UTTARA BASTI AND ITS MODERN ASPECTS

CONTENTS:

• Definition

• Basti Yantra

• Indications

• Contraindications

• Types of Uttara Basti

• Dose of Uttara Basti

• Procedure of Administration of Uttara Basti

• (A) Males

• (B) Females

• Modern point of view of Uttara Basti

• Uttara Basti Karmukata / Mode of Action of Uttara Basti

I. DEFINITION:

उत्तरबस्तिसज्ञा उत्तरमार्गदीयमानतया, किंवा श्रेष्ठगुणातया उत्तरबस्ति: |

Uttara Basti is a mode of administration of medicine through the urinary passage in both men and women, and through the vaginal tract in women.

It is called Uttara Basti, since the medicines are administered through the Uttara Marga i.e., the anteriorly lying orifices - the urethra and vagina.

Uttara Basti has been given major importance in the classics due to its efficacy in management of many Streerog / gynecological disorders, specially infertility and impotency.

II. BASTI YANTRA:

The Basti Yantra comprises of two parts.

• Basti Netra
• Basti Putaka

1. Basti Netra: 

Also known as Pushpa Netra.

Basti Netra for Males:

Material	Gold, silver
Lenght	Charaka – 12 Angula Sushruta – 14 Angula
Structure	broad at base tapering at end shape of Netra should resemble the stem of jati pushpa (jasmine flower) end of the netra should resemble gopuccha (tail of cow)
Chhidra	big enough to pass a mustard seed
Karnika	2, in the centre and at base.
Netra Pranidhana (Lenght of insertion)	Sushruta – 7 Angula Ksharapani - 4 Angula

Basti Netra for Females:

Material	Gold, silver
Lenght	10 Angula
Structure	broad at base tapering at end shape of Netra should resemble the stem of jati pushpa (jasmine flower) end of the netra should resemble gopuccha (tail of cow)
Chhidra	big enough to pass a green gram
Karnika	2, at base and at 4 Angulas from tip.
Netra Pranidhana (Lenght of insertion)	Mutramarga: bala (upto 12 yrs) – 1 Angula stree (reproductive age) – 2 Angula Grbhashaya: 4 Angula.

2. Basti Putaka:

• This part of the instrument is meant for holding the medicine.

• In the ancient times, the urinary bladder of animals like cow, ox, pig, goat, sheep, deer, etc were used.

• These bladders were impregnated with kashaya dravyas and tailas for many days in order to sterilize them, and maintain their flexibility.

• If bladders were not available, then  skin of Plava or Ankhapada birds were used.

• Since the quantity of medicine in uttara basti is less, the size of the Putaka is small too.

The Putaka should have the following gunas:

• Druda (firm)
• Tanu (thin)
• Nasta sira (free of veins)
• Durgandha rahita (devoid of bad odour)
• Rakta varna (red or pink in colour)
• Mrudu (flexible and elastic)

III. INDICATIONS:

1. Mutraghata
2. Yoni vyapad
3. Ashmari
4. Vankshana Shula
5. Mutradosha
6. Mutraghata
7. Sharkara
8. Shukra dushti
9. Kshatartava
10. Rajah nasha
11. Atyartava
12. Obstruction in Apara
13. Basti shula
14. Meha shula

IV. CONTRAINDICATIONS:

Males: 

1. Urethral Stricture
2. Bleeding disorders
3. Carcinoma of the bladder or penis
4. Hypopadiasis or epispadiasis

Females:

Intra vaginal basti:

• recto-vaginal fistula
• hypersensitivity
• menorrhagia

Intra uterine basti

• carcinoma of cervix
• vasico-vaginal fistulas
• vaginal fibroids
• hypersensitivity
• heavy bleeding

V. TYPES OF UTTARA BASTI:

(a) On the basis of route of administration: The Bastis are classified into 3 types:

1. Mutrashayagata : Administration through urethral route (more common in men)
2. Yonigata: Administration through vaginal route.
3. Garbhashayagata: Administration through uterine route.

