A scientific approach to Uttara Vasti

A scientific approach to Uttara Vasti

Uttara Vasti, as Chakrapani commented “Shrestanam”  “Shrestagunataya” , which means

the best and gives rise the best results.The Uttara Vasti is administered through the mootra and yoni marga. These two are of uttramarga where as guda becomes “Adhra Marga” . Uttara Vasti also has the Netra and Putaka. The Uttara Vasti Netra is called as “Pushpanetra”. Thepushpa refers to the “Artava” or “Rajas” of female and to the

“Sukra” of the male. Thus the treatment Uttara Vasti is used for the Sukra and Artava

diseases justifiable.It becomes a best treatment in the Panchakarma.The methods of administration of medicament i.e. drug evolution, drug sources and routes of drug

administration is necessary to discuss here. American Medical association (Ama) council defines Drugs as “a comprehensive, convenient and authoritative reference book that includes information on both old and new single entity drugs and mixtures”. This book of modern medicine refers Charaka and Susruta as the fathers of medicine 5. The pharmacology book refers the various routes of drug administrations. Out of those “Trans Urethral or Trans Uterine” routes are not mentioned. They have the rest of routes and described “Trans rectal” as only enemata, but not given any specified interest or identification to the Trans rectal route of administration of medicine. The Uttara Vasti as discussed will have an apparatus made of Uttara Vasti Netra and Putaka. These are replaced now a day with rubber catheters such as Folley’s catheter or metallic catheters.

Uttara Vasti Netra:

The types of Uttara Vasti Netra differ for male and female. The male Uttara Vasti can be

administered at any time but for female it is necessary to wait for the “Ritukala” i.e. menstruation,as the Os is open at that time.The sizes of Uttara Vasti Netra mentioned by Acharya is as under –

Size of the Netra Description

Male 12 cms (Anguli) resembling jasmine flower stalk,

tail of the cow,

hole equal to mustard seed (Charaka)

14 (Anguli) cms – (Susruta)

Female 10 cms (Anguli) comfortable size to pass the urethra,

hole equal to Green gram seed

for full grown nulli paras 4 (Anguli) cms

virgins 1 (Anguli) cm

Garbhashaya sodhana should not be performed in the virgins.

Uttara Vasti Putaka:

Putaka is a sac made up of sheep, goat or hog urinary bladder . If it is not available it

is better to use the skin of eagle. Now a days for the sterile conditions to adopt we are using

plastic bags.

Eligible:,

This is used for the people who have

the following conditions;

Male:

1. 13 varieties of mootra Dosha – Mutouksada, Mutra jathara, Mutra krichra, Mutrotsanga,

Mutra kshaya, Mutraateeta, Asteela, Vtavasti, Ushnavata, Vtakundalika, Raktagrandhi, Vidwighata, and Vasti Kundalika

2. Mutra sharkara

3. Ashmari

4. Vasti shoola

5. Vankshana shoola

6. Shukra Dosha

7. Sukraotseka

8. Dhwajabhanga

9. Klaibya

Female:

1. 13 varieties of mootra Dosha – Mutouksada, Mutra jathara, Mutra krichra, Mutrotsanga,

Mutra kshaya, Mutraateeta, Asteela, Vtavasti, Ushnavata, Vtakundalika, Raktagrandhi, Vidwighata, and Vasti Kundalika

2. mootra Vyadhi

3. artava Dosha

4. yonivyapat

5. yoni shoola

6. Rajosrava (Adhika)

7. Rajonasha

8. Akala rajopravritti

9. vandhya

10. garbhashaya Vyadhi

11. placental retention

Non eligible:

Prameha – as in prameha no balder is involved and have the “Prabhuta mutrata and

Avila mutrata” the uttra Vasti has no value in this disease. Virgins – as garbhashaya shodhana

Administration time:

Male: at any time after the evacuation of the Bladder

Female: at the time of menstruation and at any time in case of Asrigdhara and Yoni vyapat

Dravya:

The quantity is differed as the size of urinary bladder and uterus differs. No classical

texts dealt this point better. But in practice it i seen approximately 2-tola i.e. 25ml of the liquid

is administered in to bladder and 10 to 12 ml in to uterus. As snehika and Nirooha are the methods used in regular Vasti of rectal root, in the same way the difference is noticed here also.

