). Lobules consists of tiny hollow sacs called Alveoli. Drain into single lactiferous duct and converge at nipple. Before that dilate at lactiferous sinus ( Ampulla ). This lactiferous sinus act as a reserviour of Milk during lactation .

46. Mammary glands are surrounded and supported by Connective tissue – Stroma . It has fibrous & fatty components. The Fibrous stroma forms – cooper’s Ligament known as suspensory ligaments of cooper.

47. Pectoral Fascia – Sheet of connective tissue associated with pectoralis Major. Retromammary space- layer of loose connective tissue between the breast’s base & the pectoral fasica It is filled with loose areolar tissues.

48. At birth- T he breast is rudimentary and consists of a tiny nipple from which radiates a few ducts. Further development occurs until the time of puberty .

49. At Puberty- The beginning of changes in the mammary gland is occurs at the time of pubery before menarche. This development is stimulated by the estrogens of the monthly female sexual cycle;

50. During Pregnancy - During 1st half of the pregnancy, ductal system develops further with the appearance of many new alveoli. But there is no milk secretion . During the 2nd half of the pregnancy – growth of glandular tissues occur colostrum is secreted during 2 nd half of pregnancy but in a very small amount.

51. Hormones involved in the growth of mammary glands 1. ESTROGEN – responsible for growth & branching of ductal system of mammary gland. Also responsible for fat accumulation in the breasts. FOUR OTHER HORMONES – Growth hormone Prolactin Adrenal glucocorticoids Insulin MODE OF ACTION ------- Help in PROTEIN METABOLISM

52. 2. PROGESTERONE – Promotes development of Lobule- Alveolar System Stimulates development of Glandular tissues.

53. 3. PROLACTIN – Necessary for milk secretion . Normally , it is inhibited by PIH , secreted by Hypothalamus . During 5 th month of pregnancy , prolactin secretion starts increasing . MODE OF ACTION – Act on mammary glands , causes proliferation of Epithelial cells of Alveoli.

54. 4 . Placental Hormones – ESTROGEN & PROGESTERONE secreted from placenta are essential for further development of mammary glands during pregnancy . HUMAN CHORIONIC SOMATOMAMMOTROPIN – it was first named human placental lactogen and was believed to have functions similar to those of prolactin .

55. 5 . OTHER HORMONES – GROWTH HORMONE THYROXINE CORTISOL RELAXIN Enhance growth & development of mammary glands in the stages.

56. LACTATION –

57. 1. MILK SECRETION

58. LACTOGENESIS - Small amount of milk secretion occurs during later months of pregnancy . But free flow of milk occurs only after parturition . Milk secreted before & after parturition Called colostrum . Yellow in colour , rich in proteins and salts , sugar content is low No fat

59. ROLE OF HORMONES IN LACTOGENESIS - PROLACTIN – responsible for lactogenesis . During 2 nd half of pregnancy , large quantity of prolactin is secreted but its activity is supressed by estrogens & progesterone secreted by plactenta . So, lactation is prevented during pregnancy . Immediately after delivery of baby and expulsion of placenta, there is sudden loss of estrogen & progesterone . Now, prolactin acts on breasts and promotes lactogenesis .

60. GALACTOPOIESIS - Maintenance of Milk Secretion depends upon following Hormones – GROWTH HORMONES THYROXINE CORTISOL MODE OF ACTION – these hormones are essential for continuous supply of glucose, amino acids , fatty acids ,calcium and other substances necessary for milk production .

61. ROLE OF HYPOTHALAMUS IN GALACTOPOIESIS - The milk production is continued for 7 to 9 months after delivery only if feeding the baby is continued. Suckling of nipple by the baby is responsible for continuous milk production. When the baby suckles, the impulses from touch receptors around the nipple stimulate hypothalamus. It is suggested that hypothalamus releases some prolactin -releasing factors, which cause the prolactin secretion from anterior pituitary. Prolactin acts on glandular tissues and maintains the functional activity of breast for subsequent nursing.

62. B. MILK EJECTION - Milk ejection is the discharge of milk from mammary gland. It is a neuroendocrine reflex. Milk ejection reflex or milk let-down reflex. DEPENDS UPON – a. suckling exerted by the baby b. contractile mechanism in breast, which expels milk from alveoli into the ducts.

63. Milk ejection reflex Plenty of touch receptors are present on the mammary glands, particularly around the nipple. When the infant suckles mother nipple, the touch receptors are stimulated. The impulses discharged from touch receptors are carried by the somatic afferent nerve fibers to paraventricular and supraoptic nuclei of hypothalamus. Now hypothalamus, in turn sends impulses to the posterior pituitary through hypothalamo-hypophyseal tract. Afferent impulses cause release of oxytocin into the blood. When the hormone reaches the mammary gland, it causes contraction of myoepithelial cells, resulting in ejection of milk from mammary glands.

64. MILK – EJECTION REFLEX

65. EFFECT OF LACTATION ON MENSTRUAL CYCLE Woman who nurses her child regularly does not have menstrual cycle for about 24 to 30 weeks after delivery. It is because, regular nursing the baby stimulates prolactin secretion continuously. Prolactin inhibits GnRH secretion from hypothalamus resulting in suppression of gonadotropin secretion from anterior pituitary. In the absence of gonadotropin,i.e there is no LH & FSH production. the ovaries become inactive and ovulation does not occur.

66. When the frequency of nursing the baby decreases (after about 24 weeks) the secretion of GnRH and gonadotropins starts slowly. When sufficient quantity of gonadotropins is secreted, the menstrual cycle starts.

67. OVERVIEW OF LACTATION -

68. Composition of Milk -

69. Changes in mother during Lactation - At the height of lactation in the human mother, 1.5 liters of milk may be formed each day & great quantities of energy is required ; Large amounts of metabolic substrates are also lost from the mother. For example, about 50 grams of fat enter the milk each day, as well as about 100 grams of lactose , which must be derived by conversion from the mother’s glucose. Also, 2 to 3 grams of calcium phosphate may be lost each day.

70. The output of calcium and phosphate by the lactating mammae will often be much greater than the intake of these substances. To supply the needed calcium and phosphate, the parathyroid glands enlarge greatly, and the bones become progressively decalcified .

71. Antibodies and Other Anti-infectious Agents in Milk Not only does milk provide the newborn baby with needed nutrients, but it also provides important protection against infection. Particularly important are antibodies and macrophages that destroy Escherichia coli bacteria, which can cause lethal diarrhea in newborns.

72. Applied physiology of Mammary Glands

73. Breasts are usually affected by three conditions – Infection Benign tumours Malignant tumours

74. MASTITIS - Inflammation of breast tissues. Mostly occurs in breastfeeding women – LACTATIONAL MASTITIS . Rarely seen in non – lactational women . CAUSE – occur due to blockage of duct – leads to milk stasis . Signs and symptoms – PAIN REDNESS & SWELLING .

75. BREAST ABSCESS - Buildup of pus . Cause – from infection – common in lactating mothers . Staphylococcus Aureus . Bacteria may enter the breast via – Cuts on breast tissues cracked nipples SYMPTOMS – Pain, redness , swelling , discharge.

76. Fibrocystic Breast Changes - Benign condition . Fluid filled cysts along with areas of fibrosis in one or both breasts . Associated with hormonal fluctuations . ( ESTROGEN Level rises) Occur between 30 to 50 years . Before menstruation = increases After Menstruation = Decreases . Signs & symptoms – not always . Pain , tenderness & lumpiness in the outer ,upper quadrant of breast . Sometimes discharge