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 .