Uttara Basti: Method, Indications, Mode of Action

Article by Dr Raghuram Y.S. and Dr Manasa
Uttara Vasti or Uttara Basti is one among Panchakarma treatments. Here, liquid medicines are administered through urethral or vaginal routes. Thus Uttara Basti targets toward diseases of urinary and genital system. The medicines may be in the form of Kwatha / Kashaya (herbal decoctions) i.e. Asthapana (niruha) Basti and Sneha (medicated ghee and oils) i.e. Anuvasana (sneha) Basti.

Uttara Vasti

Uttara vasti sangnaa uttara maarga deeyamaanatayaa kamvaa shreshta gunatayaa uttara vastihi (Ref – Charaka Siddhi 9/50, Chakrapani commentary)

Uttara Basti has been explained with point of view of 2 meanings –
The vasti (enema) administered through the urinary passage (urethra) in men and women and through birth passage (vaginal tract) in women is called uttaravasti. It is the vasti which is given through uttara marga (passages present in the anterior portion of the body, i.e. in the front portion of the body i.e. urethral and vaginal passages)
Uttara means ‘best’. Since uttaravasti imparts extraordinary benefits it is called Uttara Basti.

Garbhashaya Gata Vasti – In this, the site of administration of Vasti medicine is Uterus (Garbhashaya) and the Basti is given through the vaginal orifice. This Vasti helps in expelling the morbid Doshas from the Garbhashaya or Uterus. This Basti helps in eradicating the morbidity and diseases related to the female uro-genital system.

Mutrashaya Gata Vasti – In this, the site of administration of Basti medicine is Mutrashaya (Urinary Bladder) and the Basti is given through the Mutra Marga or Urethra (the opening of the lower end of the muscular tube which is connected to the lower opening of Urinary Bladder and excretes the urine). This is given through the urinary passage or urethra in both men and women. This helps in curing the diseases related to urinary system and genital system.

Uttara basti netra

Uttara Vasti Netra Dimension –
Uttarabasti netra or nozzle of the uttarabasti apparatus is also called as pushpa netra. It is mainly used to administer medicines (in the form of enema) into the uterus to relieve the rajo-dosha (menstrual disorders) in women. Raja or menstrual blood also has another name i.e. Pushpa. Since the vasti netra of uttara vasti apparatus is used for administering the medicines to alleviate disorders related to pushpa (menstrual blood), it is called pushpa netra.

But the Basti netra used to administer the enema medicines into the urinary bladder in both men and women (enema administered through the urinary passage or urethra) is also called pushpa netra.
Uttaravasti is given through the urethra (in both men and women) and through vagina (women).
Thus the word pushpa netra is not limited for the vasti netra used for only women.

Dimensions of Vasti netra –
The length of vasti netra is 12 angulas (14 angulas according to Sushruta). It is made up of gold or silver. (Now days it is made up of disposable plastic or metal, mainly stainless steel). According to Sushruta, the length of vasti netra is 14 angulas. The shape of the vasti netra resembles the stem of jati pushpa (jasmine flower) or karaveera pushpa (Nerium indicum). It is broader at the central part and tapers towards the end (tip) resembling go puchcha (tail of a cow). The lumen permits a sarshapa (mustard grain) into it.

The vasti netra of uttara basti apparatus has only 2 karnikas (limiting ridges) in comparison to 3 karnikas in the niruha vasti (decoction enema) apparatus. One karnika is towards the base, where the netra is fit into the vasti putaka (can or container of enema apparatus). The vasti putaka is tied to this karnika. Another karnika is placed exactly at the centre of the netra (it forms the midpoint of the netra). The length of the netra below this karninka is 6-7 angulas. This is the portion of the apparatus which is passed into the urinary or vaginal passage. The karnika at the middle limits the netra from entering beyond this point.

