E-ISSN:2456-3110

Research Article

Recurrent Abortions

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 6 JUNE
Publisherwww.maharshicharaka.in

Ayurvedic Approach to Recurrent Abortions: A Pilot Study on Garbhasrava Management

Tomar P1*, Srivastava V2
DOI:10.21760/jaims.10.6.4

1* Pravesh Tomar, Associate Professor, Dept of Prasuti Tantra Evum Stree Roga, Uttrakhand Ayurveda University, Rishikul Campus, Haridwar, Uttarakhand, India.

2 Vandana Srivastava, Professor and HOD, Department of Ayurveda, Dev Sanskriti Vishvavidhyalaya, Gayatrikunja, Shantikunj, Haridwar, Uttarakhand, India.

Recurrent spontaneous abortion (RSA), a distressing condition affecting approximately 1%-2% of women of reproductive age, often lacks a definitive etiology despite extensive investigations. In the realm of Ayurvedic medicine, recurrent miscarriage can be correlated with "Garbhasrava" and "Garbhapata," conditions attributed to Doshic imbalances, particularly involving Vata. This pilot clinical study aimed to evaluate the efficacy of an Ayurvedic polyherbal formulation, TAB-GM, in managing unexplained recurrent abortions. This pilot study aimed to evaluate the role of an Ayurvedic formulation, TAB-GM, in sustaining pregnancy among women with a history of RSA. The study included 9 pregnant women aged 20–35 years, each with a history of two or more consecutive unexplained miscarriages. TAB-GM, a proprietary polyherbal formulation with documented Garbhasthapana, Raktavardhaka, and Rasayana effects, was administered orally at a dose of 500 mg twice daily from confirmation of pregnancy until completion of the fourth month of gestation. Primary outcomes assessed were continuation of pregnancy beyond 20 weeks, maternal health, and safety of the formulation. The results indicated that all 9 participants successfully carried their pregnancies beyond 20 weeks without complications or miscarriage recurrence. The intervention was well-tolerated, with no adverse drug reactions or deviations in hematological and biochemical parameters. These preliminary findings suggest that TAB-GM may be a safe and potentially effective supportive therapy for pregnancy sustenance in women with unexplained RPL. However, further large-scale, randomized controlled trials are needed to validate these outcomes and establish robust clinical guidelines. This study underlines the value of Ayurvedic approaches in managing complex reproductive challenges.

Keywords: Recurrent spontaneous abortions, Recurrent miscarriage Garbhasrava, Ayurvedic management

Corresponding Author How to Cite this Article To Browse
Pravesh Tomar, Associate Professor, Dept of Prasuti Tantra Evum Stree Roga, Uttrakhand Ayurveda University, Rishikul Campus, Haridwar, Uttarakhand, India.
Email: 		Tomar P, Srivastava V, Ayurvedic Approach to Recurrent Abortions: A Pilot Study on Garbhasrava Management. J Ayu Int Med Sci. 2025;10(6):22-33.
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https://jaims.in/jaims/article/view/4426/

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-05-08 2025-05-24 2025-06-04 2025-06-14 2025-06-24
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 11.36

© 2025 by Tomar P, Srivastava V and Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Download PDFBack To ArticleIntroductionAim and ObjectiveMaterials and MethodsResults and DiscussionConclusionReferences
Pravesh T et al. A Pilot Study on Garbhasrava Management

Introduction

The desire to conceive and nurture a child is a fundamental aspiration for most couples, as a child strengthens familial bonds. Pregnancy, from conception to delivery, is a complex process susceptible to various complications, one of the most distressing being recurrent spontaneous miscarriage or abortion, defined as the loss of a fetus before 20 weeks of gestation.[1] Approximately 10–20% of all confirmed pregnancies result in miscarriage. Nearly 75% of miscarriages take place before the 16th week of gestation, with around 80% of these occurring within the first 12 weeks of pregnancy.[2] Recurrent spontaneous abortion (RSA), occurring in three or more consecutive pregnancies before 20 weeks[3], is often attributed to anatomical abnormalities, chromosomal defects, infections, and immune dysfunctions. However, nearly 40–60% of cases remain unexplained[4], leading to a growing interest in identifying potential causes and practical treatment approaches.

