Introduction:
Even though Uttara Basti is dealt under the 24
varieties of Sneha pravicharana, it is a type of Basti Upakrama & possesses
both Nirooha and Anuvasana properties depending on the medicine used (Dalhana
Su.Chi.36). It is considered as best among the
varieties of Basti (Chakrapani on Ca.Si.12/1). As per the classics
Uttara Basti is best answer for the management of infertility, Sexual problems
and many gynecological conditions like Yonivyapaths. In spite of its large
applicability UB is not in routine practice. This therapeutic procedure can be
successfully practiced without any complications, if one follows proper aseptic
precautions to avoid UTI.
Definition
aÉÑSÉã¨ÉUãhÉ qÉÉaÉãïhÉ
SÏrÉiÉ CirÉѨÉU oÉÎxiÉ: | (Aruna Datta on
A.H.S 19/70)
E¨ÉU qÉÉaÉï
SÏrÉqÉÉlÉiÉrÉÉ ÌMüÇuÉÉ ´É㸠aÉÑhÉiÉrÉÉ E¨ÉU oÉÎxiÉ | (Chakrapani on Ca.Si.9/50).
The term Uttara
basti can be understood in two ways:
1. One which is given
through Mutra marga in males and both mutra & apatya marga in females.
2. One which possesses
superior qualities/which gives best results.
Hence
for the practical purpose we can classify Uttara Basti into following types.
· Mootrashaya (Intra
vesicular)
·
Mootramarga (Intra
Urethral)
·
Apathya Marga (Intra
Vaginal)
·
Garbhashaya (Intra
Uterine)
Apparatus
Basti
netra and Basti putaka are the two components made use in the procedure of
uttara basti. UB Netra is called as ‘Pushpa
Netra’ & it was made by either gold/silver (Ch.Si.9/50). Putaka was
made by the bladder of different animals. But
now a day it has been replaced by simple rubber catheter and disposable
syringe.
Instruments
required
·
Disposable syringe
of 30ml capacity
·
Disposable rubber
catheter No 6/7 (Or according to the size of Urethral meatus)
·
Green wound cloth
with a central hole.
·
Glass / Steel bowl
of 50ml capacity
·
Cotton swabs
·
Sponge holding
forceps
·
Surgical gloves
·
Beta dine or
Triphala kashaya
·
Medicine- Taila or
Kashaya or Ksheerapaka according to the condition
(All instruments including medicine are
autoclaved. Freshly prepared kashaya & ksheerapaka can be used directly
after cooling)
Procedure: (Here only Male intra Vesicle UB procedure is
explained)
Though a very simple procedure it
requires careful administration and patient compliance. The entire procedure
can be divided into three parts:
a)
Pre operative
procedure
b)
Operative
procedure
c)
Post operative
Procedure
a) Pre operative procedure:
· Before starting UB
2-3 Asthapana basti should be given in order to purify Malamarga and Ashaya prashithilata.(A.H.Su
19/70)
·
All the patients were explained about the UB procedure in detail and
were taken into confidence to overcome their apprehension.
·
Preparation of
local area i.e. shaving of the pubic hairs
·
Patient should be
free from any natural urges
·
Patient must have
taken hot water bath
·
Advised to have
light meals, Yavagu with Ksheera & ghrita / Idli-Sambar.
·
Sthanika abyanga
followed by sitz bath
·
Bladder should be
empty before administering UB.
b) Operative procedure:
·
Patient is made to
lie down in supine position in a relaxed manner with his under garments taken
off.
·
Then the pubic
region and Penis were properly cleaned with betadine and covered with sterile
green wound cloth.
·
Autoclaved medicated
oil (30ml) is taken into syringe and rubber catheter is fixed to the nozzle.
·
Lubricate the
catheter with same oil
·
The penis is then
held perpendicular to the body / made straight.
· Gently introduce
the tip of catheter into urethra, little oil is pushed to aid smooth passage of
catheter and slowly introduce the catheter into bladder.