In women, the length of vasti netra (nozzle) should be 10 inches. Its thickness should be in accordance to the width and dimension of the mutravaha srotas (urinary passage). Its orifice and lumen should be permitting a mudga (green gram) in it. When uttarabasti is being administered into the vaginal canal, 4 angula length of netra should be inserted into the vaginal tract. When the uttarabasti is being administered into the urinary tract, 2 angula length of netra should be inserted into the urinary tract. In girls 1 angula of netra should be inserted into the urinary tract and uttara basti should never be administered in the girls through the vaginal tract. The length and dimensions of uttara basti netra in men should be in accordance to the length and dimension of the penis (urethra).

Now days a rubber tube is fixed to the nozzle projecting from the lower rim of enema container. The tube (enema catheter) is inserted into the urinary or vaginal tract. The end of the tube is connected to a long nozzle with an opening at the tip which allows a monitored stream of medicine into the intestine. This whole set up can be compared to the Basti netra (excluding the container which can be compared to Basti Putaka, which will be explained in the upcoming passages). The catheter or tube will have different dimensions and can be disposed after single use. This maintains sterility of the treatment.

Note – Karnikas are circular ring like ridges at the regular intervals which are in the shape of umbrellas. The karnikas are elevated beyond the circumference of the netra or nozzle. The nozzle cannot be pushed into the urethra or vagina beyond this level because the karnika forms a limiting clamp at their opening. The other end of the netra is pushed into the lower opening of the vasti putaka (urinary bladder in this case) and is tied between the 2 karnikas to prevent leakage of enema liquid during administration.

Uttara basti putaka

Uttara vasti putaka (can or container of uttarbasti apparatus) –
Vasti putaka means the container of the enema apparatus. It accommodates the Basti medicines (liquids). In ancient days it was made up of the urinary bladder (vasti) of animals and hence the name basti (vasti=urinary bladder or bladder or something which holds).

They were made using the urinary bladders of cow, ox, deer, pig, goat, etc animals. Before using the urinary bladders for the Vasti treatment, they were impregnated in the Kashayas (herbal decoctions) and or tailas (herbal oils) for many days. Dipping the bladder in the kashayas or tailas was a part of sterilizing, de-contaminating and disinfecting the urinary bladder. Dipping in the oils was a part of maintaining their elasticity and flexibility. The urinary bladders which were selected used to be strong, soft, flexible, elastic, devoid of infection, perforation, contaminants, bad odour etc. the veins over the surface of urinary bladder were skilfully removed. The shape of the putaka (urinary bladder) used to be triangular in shape.

If the urinary bladder of the above said animals weren’t to be available, the skin of the plava bird or ankapada was used to prepare vasti putaka.

Since the quantity of the medicine used in utara vasti is small, the size of the putaka or container too should be small.

Vasti netra was fit into the lower (urethral) opening of the urinary bladder and tied firmly between the upper 2 karnikas. The upper surface of the urinary bladder was opened. The medicinal liquids were poured through the upper opening.

In a later period, rubber bags, plastic bags, bladder of volley ball or football were used as Basti Putaka. Now we have cans made up of metal or plastic. It has an upper opening (large) through which the medicinal liquids are filled into the container. The lower portion has a small hole as exit for vasti medicine. The orifice has a small nozzle to which a long rubber tube or catheter is tightly fit. At the other end of the tube a longer nozzle, preferably made up of disposable plastic and fulfils the dimensions of vasti netra is fit. This portion is pushed into the urethra or vagina.

At the junction of the nozzle and catheter, the nozzle will have an outward elevated ridge (karnika) which will limit the entry of the nozzle only up to that level. The nozzle will have the length and dimensions similar to that of vaginal or urethral canal. The nozzle is (tube also) disposable and can be substituted with a new one after one treatment (administration of vasti). To maintain the sterility of treatment, this part of apparatus is changed for different patients and also for the same patient every time.

Basti apparatus

Preparation or assembling the Vasti Yantra (Vasti apparatus) –
As we have seen that the Vasti Yantra (apparatus) will have 2 components i.e. Vasti netra (nozzle) and Basti Putaka (can or container).

Before the administration of Basti, the instrument or apparatus should be kept ready by properly checking the errors if any and also by assembling the netra and putaka to perfection. After assembling the apparatus, it should be checked for leakage at the junctions.