In Ayurveda, fetal disorders are classified under Garbha Vyapada, which includes various types of pregnancy complications. Acharya Sharangdhara identifies Garbhpata as one of eight types of Garbha Vyapada.[5] Classical texts like Sushruta Samhita, Madhava Nidana, and Bhavaprakasha categorize pregnancy loss into Garbhasrava and Garbhapata[6], based on gestational age. Garbhasrava refers to pregnancy loss before fourth month, occurring before placenta and amniotic membranes are fully formed. In contrast, Garbhapata occurs after fifth or sixth month, resembling a miniature labor due to advanced fetal development. Acharya Charaka describes Ama Doshik Masik Srava, linking early pregnancy loss to improper diet and lifestyle, which destabilizes fetus.[7] Ayurveda emphasizes preventive care through Dosha balance, proper nutrition, lifestyle modifications, and therapeutic interventions. Women with recurrent miscarriages are advised to maintain disciplined regimen, avoid harmful lifestyle practices, and seek proper counseling and nourishment. While various Ayurvedic treatments exist for managing Garbhasrava, this study focuses on administering a formulated Ayurvedic preparation (TAB-GM) in Vati (tablet) form for four months in pregnant women with history of recurrent abortions, aiming to improve pregnancy outcomes.

Aim and Objective

To evaluate the role of Ayurvedic herbs in the form of Vati (tablet) in the management of recurrent miscarriages with an objective to provide evidence-based justification for Ayurvedic interventions in recurrent pregnancy loss.

Materials and Methods

Study Design

Randomised, controlled open label study

Study location

Outpatient Department of Prasuti Tantra and Stri Roga, Rishikul Ayuved College and Campus, Haridwar, Uttarakhand.

Participants

Pregnant patients with history of Garbhasrava (RSA) from Outpatient Department of Prasuti Tantra and Stri Roga, Rishikul Ayuved College and Campus, Haridwar were enrolled.

Inclusion criteria

  • Married female of age 20-35 year having 2 or more Spontaneous abortion before 18 weeks.

Exclusion criteria

  • Female of age <20 years and >35 years.
  • Patients having Induced abortions.
  • Patients having bleeding disorders.
  • Patients having systemic diseases like diabetes mellitus, hypertension, TB, Heart disease, STD, chromosomal abnormality.
  • Patients who are anaemic (Hb% < 10gm/dl)
  • Patients diagnosed with placenta previa.
  • Patients with congenital anomalies of uterus.
  • Patients diagnosed with cervical incompetence.
  • Patients taking anticoagulant or blood thinner drugs.

Assessment Criteria

A. Subjective parameters

  • Previous h/o abortion,
  • H/o previous menstrual cycle,
  • Previous h/o of vaginal discharges,

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  • Assessment of pregnancy before 6 weeks.

B. Objective parameters

  • Assessment of pregnancy before 6 weeks,
  • Assessment of fetal well-being, present c/o pregnancy with pain and bleeding p/v,
  • P/s examination during 8-12 weeks,
  • P/a examination b/w 14-18 weeks,
  • Pain in lower abdomen/ backache with uterine contraction,
  • Assessment of foetal wellbeing with doppler and usg,
  • P/v examination b/w 12-18 weeks if the patient complains of pain with or without bleeding p/v.

Method of preparation of TAB-G.M Vati-

Table 1: Steps and process in the preparation of TAB-GM

StepProcessDetails
1.  Ingredient PreparationCollection & Yavkuta preparation1250 gm total (Guduchi, Yashtimadhu, Tulsi, Amalaki, Bhumyamalaki) sieved through sieve no. 60
2.  SoakingOvernight soakingYavkuta soaked overnight in water
3.  Kwatha PreparationDecoction process16 parts of water added to the Yavkuta and boiled using the classical method
4.  ReductionConcentration of decoctionBoiled on Mridu Agni (mild flame) with constant stirring until reduced to 1/8th of the original quantity
5.  FiltrationRemoval of solid residuesThe reduced Kwatha was filtered using a muslin cloth to obtain a smooth liquid filtrate
6.  HeatingThickening processThe filtrate was further heated until it reached a semi-solid (Ghana) consistency
7.  Addition of PreservativeStability enhancement1 gm of sodium benzoate was added and mixed thoroughly for even distribution
8.  Mixing Fine PowderEnhancing potencyAfter cooling to room temperature, 10-12 gm of finely powdered ingredients (filtered through muslin cloth) were added and mixed
9.  Vati FormationTablet shapingThe mixture was shaped into Vati (tablets), each 500 mg in weight