·
Then slowly inject
the oil into the bladder
·
Carefully remove
the catheter and allow the patient to lie in the same position for 5 minutes.
c) Post operative Procedure:
· Educate the
patient to note down the time of first micturation and associated feelings
following the procedure.
· After basti
pratyagamana evening one more UB can be given
· Post regime should
be like Anuvasana basti.
· During the course
of treatment patients are instructed to avoid all sorts of extremes and if
possible not to have sex.
Dosage:
1 Śhukti
or ½ Pala = 25 ml. Can be given up to 1 prakuncha i.e. 1 Pala=48ml
Duration:
•
2-3 UB per day for
3 consecutive days, with gradual increase in dosage.
• Procedure should
be repeated after an interval of 3 days and such sittings may be continued as
many. Dose and duration can be altered based on the condition of patient.
Indication
in Male: (Su.Chi.37/115)
UB in male is
indicated in following conditions. Clinically tried medicine examples are given
in bracket.
·
Śhukra dushti
(Medicine selected according to Dosha)
·
Śukra nasha (KB
101)
·
Mootra kricchra
(Gokshura, Triphala or Panchavalkala Kasahya)
·
Mootraghata (Trina panchamoola kashaya/Gokshuradi taila)
·
Śukrotsheka
(Chandanadi taila)
·
Śharkara
(Gokshura- Punarnavadi kashaya)
·
Ashmari (Varunadi
/ Gokshuradi Kashaya)
·
Basti-Vankshana shoola (Bala taila/ MNT)
·
BPH (Daru haridra
kashaya)
·
Azoospermia (Pippalyadi taila/KBT 101/ Bala Ashwagandha Taila)
·
Klaibya (Ashwagandha taila/ Mahamasha taila)
Indication
in Female: (Su.Chi.37/115) UB in female is indicated in following
conditions.
·
Garbhashaya
Vikriti:
§ Thin Endometrium (BAT/
Mahamasha taila)
§ Tubal block ( Shatapushpadi taila)
§ Salphingitis ( Yashtimadhu Taila)
§ Endometriosis (Moolakadi taila / Ashwagandha taila)
·
Śhonita dushti (Ch.Si.9/63)
·
Puspa nasha (A.H.S.29/70)
·
Yoni vyapaths (20)
·
Yoni shoola (MNT)
·
Scanty/Non hostile
cervical mucus (Rasa taila/ BAT/ Chandanadi taila)
·
Cervical erosion (Jatyadi taila / Yashtimadhu taila)
·
White discharge (
Triphala kashaya/ PVK )
Contra
Indications:
·
Madhumeha- Na
Uchito Mehinam Kwachit (Bhava Prakasha & Su.Chi.37/126)
·
Urethral stricture
(Where catheter does not pass)
·
Neurogenic bladder
·
Virginity
·
Ca of cervix
·
Hypersensitivity
Apratyagamana
of UB:
If UB dravya doesn’t come out even after 24hrs of
administration and if patient feels difficulty in passing urine, one can go for
Shodhana varti (Ch.Si.9/57) / catheterization.
Discussion
& Conclusion:
· According to
Vagbhata before starting UB, Asthapana basti should be given for 3 days, to
make marga shuddi and Ashaya prashithila.
· Charaka advises to
give 2-3 UB and Sushruta 3-4 UB per day. But for the convenience UB may be
administered once daily for one week.
The course of treatment can be repeated according to the necessity with a gap of
one week.
· As per the
classics UB is administered in sitting posture in Erect Penis. But practically
to administer catheter flaccid penis and
supine position will be more comfortable.
·
The catheter should not be forcefully inserted if any obstruction is
met with.
·
25-30ml of oil
is ideal dosage for UB (Intra vesicle), but dosage varies according to site and
form of medicine.
·
In all my cases
retention was between 2 to 6 hrs.
·
UTI- Urinary tract
infection is most common complication if medicine is not sterile.
·
If all the
instruments and medicine are autoclaved or fresh medicine is used practically no complications are seen.