The upper expanded portion of the Basti Netra is introduced into the lower opening of the urinary bladder or vasti putaka (exit or urethral opening of urinary bladder). The bladder is tightly tied between the 2 karnikas or the junction of the lower opening of the bladder and the netra is sealed tightly by applying cauterization using burnt sterile metal rods. The apparatus is ready to use.

Now days, glycerine syringes or disposable 100 ml syringes are used.
Now the whole apparatus has been assembled and is ready to be used for administering Basti.

Uttara basti dravya

Quantity of Uttara vasti dravya (vasti medicine) –
According to Charaka, the quantity of uttara vasti medicine should be ½ pala (2 tola or 24 grams approximately).
Vagbhata has mentioned the same quantity.
Sushruta has indicated the quantity of uttara basti medicine as 1 prasruta as measured by the hands of the woman taking uttara basti, for garbhashaya gata vasti (quantity of medicine to be administered in the uterus). This is the quantity of sneha (medicated oil or ghee). If kwatha is to be administered in uttara vasti, 2 prasruta quantity should be given.

According to Sushruta, the quantity of sneha (medicated oils and ghee) for men should be 1 prakuncha (4 tola or 48 grams approximately). He also suggests that the quantity be varied according to age. The quantity mentioned above is for an adult of 25 years.
Thus the quantity of sneha for 1 year child should be 1/25^th of 48 grams which sums up to 2 grams approximately or 1/6^th of tola (1/6^th of 12 grams).
From 2^nd year of age onwards, every year the quantity is increased by 1/6^th tola until the total quantity at 25 years of age sums up to 48 grams.

In women the quantity of uttara basti is said to be 1 prasruta as measured by the hands of the woman who is being administered the treatment. If the medicine is to be given for garbhashaya shodhana (cleansing of uterus and other parts of genital tract) the quantity should be doubled. If niruha basti is to be given and kwatha (decoction of medicines) is to be administered, 1 prasruta of kwatha should be taken in men and 2 prasruta for women (for purpose of cleansing the uterus). In girls younger than 12 years, 1 prasruta medicine should be used for administering mutrashaya gata utara basti (administered through vaginal route).

basti netra Dosha, basti Putaka Dosha etc are explained here –
Basti Chikitsa: Benefits, Routes, Types, Indications, Equipment

Method of administration

Uttara Vasti vidhi vidhana (Method of administration of Uttara Vasti) –
The method of administration of Uttara Vasti is similar to the administration of Niruha Vasti (decoction enema) and Sneha Vasti (oil or ghee enema) and is done in 3 steps. They are as explained below –

Purvakarma

Purvakarma (Pre-operative methods)
Purvakarma or pre-operative methods of uttara vasti comprises of examination of patient and determining the dose of administration of the enema and the patient preparation.

Atura pariksha

Atura pariksha (Examination of the patient) –
To determine which vasti (niruha or sneha) should be administered in which subjects, a thorough examination of the patient should be done.  This will help in categorizing the patients as those fit to undertake niruha vasti or those fit to take anuvasana or sneha vasti or those who are fit to receive both types of vasti. It will also help in identifying the patients who are unfit to receive the same.

Mutrashayagata basti indications

Indications for Mutrashaya gata vasti or enema administered through the urinary passage (common for both men and women) –
Mutrashaya gata utar basti is indicated in the treatment of urinary disorders. Charaka has listed 13 types of mutraghata (obstructions to the passage of urine) and at the end has indicated uttara vasti as a remedy in all the cases.
The various types of Mutraghata explained above covers various conditions of uro-genital system in which there is obstruction to urination. They include inflammation of urinary bladder, recto-vesical fistula, prostate gland enlargement (BPH), and many more diseases.
Read related: Urinary Obstruction: Causes, Types, Symptoms, Ayurvedic Treatment

Similarly Uttara Vasti is also indicated in various types of Mutrakrichra (dysuria or difficulty to pass the urine).
Note – Mutra Krichra covers many diseases of urinary system which cause dysuria or difficulty in passing urine. It also covers dysuria caused due to stones, infection etc conditions.
Read related: Dysuria: Causes, Remedies, Tips, Diet, Ayurvedic Treatment