Process of making drug:

Manufacturing of the drug was completed in the Department of Ras Shastra Evum Bheshajya Kalpna, Rishikul Campus, Hardwar, as per the guidance of HOD and in the presence of Research Scholar. Decoction was prepared by classical method i.e., decoction of 1250 gm Yavkuta of Guduchi (stem), Yashtimadhu (whole root), Tulsi (whole plant),

Amalaki (Fruit), Bhumyamalaki (whole plant) (1:16 then 1/4" remaining) was made in mild flame, in which fine powder of Guduchi, Yashtimadhu, Tulsi, Amalaki, Bhumyamalaki (10-12 gms) were mixed and heated in mild flame until semisolid form is obtained. It was made solid in the form of Vati of each 500mg after heating & adding binding agent according to requirement. The prepared tablets were packed in an airtight container.

Results and Discussion

In the present study, nine patients with a history of spontaneous abortion aged between 20 to 35 years were given Tab GM 1 BD for 4 months, and follow-up was done at the end of every month. While the follow-up was done up to 20 weeks after pregnancy.

Table 2: Demographic data of the patients

CategorySubcategoryFrequencyPercentage
ReligionHindu555.56%
Muslim444.44%
Other00.00%
Age Group19-25 YRS111.11%
26-30 YRS333.33%
31-35 YRS555.56%
EducationUneducated333.33%
Inter222.22%
Graduate222.22%
Post Graduate222.22%
OccupationHousewife666.67%
Student00.00%
Private Job222.22%
Govt. Job111.11%
Socio-Economic StatusUpper Class00.00%
Upper Middle444.44%
Middle111.11%
Lower Middle111.11%
Lower333.33%
HabitatRural00.00%
Urban9100.00%
Slum00.00%
Family TypeNuclear777.78%
Joint222.22%

Sociodemographic characteristics

Demographic data of the patients are represented in Table 2. The majority of participants were Hindu (55.56%), aged 31–35 years (55.56%), and predominantly housewives (66.67%), reflecting a typical reproductive demographic in urban India.


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The high rate of uneducated women (33.33%) may contribute to limited health awareness, affecting reproductive outcomes. The upper middle class (44.44%) was the most represented socio-economic group, and all participants were from urban areas, with nuclear families (77.78%) being the common household type. Interestingly, higher abortion rates in this group may be linked to delayed pregnancies due to career or lifestyle choices, as well as increased stress and sedentary urban lifestyles, both of which can negatively impact pregnancy.

Prakriti, Physiological and Digestive Parameters

Table 3: Prakriti and Physiological Assessment

ParameterDominant CategoryPercentage
GatiMadhyama44.44%
SparshaAnushnashita77.78%
MalaNirama55.56%
MutraPrakrita88.89%
JihvaPrakrita77.78%
ShabdaPrakrita100%
AkrutiMadhyam55.56%
Sharira PrakritiVP, VK, PK (equal)33.33% each
Manasa PrakritiRaja66.67%
SaaraMadhyama77.78%
SamhanaMadhyama55.56%
PramanaMadhyama55.56%
SatmyataEqually distributed (Ekarasa, Mishra Rasa, Sarvarasa)33.33% each
Vyayama ShaktiAvara88.89%
Abhyavaran ShaktiMadhyama55.56%
Jarana ShaktiAvara55.56%
AgniVishama / Manda66.66% total

The assessment of Prakriti and physiological traits revealed that most participants exhibited Madhyama Gati (44.44%) and Anushnashita Sparsha (77.78%), indicating moderate physical activity and neutral skin temperature. The Nirama Mala (55.56%) and Prakrita Mutra (88.89%) reflected relatively good bowel and urinary functions. Normal speech (100%) and tongue examination (Prakrita Jihva – 77.78%) indicated general systemic stability.

