Uttar Basti- A critical review

86 Journal of Ayurvedic and Herbal Medicine 2016; 2(3): 86-88 Review Article J. Ayu. Herb. Med. 2016; 2(3): 86-88 May- June © 2016, All rights reserved www ayurvedjournal.com *Corresponding author: Dr. Rashmi Sharma Assistant Professor, Department of Prasuti Tantra & Stree Roga, Dr. Sarvepalli Radhakrishnan Rajasthan Ayurved University, Jodhpur, Rajasthan-342037, India Email: vd_rashmi 11[at]yahoo.com Uttar Basti - A critical review Rashmi Sharma 1 , Chandan Singh 2 1 Assistant Professor, Department of Prasuti Tantra & Stree Roga, Dr. Sarvepalli Radhakrishnan Rajasthan Ayurved University, Jodhpur, Rajasthan-342037, India 2 Associate Professor, P.G. Department of Dravyaguna Vigyan, Dr. Sarvepalli Radhakrishnan Rajasthan Ayurved University, Jodhpur, Rajasthan-342037, India ABSTRACT In Ayurvedic Gynecology Sthanik Chikitsa (Local therapies) are the specialized treatment procedures. These procedures basically deal with the disorders of Tryavarta Yoni (Three coverings of Vagina). Vitiation of Vata is mainly responsible for Yoniroga and Artava Vikara . " Basti " is best Vata Shamana Chikitsa . Out of this Uttar Basti is most widely used and unique treatment concept of Stree Roga . In this Study Uttar Basti is reviewed through ancient texts and an effort is made to understand the concept of Uttar Basti Keywords: Ayurveda, Stree Roga, Sthanika Chikitsa, Uttar Basti . INTRODUCTION I n Ayurveda , for Chikitsa of any Roga there are two main measures- Shaman Chikitsa (medicinal treatment) and then Shodhan Chikitsa (Bio-purification procedures) i.e. Panchakarma . Our ancient Acharyas describe some Sthanika Chikitsa (Local therapies) in Ayurvedic Stree Roga (Gynecology). Sthanika Chikitsa mainly includes Uttar-Basti (insertion of Medicated oil or decoction into Intra Uterine Cavity through Vagina), Yoni Dhawan (Cleaning of Vagina), Yoni-Pichu Dharan (insertion of Tampoons socked in medicinal oil or liquid), Yoni-Dhupan (Vaginal Fumigation) etc. These Sthanika Chikitsa possesses outstanding and satisfactory outcomes in the management of Various Stree Rogas . In this Study Uttar Basti is reviewed through ancient texts and discussed with respect to definition, sites of application, duration of time, indications, and procedure. The Standard Operating Procedures (SOP) of Uttar Basti is also given. AIMS AND OBJECTIVES  To study Uttar Basti from different Ayurvedic texts  To develop a Standard Operating Procedure for Uttar Basti MATERIAL AND METHODS This is a conceptual type of study. Textual materials are used for the study from which various references have been collected. Uttar Basti The medicaments are introduced inside the body by the help of urinary bladder that procedure is named as Basti . In all Panchakarma therapy Basti is Pradhana due to its different actions and Nanavidha Dravya Samyoga . Among the three types of Basti, Uttar Basti has some special quality, so it is nominated as " Uttar " i.e. " Shrestha ". The Basti which is given in Uttar Marga (i.e. in urinary or vaginal passage) than usual Adho Marga (i.e. in anal passage) is termed as Uttar Basti [1] . Uttarbasti is indicated in Yoni Roga, Vandhyatva (infertility), Yoni Vibransha (prolapsed of uterus), Mutraghata, Mutrakruccha, Garbhashya Roga, Asrugdar (dysfunctional uterine bleeding), Yoni Shula and Artava Vikara [1] . Uttar Basti is contraindicated in Virginity, Carcinoma of Cervix, Heavy bleeding, HIV, Hepatitis B, Hypersensitivity, Vesicovaginal fistula etc Ideal time for the administration of Uttar Basti is Rutu Kala (after completion of menstrual bleeding), because at that time the uterus and vagina are devoid of covering and their orifices are open, thus receives Sneha easily. In emergency cases it can be given in other days than Rutu Kala . Uttar Basti Yantra consists of two parts- Bastiputaka and Bastinetra (Pushpanetra). As the quantity of drug to be used in Uttar Basti is less in comparison to Basti, Bastiputaka should be Mridu and Laghu [2] .