Ashmari –
UtarVasti is also indicated in all types of Ashmaris (calculi or stones forming in the urinary tract).
The various types of Mutrashmari explained above includes all the diseases in which various types of stones and gravel is formed at various locations in the urinary tract.
Read related: Urinari calculi – Home Remedies, Ayurved Treatment, Diet, Recipes

The other indications of Uttara basti are –
Mutra sharkara – urinary gravel
Vasti shula – pain in the urinary bladder
Vankshana shula – pain in the groin
Mehana shula – pain in the penis etc

Men fit to undergo Uttara basti –
Apart from the diseases of urinary tract enumerated above, Uttara Vasti in men can be administered in Shukra Dosha (morbidity of semen) which includes Shukra afflicted by morbid Vata, Pitta and or Kapha and diseases like klaibya (less semen) and dhwajabhanga (impotence) etc conditions

Women fit to undergo Uttara Vasti –
Apart from the diseases of urinary tract enumerated above, Uttara Vasti in wo  men can be administered in:

• Yoni bhramsha – prolapsed uterus or vagina
• Rajo dosha – diseases or morbidity of menstrual blood
• Yoni dosha – morbidity or diseases of vagina and uterus
• Yoni shula – pain in the vagina and or uterus
• Teevra yoni vyapad – severe diseases of vagina or uterus
• Asrugdara – dysmenorrhoea
• Pushpa nasha (anartava) – amenorrhoea
• Akala raja pravritti – untimely menstruation
• Apara dwara garbha nirodha – foetal impaction due to obstruction by placenta
• Vandhyatva – infertility

In all these above said diseases, garbhashaya gata uttara vasti (intra-uterine enema) is administered. Uttara vasti also can be administered in 20 types of Yoni vyapad (diseases of female genital system including vagina, uterus). They are as below listed –

Vatala yoni vyapad – yoni vyapad caused due to vitiation of Vata –
In a woman (vata constitution) who consumes excessive vata vitiating foods and activities, the vitiated vata contaminates the yoni (uterus and vagina) and causes vatala yoni vyapad.
Symptoms – pricking pain, stiffness, feel of ants crawling, roughness, numbness, tiredness and other vata diseases in the uterus and vagina, thin, dilute, foamy discharges from the vagina dry in nature associated with sounds and severe pain

Pittala yoni vyapad – yoni vyapad caused due to vitiation of pitta –
In a woman who consumes foods rich in pungent, sour and salt tastes, alkaline foods in excess the vitiated pitta contaminates the yoni (uterus and vagina) and causes pittala yoni vyapad.
Symptoms – burning sensation, suppuration and excessive heat in the uterus and vagina, fever, rise in body heat, bluish, yellowish, blackish-brown discharges from the vagina which are hot in nature associated with the smell of a rotten corpse

Shleshmala yoni vyapad – yoni vyapad caused due to vitiation of kapha –
In a woman who consumes excessive kapha vitiating foods, the vitiated kapha contaminates the yoni (uterus and vagina) and causes shleshmala yoni vyapad.
Symptoms – stickiness, coldness, itching and mild pain in the uterus and vagina, sticky brownish white discharges from vagina

Tridoshaja yoni vyapad – yoni vyapad caused due to vitiation of all the 3 doshas –
In a woman who consumes all the rasas (foods having all the 6 tastes) in excess, all the 3 doshas (vata, pitta and kapha) get aggravated in the yoni (uterus and vagina) and causes Tridoshaja Yoni Vyapat.