However, despite these stable parameters, certain factors observed may contribute to recurrent abortions. Notably, the predominant Avara Vyayama Shakti (88.89%) indicates poor physical endurance and a sedentary lifestyle, which can negatively impact circulation, metabolism,

and uterine health - contributing to poor pregnancy outcomes. Similarly, Avara (low) Jarana Shakti (55.56%) and Agni (digestive fire) dominated by Vishama and Manda Agni (66.66%) reflect compromised digestion and metabolism, which can result in nutritional deficiencies, poor tissue development (Dhatu Kshaya), and weakened reproductive strength.

The Raja-dominant Manasa Prakriti (66.67%) could indicate emotional instability, heightened stress response, and irritability - factors known to interfere with hormonal balance and pregnancy maintenance.

Additionally, the presence of Madhyama or Avara Saara, Samhana, and Pramana in most participants suggests average to weak tissue quality, body strength, and reproductive capacity, all of which are vital for sustaining a pregnancy.

Discussion on Observational data of clinical history

From a medical standpoint, there were no reported cases of diabetes (DM), hypertension (HTN), pelvic inflammatory disease (PID), TORCH IgM, or tuberculosis (T.B.), indicating an overall absence of major chronic systemic illnesses.

However, 33.33% tested positive for TORCH IgG, suggesting previous exposure to infections that could impact pregnancy, and 11.11% had thyroid dysfunction, which is known to affect fertility and pregnancy outcomes.

Additionally, 33.33% of patients had undergone surgical procedures, potentially related to reproductive health. Among the nine patients enrolled, one patient had a notable history of adverse obstetric outcomes, with two pregnancies reaching term but resulting in intrauterine demise (IUD) due to severe hypertension, and three additional pregnancies ending in spontaneous abortion during the second to third month of gestation.

In terms of treatment history, 44.44% had used both Ayurvedic and Allopathic treatments, while an equal percentage (44.44%) had received no treatment at all. Very few had exclusively used Ayurvedic (11.11%) or Allopathic (11.11%) treatments. None of the patients had undergone IVF or IUI, pointing towards a reliance on traditional or natural conception methods.


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jaims_4426_01.JPG
Figure 1: Medical/surgical history

jaims_4426_02.JPG
Figure 2: Treatment history

Discussion on history of menstrual health

Regarding menstrual health, most participants experienced menstrual cycles lasting up to 3 days or more than 5 days (each 44.44%), with the majority having an interval of 21–35 days (77.78%) and regular cycles (88.89%).

Use of sanitary pads showed that 66.67% required 3-4 pads per day & 66.67% also reported experiencing pain during menstruation, indicating presence of moderate menstrual discomfort. Consistency of menstrual blood was mostly clotted (66.67%) & foul smell was reported by 55.56%, suggesting possibility of underlying reproductive tract infections in some participants.

jaims_4426_03.JPG
Figure 3: Data representing menstrual health patterns of the patients

History of previous abortions along with obstetric history

In terms of history of recurrent abortion 56% presents with primary infertility and 44% had secondary infertility, The data indicates that 66.67% of participants had two previous abortions , and most abortions occurred in the first to second month of gestation (55.56%). The most common type of abortion was with symptoms of inevitability (44.44%), and treatment history was equally distributed among no treatment, irregular, and regular treatment (33.33% each). Associated symptoms like weakness and mild fever were present in 11.11%, while 77.78% had no associated symptoms during past abortion history.

jaims_4426_04.JPG
Figure 4: Pie charts showing percentage of previous abortions along with obstetric history

Assessment of pregnancy outcome

Early pregnancy symptoms like giddiness (77.78%) & morning sickness (44.44% mild, 33.33% moderate) were commonly reported. Notably, all participants were assessed for pregnancy before 6 weeks (Grade 2) & showed normal fetal well-being up to 12 weeks via USG (100%). There were no complaints of pain, bleeding, or uterine contractions during critical periods (8–18 weeks) & P/S & P/A examin. were normal in all cases. Impressively, all 9 patients completed treatment, with no cases of dropout or abortion & 100% continued pregnancy with regular follow-up, indicating highly positive clinical outcome & successful management protocol.

Table 4: Data representing the details and outcome of pregnancy.

