The Contribution of Oja in Pregnancy with Special Reference to Immuno-Modulation

Abstract

Pregnancy is one of the most significant stages in a woman\'s life. It refers to the time when a fetus develops inside a woman\'s uterus or womb. The gestation period lasts around 40 weeks from the beginning of the last menstrual period(LMP). Ayurved has mentioned a novel concept known as Oja. Oja is one of the most crucial component responsible for the up keep and nourishment of life. It is supposed to be in the heart and operates through out the entire body. Oja manages and oversees the body\'s whole operational system. Different Acharyas have identified Oja as Sarvadhatu Sara (essence of all Dhatus), Shukravishesha(energy), Jeevashonita (blood), Prana (vital energy), Bala(strength), Shleshma(mucus), Jeeva(life),Ushma (warmth) and so on. They have also considered Oja as Upadhatu (sub tissue) and its Vikruta Avastha (disorder)is Mala. Ayurveda explains the significance of Oja in the process of fertilisation, implantation, growth and development of the fetus during pregnancy. We can reconcile the current concept of immuno - modulation in pregnancy with our ancient theory of Oja. According to contemporary science,the immune system plays an important role in the preservation of pregnancy.

Introduction

I. INTRODUCTION

The term "Garbha" refers to the living being inside the womb. According to Ayurveda, Garbha is created as a result of the interplay between Shukra(sperm), Shonita(ovum) and Atma(soul) in relation to Shodasha Vikaras(manifestations) and Ashta Prakriti (developers)for the formation of Garbha, other elements such as Panchamahabhuta viz . Prithvi (earth),Jala (water), Agni or Teja (fire),Vayu (air)) and Akasha (ether or space) six procreative factors (Shad Garbhakara Bhavas) as Matrija (maternal), Pitrija (paternal), Atmaja (soul), Rasaja (nutritional), Satmyaja (adoptability) and Sattvaja (psychological) and Garbha Sambhava Samagri viz. Ritu (conception period), Kshetra (uterus), Ambu (nutritional circulation through blood), and Beeja (sperm and ovum) are also necessary.

 In Ayurveda, there is a concept called Oja which refers to an entity that unites the body, mind, sensory organs, and soul in a state of harmonious functioning. Oja is believed to maintain accountability between life and death. There are two types of Oja viz . Para, and Apara Oja, which are explained in Ayurvedic texts. Para Oja is the primary form of Oja formed during an individual's intra-uterine life. It is located in the heart and is not impacted by straight forward physiological aberrations. On the other hand Apara Oja is formed  by food and produced as end product  after the formation of   seven Dhatus viz . Rasa – (nutritious part of food that reaches blood from gut), Rakta (blood tissue), Mamsa (muscle tissue), Meda (fatty tissue),Asthi (bony tissue),Majja (bone marrow) Shukra ( sperm) This type of Oja is influencable by etiological and medical conditions. This type of "Oja" is influenced by various factors such as diseases and other underlying causes. It is about half the size of an Anjali(‘Anjali Pramana ’is the unit of measurement of the liquid Dhatus in the body) Oja is regarded by some Acharyas as "Rasa Sneha" and "Sarvadhatusara"(optimum nutritional essence).

Our ancient texts have cited multiple sources that explain the role of Oja in processes like fecundity, implantation, growth, and development, involving factors such as Prana(life), Bala(strength) Shukravishesha (energy, Shleshma (mucus) Jeevashonita, Teja(glow), Ushma (Heat), etc. Similarly, the idea of immunology during pregnancy is explained by contemporary science. There is an immunological paradox in a successful pregnancy.

A foetus is one tissue that is frequently transplanted and tolerated during pregnancy, according to basic immunology. The immune system's enigmatic process keeps the foetus from being rejected and functions as an antigenically unnatural entity to expectant women. A more thorough discussion of the immune modulation mechanism is provided, along with an explanation of the Oja principles found in our classics.