(B) On the basis of form of drug: The Bastis are classified into 2 types:

1. Snaihika: The main ingredient is Sneha Dravya.
2. Niruhika: The main ingredient is Kashaya Dravya.

VI. DOSE:

Sneha:

Charaka: 24 ml (Ardhapala)

Sushruta: 1 Pala (25 years and above)

Vagbhata: 24 ml (1 Shukti)

Kashaya:

1 Prasruta or 96 ml.

VII. PROCEDURE OF ADMINISTRATION OF UTTARA BASTI:

(A) MALES:

(i) POORVA KARMA:

1. Selection of Patient: 

It should be made sure that the patient selected is fit for Basti. He should not have any conditions that are contraindicated for Basti Chikitsa.

2. Examination of the patient: 

Examination of factors like Dosha, Aushadha, Desha, Kala, Satmya, Agni, Satva, Vaya, and Bala, etc. should be done. Only then it is possible to get the desired results.

3. Preparation of Basti: 

Preparation of Basti should be done according to the rules mentioned by the Acharyas.

4. Time of administration:

Morning time is considered optimum for the administration of Uttara Basti.

5. Preparation of patient / Atura Siddhata:

• Most often, Uttara Basti is given after 2-3 Niruha Bastis.
• The Uttara Basti is scheduled in the afternoon, after the administration of Niruha Basti in the morning.
• Before the adminstration of Uttara Basti, the patient is prepared by giving Sthanik Abhyanga followed by Nadi Swedan in the lower abdominal region, thighs and groins.
• Then the patient is advised to take bath with warm water.
• If the patient is scheduled for Snaihika Uttara Basti, then he should be given Yavagu along with meat soup, ghee and milk before the administration of Basti.
• Then, after passing the urges of mala, mutra and flatus, the patient is made to lie on the Basti seat.

(ii) PRADHANA KARMA:

1. Bed for Basti:

• Should not be too high or too low.
• Should be not be too soft or too hard.
• A soft knee high chair can be used too.

2. Assembling the apparatus:

• The Basti Netra and Basti Putaka should be tied properly as mentioned in the Ayurvedic texts.
• The basti dravya should be filled properly in the basti putaka that does not contain any air and there is no leakage.
• In the present practice, urinary rubber catheter no.8 or no.11 can be used as Basti Netra.
• And 50 cc syringe can be used as the Basti Putaka.

3. Position of the patient:

• The patient is seated on a soft chair in a comfortable and straight position.
• His phallus should be made erect by gentle massage.

4. Introduction of Basti Netra:

• Ghee / oil should be smeared over the netra and the urethral opening.
• Then, with firm hands, the Netra should be inserted slowly and steadily.
• If any obstruction or pain is felt, remove the catheter or netra slowly, witout causing any discomfort to the patient and insert it again properly.
• A bladder sound can be used to remove any obstruction and to analyze the extent upto which the Basti Netra can be introduced.

5. Basti Peedana:

• Once the Netra is introduced properly, the Basti Putaka should be squeezed slowly and the medicines should be pushed in the urethra at a steady pace.
• Some amount of medicine should be left in the Putaka to prevent the entrance of air.

(B) FEMALES:

(i) POORVA KARMA:

1. Selection of Patient: 

It should be made sure that the patient selected is fit for Basti. He should not have any conditions that are contraindicated for Basti Chikitsa.

2. Examination of the patient: 

Examination of factors like Dosha, Aushadha, Desha, Kala, Satmya, Agni, Satva, Vaya, and Bala, etc. should be done. Only then it is possible to get the desired results.

3. Preparation of Basti: 

Preparation of Basti should be done according to the rules mentioned by the Acharyas.

4. Time of administration:

• Rutukala is the perfect time of administration, as during this period, the yoni and garbhashaya are dilated and avaranrahita.
• Rutukala is the time just after menstruation or the 4th day of menstruation.
• Medicine administered during this time reaches its destination properly, without any obstructions and gives optimum results.
• However, in emergency cases, this rule can be ignored.

5. Preparation of patient / Atura Siddhata:

• Most often, Uttara Basti is given after 2-3 Niruha Bastis.
• The Uttara Basti is scheduled in the afternoon, after the administration of Niruha Basti in the morning.
• Before the adminstration of Uttara Basti, the patient is prepared by giving Sthanik Abhyanga followed by Nadi Swedan in the lower abdominal region, thighs and groins.
• Then the patient is advised to take bath with warm water.
• If the patient is scheduled for Snaihika Uttara Basti, then she should be given Yavagu along with meat soup, ghee and milk before the administration of Basti.
• Generally, 2-4 Uttara Bastis are administered in the course of day and night.
• Then, after passing the urges of mala, mutra and flatus, the patient is made to lie on the Basti bed.