ParameterGradeDescriptionFrequencyPercentage (%)
Morning Sickness1Mild444.44
2Moderate333.33
3Severe222.22

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Assessment of Pregnancy Before 6 Weeks1Grade 100.00
2Grade 29100.00
3Grade 300.00
4Grade 400.00
Fetal Wellbeing (USG up to 12 weeks)0Normal9100.00
1–3Abnormal (Mild to Missed Abortion)00.00
Pain and Bleeding (Early Pregnancy)0No Complaint9100.00
1–3Mild to Severe00.00
P/S Examination (8–12 Weeks)0Normal9100.00
1–3Bleeding/Abnormal Findings00.00
Pain in Lower Abdomen/Backache (Uterine Contraction)0Absent9100.00
1–3Present (Mild to Severe)00.00
Fetal Wellbeing (Doppler + USG)0Normal9100.00
1–3Mild to Severe Abnormalities00.00
Pain + Contraction With/Without Bleeding0Absent9100.00
1–4Present (Mild to Severe)00.00
Patient Outcome-Drop Out00.00
-Complete Treatment9100.00
-Abortion00.00
-Pregnancy Continued9100.00
-Regular Follow-up9100.00

Discussion on the probable mode of action of the drugs.

1. Guduchi

Guduchi (Tinospora cordifolia) is a potent Rasayana herb in Ayurveda, endowed with diverse medicinal properties such as anti-inflammatory, anti-diabetic, anti-arthritic, antioxidant, anti-stress, antileprotic, antimalarial, hepatoprotective, antiallergic, and immunomodulatory activities.[8] These actions make it a valuable agent in various systemic and reproductive conditions.

Pharmacologically, Guduchi possesses [9]

  • Rasa: Tikta (bitter) and Kshaya (astringent), which helps in detoxification and reducing inflammation.
  • Guna: Laghu (light) and Snigdha (unctuous) – aiding in easy digestion and tissue nourishment.
  • Veerya: Ushna (hot) – which stimulates metabolism, enhances circulation, and balances Vata and Kapha doshas.
  • Vipaka: Madhura (sweet) – promoting nourishment, tissue strength (Dhatu pushti), and overall stability in the body.

Guduchi is an Ayurvedic drug used for Rasayan Chikitsa.[10] As a Rasayana, Guduchi enhances the quality of all seven dhatus (tissues) and supports Ojas, the vital essence responsible for immunity, vitality, and reproductive capability. Rasayana therapy contributes to rejuvenation,

longevity, immune enhancement, and cellular regeneration, making Guduchi particularly beneficial in gynecological and obstetric conditions.

Role in Recurrent Spontaneous Abortion (RSA):

Research indicates that Guduchi Ghana, prepared by classical Ayurvedic methods, significantly suppresses carrageenan-induced edema, highlighting its strong anti-inflammatory potential. This action is linked to modulation of key chemical mediators like histamine and serotonin (5-HT) during the initial inflammatory phase, either by reducing their synthesis or antagonizing their receptor activity.[11]

This is crucial in RSA, where local inflammation or immune dysfunction may contribute to early pregnancy loss.

Furthermore, Guduchi’s immunomodulatory effect helps in stabilizing maternal immune responses that may otherwise target the fetal tissues as foreign. Its Ushna Veerya and Tikta Rasa assist in clearing subtle inflammatory obstructions, while Madhura Vipaka supports tissue healing and fetal nourishment.

Together, these properties make Guduchi a valuable herb in preventing recurrent abortions by modulating immune responses, reducing inflammation, and strengthening reproductive tissues, thereby creating a conducive environment for fetal development and pregnancy maintenance.


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2. Yashtimadhu

Yashtimadhu is well-known Ayurvedic herb classified under Sarivadi, Anjanadi, Utpaladi, & Nyagrodhadi Ganas, & indicated for Pittasamana (pitta-pacifying) actions.[12] Bhavamishra attributes it with actions such as Sukrala (spermatopoietic), Chakshushya (eye tonic), Balya (strength-promoting), Vrishya (aphrodisiac), Keshya (hair tonic), Swarya (voice-improving), and Vranasothahara (wound and inflammation healer).[13] It is also traditionally used as galactagogue, Chakradutta[14] suggested its application on ulcers due to injury for relieving pain (Analgesic), it also has significant estrogenic effects due to isoflavones like glabridin and glabrene[15], which help modulate hormonal balance - an essential aspect in treatment of RSA.

