1b. Tryavarta Yoni and anatomical insights of Garbhashaya with marma, peshi

b) Tryāvarta Yoni and Anatomical Insights of Garbhāśaya with Marma & Peśī

Learning Objective

By the end of this chapter you should be able to (i) explain the classical concept of Tryāvarta Yoni (three intravaginal spirals/folds), (ii) describe the situation, shape and relations of the Garbhāśaya (uterus) as per Ayurvedic classics, and (iii) correlate the relevant marma (vital spots) and peśī (muscle) descriptions around the female pelvis with modern anatomy.

1) Classical overview: Yoni and Garbhāśaya

Yoni in Āyurveda denotes the female genital passage in the broader sense of the term (the “parturient path/apatyapatha”), serving as the route for coitus, menstruation, conception and parturition. Ācārya Suśruta provides a precise morphologic description of this passage and the uterine bed:

• Shankha-nābhi-ākṛti yoni — the vaginal canal resembles the navel of a conch, signifying a spiralled lumen.
• Tryāvarta yoni — there are three avarta (spirals/involutions) in the canal; the Garbhāśaya is situated in the third, posterior spiral.
• Rohiṭa-matsya-mukha ākṛti — the uterus is likened to the mouth of the Rohiṭa fish: narrow at the mouth (cervical os) and expanding superiorly (uterine cavity/fundus).

Context note for exams: These three statements together form the classical Tryāvarta Yoni–Garbhāśaya core and are frequently asked in viva/short notes. Remember the trio: Śaṅkha-nābhi (shape) → Try-āvarta (folds) → Garbhāśaya in 3rd avarta (location).

2) Tryāvarta Yoni — structure & clinical mapping

2.1 The three avarta (spirals/folds)

While the classical text employs the imagery of spiralled turns, teachers and examiners commonly correlate them to recognizable subdivisions:

Exam tip: Write: “Yoni — śaṅkhanābhyākṛti, tryāvartā; tasyāstu tṛtīyāvarte Garbhāśaya,” with reference to Suśruta Śārīrasthāna 5, ‘rememberable verses’ describing these features. In structured answers, add a neat labelled sketch of the three avarta and uterine bed.

2.2 Orientation & relations of Garbhāśaya

Suśruta places the uterine bed behind the basti (urinary bladder) and between Pittaśaya and Pakvāśaya (interpreted broadly as viscera flanking the uterine bed). This nicely matches the pelvic anteverted–anteflexed orientation described in modern anatomy.

Shape: Rohiṭa-matsya-mukha ākṛti communicates a funnel-like organ—narrow cervix opening into a broader cavity, consistent with the uterine isthmus and fundus configuration.

3) Garbhāśaya: structure–function notes for answers

• Definition (functional): Garbha-āśaya — the cavity that receives, retains and nourishes the embryo, and from which the fetus is ultimately delivered.
• Mukhadvaya (two cervical lips): The concept of narrow mouth implies a controlled entrance/exit (coitus, menses, labour).
• Paridhi (bounds): Anterior — Basti; superior/lateral — adnexal regions (where Ayurvedic authors allude to structures like plāla-m-antargata comparable to ovaries/beeja-granthi in interpretive literature); posterior — rectal segment.

Short-note cue: “Garbhashaya—sthāna, ākṛti, sambandha (relations) and karma (functions),” quoting Tryāvarta Yoni and Rohiṭa-mukha ākṛti earns full credit.

4) Peśī (muscles) around the female parturient passage (Suśruta)

Suśruta gives a systematic count of peśī (muscles) and explicitly states additional muscles in the female related to stana (breasts) and the parturient passage:

• General peśī distribution: 500 muscles in the body, with region-wise counts.
• Female-specific addition:
  • 10 peśī around the two stana (five each), which attain full growth at puberty.
  • 4 peśī around the yoni-mārga (two at the external and two at the internal orifices).
  • 3 peśī around the “os” (cervical mouth).
  • 3 peśī along the passages of ovum and sperm (beeja-mārga).
    These descriptions parallel the levator ani, perineal musculature, cervical support, and adnexal/parametrial structures in modern terms.

4.1 Clinically useful mapping

Exam tactic: After listing Suśruta’s figures, write a crisp correlation to pelvic floor supports (utero-sacral, cardinal/ Mackenrodt’s, round ligament) under snāyu/bandha headings to display integration.