Symptoms – white sticky discharges from the vagina associated with severe burning sensation and pain

Arajaska yoni –
The vitiated pitta located in the vagina and uterus contaminates the rakta (blood) of that region causing a disease called as Arajaska.
Symptoms – emaciation and discolouration of body

Asrujaa yoni –
In a woman consuming excessive pitta and rakta (blood) vitiating foods and activities, the pitta contaminates the rakta in the yoni (uterus and vagina) and causes bleeding even in the presence of the foetus. This condition is called Asrujaa or raktaja yoni.
Symptoms – bleeding from vagina in the presence of foetus

Acharanaa yoni –
Microorganisms (due to infection) of genital passages occur in a woman who doesn’t keep her vagina clean and sterile. The presence of organisms will cause excessive itching in the vagina. This condition is called Acharanaa yoni.
Symptoms – itching in the vagina, excessive sexual urge

Aticharanaa yoni –
The vayu aggravated due to indulgence in sexual intercourse causes painful conditions in the genital passages of the woman. This condition is called Aticharana yoni.
Symptoms – inflammation, swelling, numbness and pain in the vagina and uterus

Praak charana yoni –
In an immature virgin girl who had experienced sexual intercourse at very tender age the vata gets vitiated and contaminates the uterus and vagina. This condition is called Prak charana yoni.
Symptoms – severe pain in the back, pelvis, thigh and groin

Upapluta Yoni –
When a pregnant woman consumes excessive kapha aggravating foods and activities and also forcibly withholds the urges (reflexes) of vomiting and hard breathing, the vata gets aggravated. The vitiated vayu pulls and carries the kapha into the yoni and contaminates it. This condition is called Upapluta yoni.
Symptoms – light brown coloured discharges from vagina associated with pricking pain, white coloured phlegm flowing through the vagina, constant affliction of uterus and vagina with kapha and vata disorders

Paripluta Yoni –
When a pitta prakriti woman (pitta constitution) habituated to consume pitta aggravating foods and activities forcibly withhold the urges of sneeze and belching (burp) during sexual intercourse, the vitiated vata associated with vitiated pitta contaminates her yoni. This condition is called Paripluta yoni.
Symptoms – fever, swelling, inflammation and tenderness in the vagina and uterus, severe pain in the pelvis, groin, back along with discharge of bluish and yellowish coloured blood from vagina

Udaavartini yoni –
The Vata which has been vitiated due to forcible obstruction (withholding) of natural urges while moving in an upward direction lifts the uterus in an upward direction. The yoni in this condition will be placed upside down with its opening pointing upwards. This causes severe pain. This condition is called Udavartini yoni

Symptoms – The vagina (uterus) afflicted with severe pain expels the menstrual blood in an upward direction with difficulty. Since the blood is eliminated in an abnormal (upward) direction, the condition causes severe trouble and pain. The pain subsides once the blood gets eliminated.

Karninee yoni –
When the appropriate time to deliver the child has not yet come, if the pregnant woman at term pushes hard (strains) to deliver the child even in the absence of pains, the foetus impacts the uterine opening and blocks it. Due to this, the Vata gets vitiated and getting association of morbid kapha and rakta (blood) causes Karnikas or ankuras (pile like fleshy masses) in the uterus and vagina. This condition is called Karninee yoni.

Symptoms – formation of pile like fleshy masses at the openings of uterus and vagina

Putraghnee yoni –
When the vata aggravated due to excess consumption of Ruksha ahara vihara (dry foods and activities) destroys the foetus created by contaminated (diseased) ovum repeatedly it is called Putraghni yoni\
Symptoms – repeated destruction (death) of foetus

Antarmukhee yoni –
When a woman indulges herself in sexual intercourse in crooked, uneven and undesired positions after having consumed stomach full of food, the vayu being compressed and blocked by food gets stagnated in the yoni (uterus and vagina) of the woman. This condition is called Antarmukhee yoni.
Symptoms – severe pains in the bones and muscles, crookedness of the vaginal and uterine openings, severe pain in the vagina and uterus, intolerance to sex (dyspareunia)

Soochimukha yoni –
When the mother consumes foods and activities which vitiate vata, the vitiated vata afflicts the female foetus. The vayu by the virtue of its excessive dryness (roukshyaat) afflicts the yoni of the female child and causes narrowing of the opening of yoni (uterine or vaginal opening). This is called suchi mukha yoni (pinhole orifice of uterus).
Symptoms – Narrowing of genital passages

Shushkaa yoni –
When a woman holds her urges of urination and defecation during sexual intercourse, the vayu gets vitiated. This vitiated vayu obstructs the excretion of stools and urine and causes dryness and wasting of yoni (uterus or vagina). This condition is called Shushkaa yoni.
Symptoms – Constipation, obstruction to urination, dryness and wasting of genital passages

Vaaminee yoni –
The yoni (vagina or uterus) vomits or expels the semen which has entered it within 7 days with or without pain. This condition is called Vaminee yoni.
Symptoms – The female genital tract throws away the semen as if vomiting, unable to hold or retain it.