J Ayu Herb Med ǀ Vol 2 Issue 3 ǀ May- June 2016 87 Pushpanetra should be of 10 Angula in Pramana, Mutrastrotasa Parinaha (circumference like urethra) and Mudga Chidra Sadrushya . In married women Basti Netra should be inserted up to 4 fingers in length. Now a day a 5 ml disposable syringe without needle and a uterine canula of a steel material is used. Sneha or Kwatha may be used for the Uttar Basti . Sneha is considered more useful in most of the diseases of Garbhashaya . The quantity of Sneha substance to be used for cleaning the uterus should be two Prasruta, this quantity is also same in case of decoction [3] . Uttar Basti should be given consecutive 3 days in increasing dose of Sneha . As per Vagabhatta it should be stopped for 3 days and then again should be repeated for 3 days continuously. Before administration of Uttar Basti previous infections should be cleared thoroughly. After this two to three Asthapana Basti (for Shodhana purpose) should be given to the patient. The woman should be placed in supine position with flexed thighs and elevated knees. After that the Pushpanetra should be inserted in vaginal passage slowly with steady hand, following the direction of the passage. Then drug should be administered by pressing the Bastiputaka with constant pressure [4] . The Basti drug should return after some time, if not returns then again Niruha Basti and Varti of purifying drugs should be used. Uttar Basti procedure is carried out by an expert, under all aseptic precautions and sterilized medicine is used, so there are no chances of introducing any kind of infection. In present days the Uttar Basti procedure includes 3 stages a) Poorva Karma b) Pradhana Karma c) Paschyata Karma a) Poorva Karma : The patient selected for Uttar Basti proceeds for the following procedures 1) Evacuation of the bladder & bowels 2) Bath 3) Light diet in the form of gruels, Milk with ghee, etc 4) Abhyanga: By any Vatashamak Tail ('Mahanarayana Taila, Dashmula Taila etc.) Abhyanga should be given for ten minutes on the Kati Pradesha, Adhodara, Prustha and Parshva Pradesha. 5) Sweden : After Abhyanga, Swedana was given to same parts for about 15 minutes with hot water bag. 6) Yoni Prakshalana : Vaginal douche with 500 ml of Panchavalkala Kwatha or Dashmula Kwatha or Triphla Kwatha was given with all aseptic precaution. 7) Examination of pulse, B.P. etc. was done. 8) Patient was placed in lithotomy position. 9) The genital organs were painted with antiseptic solution and covered with perineal towels and clips were applied to fix the covering. 10) Routine P/V examination was performed in order to assess the size, shape, position of uterus. 11) The trolley with instruments, light arrangement was made ready. b) Pradhana Karma : It includes the administration of medicine. (a) Sims speculum and anterior vaginal wall retractor were inserted in order to visualise the cervix. (b) Allis forceps was applied to the anterior lip of the cervix. (c) The vaginal canal, external os and fornices were swabbed with the antiseptic solution. (d) With the help of uterine sound, the length and position of uterus was assessed, weather the os was open or not was seen. (e) The os is dilated gradually with lubricated Hegar's dilators enough to admit the uterine canula easily. (f) Then the uterine canula was entered in direction of uterus and pushed up to internal os. Then the Basti Dravya (Sneha / Kwatha) was injected drop by drop with syringe from other side of canula. (g) At the same time of injecting the medicine into uterus patient was kept