(ii) PRADHANA KARMA:

1. Bed for Basti:

• Should not be too high or too low.
• Should be not be too soft or too hard.

2. Assembling the apparatus:

• The Basti Netra and Basti Putaka should be tied properly as mentioned in the Ayurvedic texts.
• The basti dravya should be filled properly in the basti putaka that does not contain any air and there is no leakage.

3. Position of the patient:

• The patient should be made to lie down comfortably on a bed or lithotomy table in supine position.
• Then the patient's legs should be separated and flexed into lithotomy position and should be supported by stirrups.

4. Introduction of Basti Netra:

• Ghee / oil should be smeared over the netra and the vaginal opening.
• Then, with firm hands, the Netra should be inserted slowly and steadily in the direction of vertebral column.
• If any obstruction or pain is felt, remove the catheter or netra slowly, without causing any discomfort to the patient, and insert it again properly.
• A uterine sound or Hegar's dilator can be used in case of closed internal os.

5. Basti Peedana:

• Once the Netra is introduced properly, the Basti Putaka should be squeezed slowly and the medicines should be pushed into the vagina at a steady pace.
• Some amount of medicine should be left in the Putaka to prevent the entrance of air.

(iii) PASCHAAT KARMA (SAME FOR BOTH MALE AND FEMALE):

1. Post administration medications:

• Uttara Basti is a troubling and painful procedure.
• After the administration of the Basti Vedanahara Aushadhis (analgesics) or Nidrodaya rasa (analgesics + tranquilizers) should be done, as the pain could last for about 12-24 hours.
• Ahiphenasava and Pippalimoola are the drug of choice.
• Sthanik Abhyanga and Mrudu Swedan or Nadiswedan should be done on painful areas.

2. Basti Pratyagamana kaala:

• The Pratyagamana kaal for Uttara Basti is 100 Matrakala.
• After proper Pratyagamana or return of the medicine, 2nd, 3rd, or 4th enema can be administered .
• In the evening, after taking in consideration the doshas, food including ksheera, dugdha, yusha, and mamsarasa should be given.

3. Observation of Apratyagamana and its management:

• Even after waiting for 12-24 hours, if the Basti Dravyas have not returned, then they should be made to come out by force.
• Usage of rectal suppositories like Pippalyadi varti, agaara dhoomadi varti, aaragwadhadi varti, Shodhana dravya siddha phalavarti, etc. These vartis should be the size of mudga, ela or sarshapa and should be smeared with ghee before inserting.
• Kashaya of Teekshna Shodhana dravyas should be used to give Niruhika Uttara Basti.

4. Observation of Samyak Yoga Lakshana: (similar to Anuvasana Basti)

• Clarity of senses and sense organs, intellect and Raktadi Dhatus.
• Feeling of lightness in the body.
• Increase in strenght.
• Proper and sound sleep.

5. Observation of Ayoga Lakshan: (similar to Anuvasana Basti)

• Sensation of pain in lower parts of the body, abdomen, arms, back and sides (parshva)
• Dryness and roughness in the body.
• Retention of flatus, faeces, and urine.

6. Observation of Atiyoga Lakshana: (similar to Anuvasana Basti)

• Nausea
• Stupor
• Fatigue
• Exhaustion
• Fainting
• Gripping pain

7. Observation of complications and their management:

Immediate complications comprise of:

• Neurological Shock:
• NIDAAN: Forceful insertion of the catheter in urethra and in spinchter of urinary bladder in a nervous patient.
• CHIKITSA: Immediate resuscitation.
• Spasmodic Pain:
• NIDAAN: Forceful insertion of catheter.
• CHIKITSA: Antispasmodics.

Late complications comprise of:

• Peritonitis:
• NIDAAN: Forcefully pushed medicine enters into the peritoneal cavity and causes inflammation.
• CHIKITSA: Intravenous antibiotics and anti-fungal medications.
• Infection: 
• NIDAAN: Improper sterilization of instruments, poor aspetic precautions.
• CHIKITSA: Antibiotic therapy.