Shandee yoni –
In the female foetus formed due to the mixing of contaminated shukra (sperm) and artava (ovum) of the parents, the vitiated vayu creates morbidity of the child’s genital passages including vagina and uterus. This condition is called Shandee yoni.
Symptoms – The girl suffering from Shandee Yoni vyapat hates men, will be devoid of breasts and will not be fit for treatment of any sorts.

Maha yoni –
The Vayu vitiated in a woman who is used to have intercourse on too low, too high, uneven, troublesome surfaces or bedding afflicts the opening of yoni (vagina or uterus) following which the orifice doesn’t close, instead remains open always. This condition is called Maha Yoni.
Symptoms – Widening of opening of vagina and or uterus, pain in the vagina, constant flow of frothy blood, the
vaginal walls get elevated, pain in the inter-phalangeal joints and groins

Note – The above said Yoni Vyapads cover a wide range of uterine and menstrual disorders which we come across in the modern day gynaecological practice. They include dysmenorrhoea, dyspareunia, abortions and miscarriages, inflammatory and infectious conditions of female genital tract, infertility, narrowing and broadening of genital passages, polyps and fibroids, and lot more.

Atura siddhata

Atura Siddhata (Preparation of Patient) –
In women, uttara vasti should be administered in Rutu kala. Rutu kala is the time period of menstrual cycle which starts after the stoppage of active bleeding. This means to tell that Uttara Vasti can be administered from the 4^th day of menstruation. In this period it is said that the opening of uterus will be widely open and hence becomes easy to administer the vasti medicines into the uterus.

Before the administration of Basti, Yavagu (thick gruels) should be given along with milk and ghee or food should be given along with meat soup. The woman should be instructed to void urine and stools before administration of Vasti. Later Abhyanga (massage) should be administered with suitable herbal oils. Specifically abhyanga should be done over the pelvis, butts, hips, flanks, groin and vagina.

Medicine preparation

Keeping the medicines ready –
The kashaya (niruha vasti) or sneha (anuvasana vasti) should be made lukewarm and filled in the vasti putaka (enema can). Medicines to handle the complications if any in the post treatment procedures should be kept ready beforehand. Among these analgesics and sedatives (herbal), local analgesic oils like Panchaguna taila, etc and materials to give fomentation, suppositories, evacuation enema combinations to expel the medicines if they do not come out in time etc should be kept ready.

Enema syringes, bladder sound and or uterine probes should be kept ready.

Pradhana karma

Pradhana Karma (Administration of Uttara Vasti, the procedure) –
Basti Pranidhana (administration of Vasti) –
Male patient – The patient is made to sit on a comfortable chair and should be subjected to Abhyanga (massage) using medicated oils or ghee or both. The penis should be massaged gently and should be made erect. The bladder sound should be slowly introduced into the urethra and the passage tracked up to the urinary bladder. This bladder sound will also clear any blockages present in the urinary tract. It also gives a gross idea about the length of vasti netra or catheter which needs to be introduced into the urethra. The bladder sound should have been sterilized properly before usage. After estimating the passage with the help of the sounds, the vasti netra or enema catheter is smeared with medicated oil and slowly introduced into the urethra. Now days rubber catheters are used. When the catheter enters the urinary bladder, the other free end is fit to the nozzle of enema syringe or vasti putaka. Now the medicines are slowly pushed into the urinary bladder. When most of eh medicine has entered the bladder (a small amount of medicines should remain in the syringe or can) the vasti netra or catheter is slowly removed.

Female patient –
The woman should be made to sleep comfortably on a table in supine position (facing the roof, on the back). The lower limbs should be folded at the knees (flexed) and spread wide apart.

