There are two routes for the administration of Basti described in the classics, viz. Basti (through the anal canal) & Uttara Basti (through the urogenital tract). The Basti Yantra is also used to inject medicines through the urinary and vaginal passage, for which the term Uttara Basti is given. The Uttara Basti deals with both males and females. But the following discussion is carried out taking females in view only, as required here.
- Uttara Basti as a Vishesa Chikitsa:
Acharya Sushruta has mentioned: After applying five Shodhana Karma, Uttara Basti should be given repeatedly for Artava Shuddhi. Acharya Charaka has also advised in Siddhisthana: ‘The woman, who is not able to conceive (due to Vata Dosha) should be treated by Basti because Basti is the best Chikitsa for this type of woman.
There are three reasons behind this terminology –
- It is administered after Niruhabasti (Niruhat Uttarena)
(Niruhat Uttaro Yasmat Tasmat Uttarsamgyakah.
- It is administered in the superior organ (upper passage)
(Uttarena Va Margena Deeyat),(Uttarmarga deeyamantaya.
- It is superior as it does Snehanam like Anuvasanabasti and Shodhana like Niruhabasti. (Shreshtthagunatva)
- Indications of Uttarabasti
- For conception (GarbhamYonih Tada)
- To pacify Vata (JiteVayuh)
- For urinary bladder disease (Bastijeshu Vikareshu)
- Diseases caused by prolapse (Yonivibhramshajeshu Cha)
- Severe Pelvic pain (Yonishuleshu Tivreshu)
- Gynecological disorders (Yonivyapada, Yonivyadhim)
- Menometrorrhagia (Asrigdara)
- Retention of urine (AprasravatiMutre, Mutraghata)
- Incontinence of urine (BindumBindumSravatyapi)
- Menstrual disorders (DushtamShonitam)
- Menorrhagia (Pushpodrekam)
- Pathological amenorrhoea(TasyaNasham)
- Dysmenorrhoea (Kashtam)
- Urinary diseases (Mutradosham)
- Retention of the placenta (SamsathatimApara)
- Urinary calculi (SharkaraAshamarim Cha)
- Groin pain (Vamkshana Shula)
- For all reproductive tract disorders (RogeshuNarinam Yoni Garbhashayeshu Cha)
- Not described in classics
- The only contraindication given in classics is the genital tract in girls (Balanam Apatya Marge Na Diyat Iva)
Time of administration
Uttarabasti should be given in Ritukala (just after a menstrual period) after purifying the body with two or three Asthapana Basti because Garbhashaya (Garbhashaiya or Yoni)[xiv] is prepared to soak up Sneha this time. Acharya Charaka & Vagbhata have given very correct rationalization for the choice of appropriate time by saying that all through menstruation, vaginal and uterine orifices open (Apaavrita yoni), so medicine is taken in a higher way.
- Dose of Snehana type of Uttarabasti
Acharya Sushruta has given the quantity of Snehana (oleaginous) type of Uttarabasti for the urinary tract as one Prasrita (palm of an outstretched hand and hollowed it as to hold liquid, stuffed up to the Svangulimula i.e., the base of fingers). For cleansing (Vishodhana) of the uterus, it is doubled i.e., two Prasrita. Acharya has given this dose for extreme illness and strong patients (Paramvarga) and has left the decision of fixing individual doses on the knowledge of ShalyaChikitsaka (BuddhiVikalpitam). While commenting on the same, Acharya Dalhana again clarifies that the volume can also be half or less (as decided by the physician at his discretion), depending on the strength of the disease or the capacity of the patient. Acharya Chakrapani followed Sushruta and repeated the same.12
Acharya Sharangadhara and Bhava Mishra have considered this dose as:
- In adult women: two Pala (96 ml) in the genital tract & one Pala (48 ml) in the urinary tract
- In premature girls: two Karsha (24 ml)
Acharya Vagbhata has mentioned:
- For adult women: one Prakumcha (Pala=48gms)
- For girls: 1 Shakti (24 gms)
Aforesaid Matra is Madhyama as per Acharya Vagbhata. It should be increased gradually by half & one Karsha in the second & third Uttarabasti respectively.
- Dose for Niruha Uttarabasti
If cleansing is needed by Uttarabasti:
- For the genital tract reproductive age group of women (Nullipara or parous) – 2 Prasrita
- For a urinary tract of reproductive age and girls of less than 12 years – 1 Prasrita
Day-night, a total of 2, 3, or 4 Basti should be given and the procedure should be continued for three nights gradual increase in the quantity of oleaginous substance
After giving rest for 3 days (Trayahmeva Cha Vishramya), the procedure was repeated for another 3 days.