II. LITERATURE REVIEW

A. Oja and Garbha Utpatti

The concept of Oja and Garbha Utpatti is mentioned in Charak Samhita, the ancient text authored by Acharya Charaka. Oja signifies the beginning of the formation of the embryo, which is referred to as Garbha. The Sharira Rasa provides nourishment to the Garbha and enables it to take the position in the Hridaya (heart). According to Acharya Chakrapani, the formation of Garbha begins during the Shukra Shonita Samyoga and forms the Garbha Jeeva (life). Garbha Poshan Rasa (foetal circulation) provides nutrition to the foetus and inevitably forms the Oja also. Oja helps to maintain  the Garbha throughout pregnancy period. Since the Acharyas have described the Sthana (abode) of Para Oja in Hridaya .It is supreme type of Oja which is most important for survival of life . Its quantity is supposed to be Ashta Bindu (eight drops). Another type of Oja, Apara Oja is circulated all over the body(Sarva Sharir Vapi) through arteries. Apara Oja is also developed during foetal stage. It is supposed that in eighth month of pregnancy this Apara Oja moves from foetus to mother and mother to foetus.  Apara Oja which is circulated all over the body is Ardhanjali(half handful) in quantity. Apara             Oja is important for growth and development .Shukravishesha (optimum end product of nutrition)supports Oja in development of Garbha.

B. Oja and Panchamahabhuta

As per traditional Indian philosophy, the physical body is made up of Panchamahabhuta viz Prithvi (earth) , Jala(water) ,Agni or Teja( fire),Vayu (air ) and Akasha (ether or space). Each Mahabhuta has a specific role in the development of the Garbha. Jala Mahabhuta resides in the body in all forms of fluid substances (Shleshma, Rasa, Shukra etc.). It provides functional strength to the sensory organs and keeps the fetus alive by nourishing the Oja, Dhatus and moisturizing the dryness caused by Vayu and Agni.

As per Acharyas, the state of Oja in Vikrita Avastha is considered as disorder (Mala Avastha). However, its natural state, known as Prakrita Avastha or  Shleshma, provides strength (Bala).  Further more, there are references regarding Oja in classical literature, such as Rasa Sneha, Sapthadhatu Sara, Shukra Vishesha etc. These allusions highlight the importance of Jala, which is the main component required to maintain Oja during pregnancy.

C. Oja and Shadbhavas

The combination of Matrijadi Bhavas and other pro-creative elements produce embryo. According to  Acharyas, Rasaja Bhava (nutritional factor)is the cause factor of various bodily developments such as Abhinivritti (constitutional) Abhivriddhi (growth), Prananubandha(Bonding of life), Tripti (contenment) Pushti(nourishment) and Utsaha(passion). In Garbha, Satmyaja Bhava plays a vital role in the development of Ayu, Arogya, Analasya (enthusiasm), Oja, Bala(strength), Medha(intellect) and other bodily aspects. Our ancient texts mention "Oja" as Prana and Bala, which transmit Tushti and Pushti to the Sharir(Body). Since the roles of Rasaja and Satmyaja (adaptability factor) Bhavas are comparable to those of Oja, we can consider both these Bhavas as having a role in the development of Oja in Garbha.

D. Garbhavriddhi and Oja

During gestation, the substance known as Oja plays a vital role in the embryogenesis, organogenesis and subsequent growth and development of the developing fetus. The Acharyas have explained  month-by-month development of the Garbha (Masanumasika Garbha Vridhi) in detail .But there are a few  references available regarding  Oja. The Bala, Varna and Oja in the Garbha are  formed during the sixth month. Almost every Acharya has emphasized the significance of Oja in the eighth month.

To summarise: during the eighth month of pregnancy, the fetus remains immature which causes  "Oja’’ to remain unstable and transmit between the mother and the fetus. As a result, the fetus experiences alternating moods that range from despair to excitement. Due to these factors, the eighth month is typically considered an inappropriate time for childbirth.

E. Oja and Garbhaposhana

As soon as the embryo develops, the mother starts nourishing it with Ahara Rasa and Vayu helps in its growth. According to all the Acharyas, there are two ways to comprehend Garbha Poshana.