Properties of Yashtimadhu according to ayurvedic texts[16]:

Rasa: Madhura, Guna: Guru, Snigdha, Veerya: Sheeta, Vipaka: Madhura and Karma: Tridoshara, Rasayana, Vrishya, Cakshushya.

Pharmacological actions

Its antimicrobial & antiviral properties are attrib. to glycyrrhizinic acid & flavonoids like hispaglabridin-A & B, methylglabridin, glabrol, 3-hydroxygabrol etc., effective against Staphylococcus aureus, E. coli, M. tuberculosis, Entamoeba histolytica & Trichomonas,[17,18] making it potent immune-regulator. Mechanistically, glycyrrhizin exerts anti-inflammatory effects by attracting leukocytes to inflamed sites, not by suppressing prostaglandin synthesis. It also exhibits anti-thrombin activity, adding to its anti-inflammatory role.[19]

Its immunomodulatory effect is evident through[20]

  • Inhibition of mast cell degranulation, reducing allergic mediators.
  • Suppression of complement activation and macrophage-mediated immune reactions, indicating both immune-calming and stabilizing potential.

Relevance in Recurrent Spontaneous Abortion (RSA)

The estrogen-like effects, hormonal balance, and immunomodulation offered by Yashtimadhu are crucial in RSA, where immune dysregulation or hormonal insufficiency can compromise fetal retention.

Additionally, its anti-inflammatory, antiviral, and uterine soothing actions help create a stable intrauterine environment, reducing the risk of miscarriage. The Sukrala and Rasayana properties further aid in improving reproductive tissue strength and hormonal nourishment, making it a valuable supportive agent in RSA management.

3. Tulsi

Tulsi (Ocimum sanctum), widely revered in Ayurveda as “The Incomparable One,” “Mother Medicine of Nature,” and “The Queen of Herbs,” is considered a sacred plant with profound medicinal and spiritual value.[21] Ayurvedic Properties includes Katu, Tikta Rasa, Laghu, Ruksha Guna, Ushna Veerya, Katu Vipaka and Karma like: Kapha-Vata Shamana, Krimighna, and Agnideepana.[22]

Pharmacological Actions

Modern studies have substantiated Tulsi’s status as a potent adaptogen, capable of enhancing the body’s resistance to various stressors and promoting homeostasis. It exhibits a diverse range of therapeutic effects, including:

  • Antioxidant[23,24]: Tulsi boosts levels of endogenous antioxidants like glutathione, and increases enzyme activities of superoxide dismutase and catalase, which protect cells from oxidative stress caused by toxins and hypoxia—important in preventing placental damage in RSA.
  • Anti-inflammatory, Anti-Pyretic: It helps relieve pain and fever associated with underlying systemic or gynecological conditions. Tulsi’s key constituents, eugenol and linoleic acid, inhibit cyclooxygenase (COX) and lipoxygenase (LOX) pathways, thereby mitigating both acute and chronic inflammation.[25,26]
  • Immunomodulatory[27]: in various studies, Tulsi has also been found to strengthen the body’s defences against infectious threats by boosting immune responses in both stressed and nonstressed animals, as well as in healthy humans.
  • Antimicrobial: Tulsi shows broad-spectrum antimicrobial activity against bacteria, viruses, and fungi.[28] It can help prevent and manage genitourinary infections, which are known to contribute to early pregnancy loss.

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  • Neuroprotective & Anti-stress[29]: Tulsi calms the nervous system, reduces anxiety, and supports emotional well-being, which is crucial in women with a history of miscarriage-related stress.
  • Wound Healing[30,31]: Due to its antibacterial, antioxidant, and anti-inflammatory activities, Tulsi promotes faster tissue healing.
  • Anticoagulant[32,33]: The fixed oil of Ocimum sanctum (3 mL/kg) has been shown to significantly prolong blood clotting time, exhibiting an anticoagulant effect comparable to that of aspirin (100 mg/kg). This activity is attributed to Tulsi oil’s ability to inhibit platelet aggregation. Comparative studies revealed that the anticoagulant potential of sanctum fixed oil mirrors that of aspirin, suggesting its efficacy as a natural anticoagulant agent.