- Method of Uttarabasti
Yantra (Instruments): Pushpanetra & Bastiputaka
- Pushpa Netra:
The Netra or nozzle of Uttarabasti is termed as Pushpanetra;
In nutshell, the parameters of Pushpanetra can be summarized as follows:
- Should be made of silver, gold, brass, bell metal, tin, or lead
- It must be smooth, tapering like a cow’s tail
|Age||Passage||Length||Circumference of nozzle||Size of lumen|
|Girl||Urinary||10 fingers||The flower stalk of Malati||Size of a mustard seed|
|Adult women||Urinary||10 fingers||Size of the urethral meatus||Size of Mudga seed|
|Adult women||Vaginal||10 fingers||Index finger||Size of Mudga seed|
- Uttarabasti Pustaka
- Not mentioned specifically in classics
- Can be made on the same pattern as mentioned for Guda (anal) Basti, but smaller in dose /quantum.
- Uttarbasti putaka should be made from soft material, light like the skin of an animal and in case they are unavailable skin of birds, one-fourth portion of a leather bag or any other soft leather can be used.
- Position (Sthiti)
The woman should be placed in a supine position with flexed thighs and elevated knees (Uttanaya Shayanaya Samyak Samkochya Sakthini Urdhvajanve Striye Dadyat Uttanaye)
- Procedure (Vidhi)
The nozzle should be inserted in the urinary or vaginal passage slowly with steady hands, following the direction of passage.
- Pratyavartana (Returning)
- Pratyavartana of Snehana is considered essential for Uttarabasti.
- Acharya Charaka has mentioned the administration of PippalyadiVarti (suppositories) if Basti does not return.
- Acharya Dalhana has given a very specific description of the Pratyavartana of Sneha. These measures are –Yoni Varti, GudaVarti, Sphika – Tadana & Eshana, etc.
UTTARABASTI IN PRACTICE
Now a day, Uttarabasti referred to as classic is being practiced after making several modifications. Everything has been extensively modified from its indications to contraindications, and instruments to the method, and only the Snehana type of Uttarabasti is in practice.
- Poorva Karma
- The patient is asked to evacuate the bladder & rectum.
- Yoni Prakshalana – by some Kwatha of antiseptic property
- Snehana (Abhyanga) of the local abdomen, back, thigh, and legs
- Svedana especially Nadi Sveda on the back and lower abdomen
- Pradhana Karma
The instruments used for the Uttarabasti are Posterior Vaginal Speculum, Anterior Vaginal Wall retractor, Allis’ forceps & Uttarabasti cannula fitted with a disposable syringe. Uttarbasti is done under perfect aseptic precautions. It can be given intravaginally or intrauterine. In Intrauterine Uttarbasti– The genital parts are prepared and the medicine should be autoclaved or heated and cooled at room temperature. The drug can be instilled when slightly warm but not beyond 95°F.
The routine disposable syringe is used and not more than 5 ccs of medicine (usually Snehadravya) is used in one sitting. Rubin’s cannula, Uttarbasti canula, IUI canula or butterfly needle with the needle cut off and only the tube is used. The patient is taken to the dorsal lithotomy position, and cleaned with the antiseptic solution is done. Expose the cervix with instruments (By Speculum). Before inserting the medicine, one should ensure that there are no air bubbles in the syringe or the tube and then the medicated oil is gradually pushed in, while the anterior lip of the cervix is held with Allis’ forceps and the patient is kept in head low position.
Once the speculum is withdrawn the patient may be asked to lie in the left lateral position for 15-20 mins and then shifted toward. The patient is kept in a head low position for at least 2 hours for better absorption of the drug from the vagina and to prevent any vasovagal shock.
- Pashchata Karma
- Complete rest in head low position for at least 2 hours.
- Abdominal hot fomentation with hot water bag.
- Light diet.
- Yoni shuShulaavartaYonivyapada
- Premature ovarian failure
- Tubal Block
- Granthi, Arbuda
Contraindications being considered these days can be divided into two categories –
- Absolute contraindications: Pregnancy and in-situ contraceptive device
- Relative contraindications: vaginitis, cervicitis, endometritis, endometriosis, and carcinoma.
2.4. Period of Uttarabasti
The best period is from the 6th to 12th12th-days of menstruation, as it will lead to a well-formed Bija and facilitate conception.
PROBABLE MODE OF ACTION OF UTTARABASTI
The mode of action of Uttarabasti lies not only in the Pradhana Karma but also in its Poorva Karma-
- Mode of action of Poorva Karma in Uttara Basti:
- Though classics have not specifically emphasized much upon Snehana and Svedana before Uttarabasti, this method looks to be genuine and appropriate.
- Uttarabasti deals generally with the Apana Vayu, as the close-by situated organs are its seat. Snehana and Swedana before Utttarabasti do its Anulomana and thus, Uttarabasti becomes more efficacious.
- Besides this, the chances of any type of complication are also less, if Vatanulomana is done before the procedure.