1. Before Apara Nirmana by Upasneha and Upasweda(histio-trophic nutrition)
2. After Apara Nirmana (placenta formation) by Nabhi Nadi(umblical cord)

The consumption of Ahara Rasa by a mother not only nourishes herself but also provides nourishment to the fetus. The placenta is related to the uteroplacental circulation and the Nabhi Nadi connects the Nabhi of the fetus to the feto-placental circulation, circulating the Ahara Rasa absorbed by the mother. The nourishment of the fetus is done by Siras which impart Rasa, Bala and Varna to the fetus.

The exchange of blood between the mother, placenta, and fetus is known as Rasa, Saptadhatusara and Jeeva Shonita in this context. Ahara Rasa ultimately feeds Garbha.

F. Oja and Garbhini Paricharya

Our Acharyas have described various this applications of  Ayurveda drugs viz.Hridyam(cardio tonics), Madhuram (carbohydrates), Snigdham(fats), Drava(liquid), Deepaneeya(appetiser) Samskrita (refiner), Jeevaneeya(energizers) Gana Dravyas(drugs)and Samanya (general) and Vishesha (specific) in Garbhini Paricharya (pregnancy guidelines) in their texts. These include Navaneeta(Butter), Ghrita (refined butter), Ksheera(milk), Santarpana Ahara (rich food or meal) and so on. In the Ojokshaya Chikitsa (Immuno-deficiency), these are mentioned as containing Madhura Rasa, Sheeta Virya and Madhura Vipaka, which are attributes of Oja.  There are various Viharas that can aid in pregnancy-related Oja production and maintenance, such as Abhyanaga, Mala Dharana,, Chandrika Snana, Kasturi Chandana and more. Additionally, Oushadi Dravyas(Drugs) such as Gokskura (Tribulus terrestris), Vidarikanda(Pueraria tuberosa), Kadali(Musa paradisiaca), Draksha(Vitis vinifera), Dhatri( Emblica officinalis), Panasa(Artocarpus heterophyllus), Kushmaanda(Benincasa hispida), Kharjura(Phoenix dactylifera), Bala(Sida cordifolia), Jeevaniya (energetic) and Garbhasthapaka (pro pregnancy) Gana Dravyas can also aid in the process.

G. Immunology in Pregnancy

Pregnancy is a unique situation where the immune system behaves paradoxically. During pregnancy, the foetus and the mother's uterus interact with each other in various ways to support the healthy growth and development of the foetus. The placenta and foetus rely on different immune system cells and chemicals to function properly.

H. Immuno-genicity of Decidua

During pregnancy, the trophoblast invades a large area of a woman's body, including the inner third of the myometrium and the endometrium. To prepare for implantation, establishment, and support, the uterus undergoes significant remodelling that involves numerous cellular compartments. Decidualization is a cyclical process that begins in the mid-luteal phase of the menstrual cycle in humans. In the early stages of pregnancy, uterine NK cells account for over 70% of decidual leukocytes, with macrophages being the second most common at around 20%. T-cells make up 10-20% of decidual leukocytes, while B cells and dendritic cells (DCs) are less common.

I. Uterine NK Cells

Natural killer (NK) cells are a type of lymphocytes that are believed to originate in the bone marrow. Uterine NK (uNK) cells are a specific type of NK cells that are present in large numbers in the decidua during early pregnancy, mainly at the site of implantation. However, by the time of delivery, the number of uNK cells in the decidua decreases significantly. The infiltration of uNK cells is increased by progesterone, IL15, and decidual prolactin. These cells are weakly cytotoxic and do not typically kill trophoblast cells. Instead, uNK cells are an essential source of immunoregulatory cytokines, matrix metalloproteinases (MMPs), and angiogenic factors. These various factors play a crucial role in remodeling the extracellular matrix, trophoblast invasion, and angiogenesis, which are critical processes in placentation and the establishment of early pregnancy at the maternal-fetal interface. There is a high proportion of uNK cells in fetal circulation at 13 weeks of gestation. Given their high numbers, early presence and ability to kill cells, NK cells are likely vital components of the fetal innate immune system.

J. Macrophages

In the first trimester, decidual macrophages make up approximately 20% of the human decidual leukocyte population, indicating their relative abundance. The majority of macrophages at the maternal-fetal interface in a typical pregnancy belong to the M2 (immuno modulatory) phenotype. Existing macrophages contribute to early spiral artery remodelling by generating factors linked to tissue remodelling (MMP-9) and angiogenesis decidua prior to the formation of extravillous trophoblast (vascular endothelial growth factor [VEGF]).