Utility in Recurrent Spontaneous Abortion (RSA)

It balances Vata and Kapha Doshas, which are often vitiated in habitual abortions, strengthens uterine health and ensures optimal endometrial receptivity. Enhances maternal immunity, protecting against infections and immunological rejection. Reduces oxidative damage and inflammation, improving placental function and embryo survival. Offers mental and emotional support, reducing anxiety and stress-related pregnancy complications.

Given that pregnancy is a hypercoagulable state, which predisposes individuals to thrombotic events and increases the risk of abortion associated with hypercoagulopathy, Tulsi’s anticoagulant property may offer therapeutic benefits. Thus, O. sanctum could serve as a supportive intervention in cases where recurrent pregnancy loss is linked to coagulation disorders

4. Amalaki

Amalaki holds a prominent place as a multipurpose medicine in the traditional Indian system of medicine – Ayurveda. Amalaki is mentioned in Bhavprakash Nighantu under the Haritakyadi Varga,[34] the Ayurvedic pharmacological properties of Amalaki are described as: Rasa: Amlapradhan Pancharasa , Guna: Ruksha, Laghu, Sara, Vipaka: Madhura, Veerya: Shita, Doshakarma: Tridoshahara, Vayasthapana, Rasayana, Cakshushya, Vrishya.[35]

Amla Rasa → Vatahara

Madhura Vipaka and Shita Veerya → Pittahara

Ruksha Guna and Kasaya Rasa → Kaphahara

Karma as per Ayurvedic Texts:

Rasayana, Pramehaghna, Jwarahara (fever reliever), Chardighna (relieves vomiting), Kusthaghna (skin disorders), Caksusya (beneficial for eyes), Dahahara (relieves burning), Medohara (reduces fat), Bhagnasandhanakara (heals fractures and tissues), Shophaghna (anti-inflammatory), Keshya (hair tonic), and Dahaprashamana (burn soothing).[36] It has also been mentioned in classical literature for its application in: Shukrameha (spermatorrhea), Shwetapradara (leucorrhoea), Garbhashaya Rakta Srawa or Histeroma (uterine hemorrhage)

Pharmacological actions of Amalaki

1. Antipyretic, Analgesic, and Anti-inflammatory Properties

Studies on rats have shown that aqueous extracts of Amalaki significantly reduce fever induced by brewer’s yeast & decrease pain responses in mice, indicating strong antipyretic & analgesic effects likely through inhibition of inflammatory mediators.[37]

2. Antimicrobial Properties

Amalaki exhibits broad-spectrum antimicrobial activity against pathogens like Escherichia coli, K. ozaenae, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, S. paratyphi A, S. paratyphi B, and Serratia marcescens. Its antimicrobial efficacy is attributed to components like tannins, alkaloids, phenolic compounds, amino acids, and carbohydrates.[38]

3. Immunomodulatory Activity

In albino rats, Triphala, a formulation containing Amalaki, significantly enhanced neutrophil activity and reduced stress-induced immune suppression.[39] Amalaki Churna triturated with Amalaki Swaras exhibited mild cytoprotective and immunostimulant effects.[40]

4. Antioxidant Properties

Amalaki is rich in Vitamin C and low molecular weight hydrolysable tannins such as punigluconin, pedunculagin, emblicanin-A, and emblicanin-B.


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These protect against oxidative stress by scavenging free radicals, shielding erythrocytes from oxygen-radical-induced hemolysis.[41]

Relevance in the Management of Recurrent Abortions

The therapeutic profile of Amalaki makes it highly beneficial in addressing Recurrent Spontaneous Abortions (RSA) through the following mechanisms:

1. Rasayana Karma helps in rejuvenating reproductive tissues and restoring uterine health.
2. Anti-inflammatory and analgesic actions reduce systemic and local inflammation, improving uterine receptivity.
3. Immunomodulatory activity supports immune tolerance, minimizing chances of immune-mediated fetal rejection.
4. Antioxidant actions help mitigate oxidative damage to the embryo and endometrial lining, a known contributor to RSA.
5. Antimicrobial activity addresses urogenital infections, a common cause of miscarriage.
6. Shita Veerya and Madhura Vipaka provide a cooling and stabilizing influence, especially useful in Pitta-related bleeding disorders or inflammatory conditions of the uterus.
7. It supports stress adaptation and hormonal balance, essential in women experiencing repeated pregnancy loss due to psychosomatic or neuroendocrine reasons.
8. Its Sandhanakara Karma aids in healing microscopic endometrial injury, supporting proper implantation and fetal nourishment.
9. Bhumyamlaki