5) Marma around the female pelvis: what to know for OSCE/short notes

Although specific “Yoni-marma” is not enumerated, several marmas lie immediately adjacent to or influencing the apatyapatha–garbhāśaya region. From Suśruta Śārīrasthāna (Marma-vibhāga), remember these names and implications in obstetric/gynecologic contexts:

• Basti-marma (suprapubic/vesical region): injury can be rapidly fatal or lead to severe vātaprakopa, urinary fistulae and sepsis; practical caution for lower midline incisions, suprapubic catheterization.
• Guda-marma (anal region): injury risks hemorrhage, continence loss, pelvic sepsis; relevant to obstetric perineal tears and posterior vaginal surgeries.
• Nabhi-marma (umbilical): central vital spot; in obstetrics, relevant to operative entry and postpartum care.
• Vankṣaṇa-marma (inguinal): proximity to round-ligament/inguinal canal, femoral vessels; consider during hernia/inguinal surgeries and lymphadenopathy.
• Kukundara-marma (buttock) & Katikāṭarūṇa-marma (sacro-iliac ridge area): deep gluteal/sacro-iliac region; relevant to pudendal block, sciatic safety, and pelvic pain syndromes.

Answer framing: State that pelvic obstetric procedures must respect marma-kṣetra to avoid prāṇa–vāta derangement, hemorrhage, infertility and sphincter injuries. Cite Marma-vibhāga (Suśruta Śārīrasthāna 6) in references.

6) Integrating classical and modern anatomy (for long answers)

6.1 Location & relations (diagram strongly advised)

• Anterior: Basti (urinary bladder) — hence a retrovesical uterine bed in classical phrasing.
• Posterior: Rectal segment — correlates with recto-uterine pouch (Douglas) clinically.
• Superior/lateral: Beeja-granthi region (adnexa) — inferred from classical passages discussing beeja mārga/ovum passage.

6.2 Functional correlates

• Ritukāla: yoni passage “open and receptive” — conducive to bīja-praveśa (sperm entry).
• Garbha-dharana: third avarta uterine bed — site for implantation and garbha-poshana (nourishment).
• Prasava: cervical os and yoni peśī dilate/relax, pelvic floor yields, conforming to “Rohiṭa-mukha” funnel guiding the fetal head.

7) How to write Tryāvarta Yoni–Garbhāśaya in 8–10 marks

1. Intro (2–3 lines): Define Yoni as apatyapatha and its śaṅkhanābhyākṛti.
2. Tryāvarta (2–3 lines): State three avarta; Garbhāśaya in the 3rd posterior avarta.
3. Garbhāśaya ākṛti (1–2 lines): Rohiṭa-matsya-mukha description.
4. Relations (3–4 lines): Basti (front), rectum (behind), adnexal/tubal corridors; clinical orientation A-V-A-F.
5. Peśī points (3–4 lines): Female-specific extra 20 peśī; list 4 around yoni, 3 at os, 3 along beeja-mārga, 10 in stana.
6. Marma caution (2–3 lines): Name Basti, Guda, Nabhi, Vankṣaṇa; mention surgical/obstetric caution.
7. Diagram: Labelled sketch showing three avarta and uterus.

8) Shloka supporting anatomical study

Suśruta emphasizes direct observation (śarīra-avicchinna adhyayana) for correct anatomical understanding:

शरीरे चैव शास्त्रे च दृष्टार्थः स्याद् विशारदः।
दृष्टश्रुताभ्यां सन्देहमवापोह्याचरेत् क्रियाः॥
(Suśruta Saṃhitā, Śārīrasthāna 5/51)

Meaning: One becomes adept when the truths of the body and the śāstra are both directly seen; removing doubts by what is seen and what is heard, one should then act (perform procedures). This underlines how Suśruta derived Tryāvarta-yoni and uterine details from systematic cadaveric study before applying to practice.

Why quoted here? Examiners appreciate when you anchor pelvic anatomy answers in Suśruta’s anatomical method along with the Tryāvarta description.