in head low position. c) Paschyata Karma: (a) It is important to watch and observe that the Basti Dravya was expelled out properly or not and then a sterilized gauze piece was kept into the vagina. (b) All instruments were removed slowly and perineal towels taken away. (c) Patient was advised to extend and twist her legs, was given head low position for 15 minutes in the O.T. and advised same in I.P.D. for 2- 3 hours. (d) Pulse and Blood pressure recorded for two hours. Chikitsa of Apratyavartana of Basti Dravya should be done by giving Niruha Basti and Varti of Shodhana Dravya, Pravesha (insertion) of Eshani Shalaka and by Squeezing below [5] . Uttar Basti In Various Disorders An unovulatory condition can be effectively combated with the help of administration of Uttar Basti with Phala Ghrita, Phalakalyanaka Ghrita, Shatavari Ghrita and Shatapushpa Ghrita because all this drugs will have Artavajanana property . Kshar Taila or Apamarga Kshar Taila can be used for Uttar Basti , if tubal block is due to adhesions but in cases of spasm due to fibrosis Bruhana Snehas (Bala Taila etc.) can be used [6-8] . Cervical erosion along with chronic cervicitis can be treated with Uttar Basti of Jatyadi Ghrita, Ropana Ghrita, Triphla Ghrita etc. Cervical Mucus Disorders can be treated with Jatyadi Ghrita, Go-Ghrita, Shatavari Ghrita etc. In endometrial condition Uttar Basti with Snehas prepared from Bruhana Dravyas should be administered as absorption of these Sneha Dravyas is very rapid which helps in recuperating thickness of endometrium and improving quality of endometrim. In case of Vaginal Mucosal defects Triphala, Panchavalkal, Dashamula etc. drugs should be administered by Uttar Basti to restore normal PH. Sneha Dravya (like Ghrita, Taila etc.) having Snigdha and Pichchhil Guna (properties) which helps in improving the secretions of vaginal mucosa. Similarly some herbal preparations (like Kwetha, Kalka etc.) predominantly having Kashaya Rasa which helps to decrease vaginal secretions. CONCLUSION Uttar Basti plays an important role in the disorders of Tryavarta Yoni and shows marvelous results when applied with proper indications, strict aseptic precautions and extreme carefulness. When Sukoshna (lukewarm) Sneha / Kwetha enters into the uterine cavity, network of Strotamsi (present throughout the system) carry the Uttar Basti Dravya towards the desired sites (All layers of uterus, fallopian tubes, ovary). On the basis of above study it is concluded that Uttar Basti is a very useful local treatment and offcourse used in the management of various Stree Rogas for the fruitful outcomes. Source of Support: Nil. Conflict of Interest: None Declared. 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J Ayu Herb Med ǀ Vol 2 Issue 3 ǀ May- June 2016 88 Commentary, Varanasi: Chaukhambha Prakashana, 2000. 4 Charaka Samhita-edited with "Vaidyamanorama" Hindi Commentary, Acharya Vidhyadhar Shukla & Prof. Ravi Dutt Tripathi (editors) Delhi: Chaukhamba Sanskrit Prathisthan, 2005. 5 Sushruta Samhita-edited with "Ayurveda- Tatva- Sandipika" Hindi Commentary, Kaviraja Ambikadutta Shastri (editor) Varanasi: Chaukhamba Sanskrit Sansthana, 2012. 6 Text book of Gynaecology, Dutta D.C., 7 th Edn, Kolkata: New central Book Agency Pvt. Ltd., 2010. 7 Gynaecology (Review Series), 3 rd Edn., New Delhi, Elsevier, 2006. 8 Text book of Gynaecology, Sudha Salhan, 1 st Edn, New Delhi, Jaypee Brothers Medical Publishers (P) LTD, 2011. HOW TO CITE THIS ARTICLE Sharma R, Singh C. Uttar Basti - A critical review. J Ayu Herb Med 2016;2(3):86- 88.