- Besides, Snehana and Swedana (just before Uttarabasti) relax the abdominal muscles. Good relaxation is very important for Uttarabasti, so that uterus does not get irritated by the instillation of medicine from outside. If it is not relaxed adequately, it may contract at once and may not retain any of the medicine.
- Snehana and Svedana (before Uttarabasti) also lessen the ache all through and after the procedure.
- Yoni Prakshalana carried out before Uttarabasti with Kwatha of antiseptic property nullifies the possibility of any kind of infection as a complication.
Mode of action of Pradhana Karma in Uttarabasti:
The mode of action of Uttarabasti can be understood in two ways –
- Local effect of Uttarabasti
- The effect of Uttarabasti will depend on various things; like method, instrument, drug user, etc. If the medicine is put in the cervical canal, it may act more on the cervical factors. For the factors like cervical stenosis, a Katu – Ushna Taila-based medication is more useful, while for increasing the secretion of mucous from cervical glands, a nutritive like Madhura-Sheeta Ghrita-based medicine will be more efficacious.
- In the same way, drug selection for an ovulatory and tubal factor will be different from each other. On the ovary, the effect of the drug will be after absorption and then by promoting the Hypothalamus-Pituitary-Ovarian axis, while in the tubal block, Uttara Basti acts locally. In ovulation, a drug with Snehan property can be good while for tubal block, a drug with Lekhana Karma will be better.
- The advantage of intrauterine instillation of oil is proved in modern science also as it is said that approximately 30% of the patients who have normal hysterosalpingography, conceive over the following 6 months and it is thought to be a characteristically oil-based contrast medium.
- Apart from this, Uttara Basti may also stimulate certain receptors in the endometrium, leading to the correction of all the physiological processes of the reproductive system. It may also help in the rejuvenation of the endometrium.
Thus, the mode of action of Uttara Basti can be understood in the following ways –
- Intra-vaginal Uttara Basti helps in removing infections. (If given with antiseptic drugs)
- Intra Intra-vaginal – Basti may also facilitate the absorption of the drug, as the posterior fornix has a very rich blood supply and it may also act as a reservoir of the drug (when the patient is lying down in a head low position after Uttara Basti).
- Intra-cervical Uttara Basti with oil-based drug helps to remove cervical stenosis and to restore the function of the cervix in conception and helps to treat dysmenorrhoea caused by stenosis.
- In cervical Uttara Basti with Bhrimhana drugs may stimulate the secretion of cervical mucous leading to an ascent of sperms in the uterine cavity.
- Intrauterine Uttarabasti with Ghrita-based Snehana & Brimhana drugs helps in the rejuvenation of endometrium, especially where apart from regular ovulation, poor endometrium is causing infertility or scanty menstruation.
- In cases of menorrhagia due to endometrial hyperplasia, Intra uterine Uttarabasti with Lekhana Dravyas may help.
- For a tubal factor of infertility, a high intra intra-uterine Basti with Lekhana & Ropana Dravya acts in two ways. Lekhana Dravyas removes the blockage of the tubal lumen by directly acting on obstruction mechanically and Ropana Dravyas restores the normal function of tubal cilia by stimulating it. As endometrial covering is continuous in the tubes too, its scraping and regeneration also lead to the normalization of tubal functions.
- The systemic effect of Uttar Basti after absorption: –
- Ayurveda had a very clear approach to the oral and parenteral route of drug administration from the very beginning. Thus, Acharyas have described the administration of drugs from almost all the open organs and have considered the Basti (rectal administration) the most efficacious.
- In the same pattern, Uttarabasti can also act after getting absorbed from the rich blood circulation of the uterus and posterior fornix. Then, it may act on the whole body system and can act as a parenteral route.
- The systemic effect of Uttarabasti can also be understood with the help of the system biology concept. System biology is the latest concept emerging and getting accepted in modern science. This concept believes in the artistic approach similar to as advocated in Ayurveda from the very beginning. It considers the need for a standard shift of modern science from reductionist to holistic. It believes that all bodily systems and organs are interconnected at the molecular level. This concept is the first step of modern science towards the concept of Mahabhuta and Tridosha. Ayurveda also considers whole the body as one unit on the Mahabhautic level. Still, Tridosha and Mahabhuta are something broader, but more abstract than molecules, which will be explored in modern science too in the coming future. It is now clear that ‘whatever may the effect Uttarabasti drugs have on the physiology of the reproductive system, it will involve the physiological functions and corrections of other systems.
- Thus, Uttarabasti can be taken as a parenteral route of administration for reproductive diseases, as it can act, locally as well as systemically.
Dr. Ankit K. Garg
M.S (Ayu) OBGY
Former resident ITRA, Jamnagar
Address-Ridhi-Sidhi Bhawan bedal road Falna Dist.-Pali, (Raj).306116 Phone -8302463471