Table showing the quantities of Uttara Vasti dravya according to different Acharyas

Acharya Vasti Ashaya M/F/C Quantity Equal measure in ml

Charaka Sneha Mutra M ½ Pala or 2-tola 25ml

Vagbhata Sneha Mutra F 1 Prakuncha 4-tola 50ml

Vagbhata Sneha Mutra C 1 Sukti or ½ pala 25ml

Susruta Sneha Mutra F hand full 25ml

Susruta Sneha (Sodhana) Mutra F double 50ml

Susruta Kwatha Mutra F 4times 100ml

Susruta Kwatha Mutra M 2 times of Female 200ml

Vagbhata Sneha Garbha F 1 pala 50ml

Vagbhata Sneha (Sodana) Garbha F 2 Pala 100ml

Vagbhata Kwatha Garbha F 2 pala 100ml

Vagbhata Kwatha (Sodana) Garbha F 4 Pala 200ml

The sodhana of the garbhashaya with Nirooha Uttara Vasti may disturb the internal

lining and also the ovaries with huge quantities. Thus for the delivered females 2 pala and

others 1 pala is administered. But if the block of the ovarian tubules is to be removed under

guided supervision the higher dose is recommended. Thus the Vagbhata promoted the

medium dose of 1 pala for every body.Uttara Vasti according to Charaka consists of Ardhapala Sneha i.e. 2-tola (24ml) . This dose is meant for the adult of the age 25 years. This seems to be the ultimate dose for the males. Vagbhata mentioned one Prakuncha Sneha i.e. 1 pala (4-tola) is madhyama matra in females for Uttara Vasti. Susruta also mentioned 4-tola for females and said the dose has  to be assessed by the physician by yukti .Other wise a hand full of the Sneha is administered for the females as Uttara Vasti 1. When the Uttara Vasti is done for the shodhana double the quantity is used 22. If the kwatha is used for the Uttara Vasti it will be double to the Sneha i.e. 2 prasruta (4-pala or 200ml) Charaka did not mention any differences in Sneha quantity for male and females. It is as the same quantity of ½ pala (2-tola or 25ml).Vagbhata mentioned the Uttara Vasti pediatric dose as shukti (1/2 pala or 2-tola or 25ml) When the drug is discussed we have to understand the method of drug administration and its mode of action on the area where it is administered.

Poorvakarma:

The poorva karma is as that of Anuvasana Vasti karma . Initially Sneha Sweda has to be

performed. Then the patient asked to take bath and food with milk 27. Then the patient will be

given Kangi with milk and ghee.

Pradhana karma:

Patient initially instructe to evacuate the bladder. Before initiating the Uttara Vasti ask the patient to lay down and soft application of Vata hara taila over the genitalia . Because of this

procedure the penis stiffens and easy penetrability of Pushpa Netra (catheter) is possible. This procedure is administered in sitting position for the males and in supine for females.

In case of the females mutrashaya gata Uttara Vasti either rubber catheter or Foley’s

catheter is used. Otherwise for the Garbhashaya gata Uttara Vasti a standard dilatation of the os and administration of the medicin is done.At this lecture the limitation is for male Uttara VastiThus now male Uttara Vasti is dealt in detail. Male urethra is approximately

20 cms long. When the penis is stiff and acceptable for the “Eshani” (probe) penetration,

in sitting position (Now a day’s supine position is also followed) slowly the probe is pushed in

to the urethra. The insertion of probe is for the patients those who have any obstruction or Mutra krichraetc. lakshanas. Other wise for the treatment Sukra or klaibya, a direct catheter will serve the purpose. When the catheter passes deep in to the urethra it stuck at the vesico urethral junction. Then slowly introduce further in to the urinary bladder. A small amount of the residual urine is passed through the catheter and it conforms that the catheter is inside the bladder. When the Sneha is inside the bladder the Anuvasana Vasti vidhi (procedures) has to be performed.

Vasti dravaya pratyagamanam:

The contents of the Vasti retain inside for more time if the quantity is less (25ml of Sneha) and forcibly evacuated as the quantity increases to the 200ml (Kwatha). The medicine introduced in to the uterus retains for much time and may dribble in to the vagina.

Complications

Common complications are –

1. Burning sensation and

2. Bleeding.

If the Vasti dravya retains for more time associated

with burning sensation –

1. Sodhana gana Uttara vasti

2. Massage over the pubic region

3. Introducing Eshani

4. Varti prayaogam through urethra or and rectum

For the Vasti daha –

1. Ksheeri vriksha kashaya Uttara Vasti

2. Yastimadu kashaya Uttara Vasti

3. Ksheera Vasti

Paschat karma:

After the main procedure completed we

look for the symptoms of complications. When

no complications are observed light meal with

either green gram or milk can be given 30. It is

preferred to give –

Mamsarasa in Vata Dosha

Ksheera in Pitta Dosha

Mudga Yusha in Kapha Dosha

As the dravya comes out on the same day 2, 3 or 4 such Uttara Vastis has to be practiced. This procedure is followed for 3 days subsequently . Give a gap of 3 days and start the procedure for once again . The other vyapats resembles the Anuvasana Vasti and to be treated as the same .