The other most common complication is Daha or burning sensation. This can be checked by Basti of 

• Ksheera vruksha sheeta kashaya along with ksheera.
• Sharkara and madhu mixed in sheeta kashaya of yashtimadhu.

VIII. MODERN POINT OF VIEW OF UTTARA BASTI:

> Apparatus Required:

• Table or bed for administration.
• Cleaning agents - Savlon, Betadine, Dettol, etc
• Forceps - sponge holding and artery.
• Sterile gloves and sterile gauze.
• Towels.
• Steel bowl- 50 ml capacity.
• Kidney tray - 1
• Anesthetic jelly - Xylocaine 2%.
• For intra urethral administration:
• Urinary rubbber/ disposable catheter no.6 or no.8
• Aspiration syringe - 30 ml capacity.
• Basti Medication.
• For intra uterine administration:
• Infant feeding tube - tip should be cut 10 cm long.
• I.V cannula
• Intrauterine insemination cannula
• Urinary rubber catheter no.11 or no.12
• 10 cc syringe.
• Ring towel.
• Cucus speculum.
• Autoclave facility.

>Pre - operative procedure:

• All the instruments and the medicine should be autoclaved.
• Examination of patient - Pulse, BP, temperature, etc.
• Pt. is made to lie down in supine position exposing the concerned part.
• The genital area is cleaned with savlon using sponge holding forceps and guaze.
• The area is washed completely and Betadine is applied.
• The physician washes hands and wears gloves.
• The medicine is filled in the syringe and the catheter is attached.
• Medicine is pushed till the tip of the catheter.

1. Mutrashayagata Uttara Basti:

> Operative procedure:

• The catheter is lubricated with Xylocaine jelly and is introduced gently into the urethra up into the bladder.
• Slowly inject the medicine into the bladder.

> Post operative procedure:

• Remove the catheter gently without causing any discomfort to the patient.
• Check the tip of the catheter to see any traces of blood to ensure no bleeding.
• Let the patient take rest in supine position for 5-10 minutes.

2. Garbhashayagata Uttara Basti:

> Operative procedures:

• Patient is made to lie down in lithotomy position with the concerned parts exposed, cleaned and draped.
• Part is covered with ring towel and only perineum is exposed.
• Lubricated cucus speculum is inserted to expose cervix which is then cleaned with a suitable antiseptic lotion.
• Uterine sound inserted gently to open the os. Hegar's dilator may also be used in case of closed internal os.
• Then the cannula or tube is inserted gently into the uterus through cervix and the medicine is pushed into the uterus slowly and steadily. This might take 2-3 minutes.

> Post operative procedure:

• Remove the catheter gently without causing any discomfort to the patient.
• Let the patient rest for about 30 minutes in head low position.

IX. MODE OF ACTION / KARMUKATA OF UTTARA BASTI:

• There is a predominance of Apana vayu in the lower part of the body.
• This sub type of vata is responsible for all the functions like defecation, urination, menstruation, flatulence, and the functions or movements of the lower limbs.
• It is clear that this sub type of vata flows in a downward motion and carries out the functions effortlessly.
• When this vata gets vitiated, it often acquires an upward motion. 
• The unnatural upward motion of Apana vayu causes obstruction in the function of other sub types of vata, pitta and kapha.
• Apana vayu become inefficient in its own fuctions and there by causes complications or difficulty in urination, defecation, menstruation, flatulence. etc.
• Therefore, the medicines administered through the lower orifices like the urinary tract or vaginal tract or even rectum, prove to have a quicker and better effect over the vitiated vayu.
• The Niruhika Uttara Basti has a chief cleansing action. It helps get rid of any obstructions caused by vitiated Apana Vayu and helps in easy and through  excretion of mala, mutra, flatus and menstrual blood.
• It helps in the restoration of sexual organs and keeps them sterilized and helps to get rid of any kind of irritation, obstruction, stagnation, inflammation or infections in the lower orifices.
• The Snaihika Uttara Basti has a chief nourishing action.
• It helps in improving the blood circulation and helps the sexual organs become strong.
• It has Vajikaran action over the body and has excellent results in cases of sterility and impotency. It helps one gain sexual vigor.
• It strengthens the reproductive organs and thereby helps in successful pregnancy.
• Uttara Basti is given great importance in cases major and chronic gynecological disorders. It is like a boon to those suffering from infertility and impotency.