K. Immuno- genicity of Trophoblast: Human Leukocyte Antigens

Human leukocyte antigens (HLAs) are similar to the major histocompatibility complex (MHC) found in humans. During pregnancy, the fetal membranes express tolerogenic HLAs rather than immunogenic ones, and the proteins expressed at the maternal-fetal interface are strictly regulated. There are two classes of MHC antigens: MHC class I and MHC class II.

The MHC class I genes are divided into two subcategories: class Ia (classic) and class Ib (nonclassic). HLA-A, B, and C fall under class Ia, while HLA-E, F, and G fall under class Ib. MHC class II (HLA-D) genes are not translated in human trophoblast cells. Extravillous cytotrophoblasts, which are human trophoblast cells, express one MHC class Ia (HLA-C) and all MHC class Ib molecules. Most cells in the human body express MHC Class Ia, which is a "badge" that identifies "self" and provides protection against immune responses. However, fetal trophoblast cells in the human placenta do not express MHC class Ia (HLA-A and B) molecules, which are responsible for rejecting allografts in humans. Interactions between class I genes and decidual NK cells lead to the infiltration of trophoblasts into maternal tissues.

III. DISCUSSION

During pregnancy, both ancient classics and modern theories emphasize the importance of Oja and immunology, respectively, for sustenance and maintenance. Failure of implantation, embryogenesis, growth and development of the fetus or termination of pregnancy can occur due to the malfunctioning of the immune system or Oja. In the first trimester, the function of Oja in Garbha Utpatti is similar to the immune genicity of decidua and trophoblast. During the second trimester, there is rapid growth and development of the fetus and nutrients taken by the mother nourish the fetus initially through Upasneha and Upasweda, and later through Apara-Garbha-Nabhi Nadi. Apara oja is generated due to the excellence of seven Dhatus and is nourished by food. Small deviations may lead to disease conditions like anaemia, HTN(Hypertension) GDM(Gestational diabetes mellitus), repeated infections, etc., in the mother and IUGR(Intra uterine growth restriction), fetal insufficiency, etc., in the fetus. Usually, Para Oja is not affected by the deviation in physiology, but if it is affected, there may be chances of IUD(Intra uterine death) or stillborn. Therefore, it is essential to provide Priya-Hitakara Ahara and Vihara to both Garbha and Garbhini to safeguard from Garbhopaghtakara Bhavas. By the end of the third trimester, complete fetal development is seen. In the eighth month, instability of Oja is observed, and this can lead to complications of prematurity and preterm delivery of fetuses like birth asphyxia, RDS(Respiratory Distress Syndrome), IVH(Intra Ventricular haemorrhage), recurrent infections, etc. Improper management of these complications may cause fetal death. Thus, Acharyas have stated that the eighth month is unfit for delivery. The baby continues to mature during this month, adding to fat stores and experiencing a rapid development of the brain. The baby becomes able to see at this stage and begins to kick more. Most of the internal organs and systems get fully developed, but the lungs still need time to mature. By month 8 baby becomes close to 18 inches long. The fetus becomes able to identity most stimuli. Most of the internal systems become well-developed, but the lungs  still remain immature.

Conclusion

In this study an Analysis of Oja in relation to immuno- modulatory regulation during pregnancy has been attempted. • Immuno-modulation occurs physiologically throughout pregnancy. •Oja plays a crucial role in fertilization, implantation and development of the fetus during intra uterine life. •Ayurvedic practices mentioned in Garbhini Paricharya (pregnancy guidelines) maintain Oja in the mother and fetus during pregnancy. •Rasayana treatment feeds Oja and yields excellence in Dhatus. Immunity is increased by an increase in Oja (Bala). Numerous studies have demonstrated the immuno-modulatory effects of the medications used in Rasayana therapy. Lehana assists in boosting immunity as well in order to attain good quality Oja (Vyadhikshamatva-Bala) immunity.

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Copyright © 2024 Asha Gochar, Rakesh Kumar Sharma. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.