9) Viva-oriented pearls

• Mnemonic for the triad: “Conch–Three–Fish-Mouth” → Śaṅkha-nābhi (shape), Try-āvarta (folds), Rohiṭa-mukha (uterus).
• One-liner: “Garbhāśaya lies in the 3rd posterior avarta of yoni (Suśruta).”
• Female extra peśī: “10 (stana) + 4 (yonimārga) + 3 (os) + 3 (beeja-mārga).”
• Marma caution keywords: Basti, Guda, Nabhi, Vankṣaṇa—avoid traumatic insult; control doṣa-udreka and rakta-srāva.

10) Self-check (Assessment)

A. Short-answer (write 50–80 words each)

1. Define Tryāvarta Yoni and list its three functional segments.
2. Explain the Rohiṭa-matsya-mukha ākṛti of Garbhāśaya.
3. Enumerate the female-specific peśī noted by Suśruta around yoni and explain their functional relevance.
4. Describe the anterior and posterior relations of Garbhāśaya and their clinical significance.
5. Name four pelvic marmas relevant to obstetrics and the dangers of their injury.

B. Long-answer (write any one)

1. Tryāvarta Yoni—detail the shape, avarta, and situation of Garbhāśaya, adding marma & peśī correlations and a labelled diagram.
2. Garbhāśaya—discuss sthāna, ākṛti, sambandha and karma per Suśruta; add female peśī distribution and clinical notes.

C. MCQs (choose one correct option)

1. Suśruta compares Yoni to:
   a) Dhanuḥ b) Śaṅkha-nābhi c) Ghata d) Padma
2. Garbhāśaya is situated in which avarta?
   a) 1st b) 2nd c) 3rd (posterior) d) None
3. Rohiṭa-matsya-mukha analogy refers to:
   a) Vagina b) Cervix c) Uterus d) Fallopian tube
4. Female-specific peśī include:
   a) Only in breasts b) Only perineal muscles
   c) Breast + around yoni + around os + along beeja-mārga d) None
5. Basti-marma injury may lead to:
   a) Mild pain only b) Severe complications including life-threatening sequelae c) No effect d) Headache

Answer key: 1-b, 2-c, 3-c, 4-c, 5-b.

References

Classical

1. Suśruta Saṃhitā, Śārīrasthāna 5 — Anatomy of the human body; memorable verses describing yoni as śaṅkha-nābhyākṛti, tryāvarta, and Garbhāśaya in the 3rd avarta; description of female-specific peśī. (Consult standard editions: Yādavaji Trikamji, Chowkhamba). English rendering corroborated in: Sushruta Samhita, Sharira-sthana, Chapter V.
2. Suśruta Saṃhitā, Śārīrasthāna 6 — Marma-vibhāga (Pelvic/abdomino-pelvic marmas: Basti, Guda, Nabhi, Vankṣaṇa, Kukundara, Katikāṭarūṇa).
3. Suśruta Saṃhitā, Śārīrasthāna 5/51 — Shloka on anatomical study by direct observation (quoted above).

Corroborative classical-modern bridges

4. Chapter V — The anatomy of the human body, translation summary: *“The vagina… three involuted turns; Garbhāśaya at the third posterior turn; uterus resembles the mouth of Rohita fish.” (Wisdomlib).
5. Contemporary academic reviews summarising third-avarta location and clinical mapping.

Note on shlokas: In this chapter we have quoted only one Devanāgarī śloka (Su. Śā. 5/51) whose text and reference are certain from an authentic source. Where the Tryāvarta Yoni–Garbhāśaya description is discussed, we have provided exact chapter context and reliable classical references without reproducing that verse in Devanāgarī here, to avoid any textual inaccuracy. For exam writing, cite Suśruta Śārīrasthāna 5 (“Memorable verses”) when stating śaṅkha-nābhyākṛti, tryāvarta and Garbhāśaya in 3rd avarta.

Rapid Recap (30 seconds)

• Yoni: Śaṅkha-nābhi-ākṛti, Tryāvarta (3 spirals).
• Garbhāśaya: 3rd posterior avarta, Rohiṭa-matsya-mukha ākṛti; anterior—Basti; posterior—rectum.
• Female peśī: 10 stana + 4 yoni + 3 os + 3 beeja-mārga.
• Pelvic marma to respect: Basti, Guda, Nabhi, Vankṣaṇa.