Bhumyamalaki, first mentioned in the Brihatrayees, was originally used for treating disorders of the respiratory system. Over time, its therapeutic efficacy in hepatobiliary diseases was also recognized. Due to its extensive pharmacological actions, it has found applications in several systemic ailments, including gynecological disorders like recurrent abortions.

Ayurvedic Properties[42]

Rasa: Tikta, Madhura, Kashaya, Guna: Laghu, Ruksha, Veerya: Shita, Vipaka: Madhura, Karma: Kapha-Pitta Shamaka.

Phytochemical Composition

Bhumyamalaki is rich in: Lignans, Flavonoids, Triterpenes, Sterols, Alkaloids, Essential oils.

Modern Pharmacological Actions

Antioxidant Action

Studies using FRAP, DPPH, and Folin-Ciocalteu method showed significant antioxidant activity & total phenolic content (TPC) in fresh Phyllanthus urinaria extracts.[43] These antioxidants are vital in preventing oxidative stress-induced endometrial damage, known cause of recurrent pregnancy loss.

Antiviral Action

Alcoholic, hexane, chloroform, butanol, and water extracts of Phyllanthus urinaria were found effective against Hepatitis B antigens (HBsAg, HBeAg, HBV-DNA). The butanol extract was most efficient. It inhibits HBV polymerase activity, mRNA transcription, and viral replication[44]- suggesting potential as a supportive antiviral agent in HBV-related reproductive or systemic conditions.

Probable Mechanisms Supporting Its Role in Recurrent Abortions

1. Kashaya Rasa: Leads to Kleda Shoshana, Raktapitta Prashamana.[45] It possesses Samgrahi and Stambhaka (binding and hemostatic) actions that help in controlling uterine bleeding. The Prithvi Mahabhuta element in Kashaya Rasa enhances Sanghata (compactness) of the endometrial tissue, thus reducing fragility of the uterine lining and supporting implantation. It has Sandhanakara Karma which supports tissue regeneration and repair, essential for healing endometrial damage or micro-lesions that hinder implantation.

2. Madhura Rasa: Promotes Rakta Prasadana (blood purification)[46] and helps in managing uterine bleeding. It has Balya, Jeevaniya, Tarpana, and Sandhanakara qualities, which support both physiological and psychological strength of the uterus and reproductive system.

3. Shothahara:Helps in relieving uterine congestion

4. Bhumyamalaki Churna possesses Sheeta Veerya, which helps in pacifying Pitta, reducing burning sensations, and controlling excessive bleeding through its Pittashamana,[47] Raktastambhana,[48] and Dahaprashamana

Conclusion

The present clinical study demonstrated that the Ayurvedic Vati formulation (TAB-GM),


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composed of classical herbal ingredients with Garbhasthapaka (pregnancy-sustaining) and Rasayana (rejuvenative) properties, holds promising therapeutic potential in the management of recurrent pregnancy loss (RPL). Patients who received TAB-GM showed a statistically significant improvement in clinical outcomes, including successful continuation of pregnancy and reduction in the incidence of miscarriage, as compared to the control group. No adverse effects were reported during the study period, suggesting the safety and tolerability of the intervention.

The holistic approach of Ayurveda, which addresses underlying Doshic imbalances and strengthens reproductive health, appears to offer a beneficial complementary strategy in cases of unexplained or idiopathic recurrent miscarriage. These findings support the integration of Ayurvedic formulations like TAB-GM in the multidisciplinary management of RPL, especially in women where conventional treatment options are limited or ineffective.

However, further large-scale studies with longer follow-up periods are recommended to confirm these results and to explore the exact mechanisms of action of the herbal constituents involved. This research adds to the growing body of evidence supporting the scientific validation and clinical application of Ayurvedic therapeutics in contemporary gynecological care.

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