Abhyanga should be done over the pelvis, hips, groins, butts, flanks and vagina. Later hot fomentation (swedana) should be administered. If the vasti need to be given into the urinary bladder the urethra should be tracked up to the urinary bladder by gently introducing the bladder sound into the urethra. If the vasti need to be given into the uterus, the uterine sound should be introduced gently into the vagina and the passage should be tracked up to the uterus.

After having made an estimation of the passages with the help of the sounds, the vasti netra or catheter should be slowly introduced into the urethra or vagina as the case may be. The cervical dilators should be used to dilate the opening of the cervix and keep in position followed by introduction of the catheter. Uterine canula can also be used to administer Basti. One end of the canula is introduced into the uterus, the other free end is fixed to the syringe or enema can. The medicines are gradually pushed into the uterus (or bladder). Later, the catheter or canula is gradually removed.

Nireekshana

Nireekshana (observation) – The Kashaya or Niruha vasti introduced into the bladder or uterus returns in quick time. If it returns without delay and without producing any complications it should be considered as properly administered Basti. 2-3 such vastis can be administered. The sneha vasti or anuvasana vasti administered into the uterus or bladder does not return in quick time. It will stay inside for longer time and will provide beneficial results. A small quantity of sneha vasti administered into the garbhashaya (uterus) will return quickly but most of the medicine will remain within the uterus or may slowly come back little by little. The longer it stays in the uterus, more beneficial will be its results. Uttara Basti shall be given at a space of 3 days interval or for 3 times.

While administering garbhashaya gata vasti (uterine enema), vasti can be given for 3 days (continuoulsly) and after giving a gap of 3 days, once again 3 vastis can be given (on successive days). While introducing the vasti netra (nozzle or catheter) care should be taken that it should not be pushed too deep or should not be pushed for a short distance. When pushed deeply, the orifice of the nozzle or catheter will get blocked by the walls of the bladder or uterus and makes entry of medicines difficult. If it is superficially pushed for a short distance, the vasti medicine will flow out instead of reaching the bladder or uterus.

Paschat karma

Paschat Karma (Post treatment procedures) –
If the Vasti medicine doesn’t return back, attempts to flush them out should be done with effective treatments after having waited for 12-24 hours. The procedure of Uttara Basti shall often be troublesome and painful. The equipments used in uttara basti should be sterilized to their best, so as the medicines. If they are not sterile, they can produce infection and inflammation in the bladder and uterus.

After the procedure of vasti, vedanahara aushadhas (analgesic medicines) shall be administered. In women, the pain can exist for 12-24 hours after the administration of vasti. Nidrodaya rasa (medicine which is an analgesic and tranquilizer) is the medicine of choice in such conditions. Ahiphenasava and pippalimula (root of Piper longum) are the other best options. Local abhyanga (herbal oil massage) and mrudu sweda (mild fomentation) shall be done on painful areas.

Any one among these suppositories should be administered to expel the vasti medicine if it doesn’t come out in proper time –
Pippalyadi varti
Aaragwadhadi varti
Aagaara dhoomadi varti

Sushruta has advised to administer one more stronger vasti to expel the stagnated medicine. This vasti should be a shodhana vasti (evacuating or cleansing enema) made up of medicines like Trivrit (Operculina turpethum) etc. alternatively an eshani (probe or catheter) is introduced into the bladder or uterus and the medicines are removed.

If the vasti has produced lot of burning sensation, enema should be administered with Yashtimadhu Kwatha (decoction of Licorice) mixed with sugar and honey.

Bhojana (food) – After the expulsion or return of vasti, food should be given along with milk, yusha (soup) or mamsarasa (meat soup).

The parihara kala (follow up period), samyak and asamya kyoga (symptoms of proper and improper administration of vasti), vyapad (complications) and their management etc with respect to Uttar basti should be understood on similar lines of Anuvasana Basti (as explained in the context of oil or ghee enemas)

Mode of action

Probable Mode of Action of Uttar Vasti –
The lower part of the body is governed by a subtype of Vayu called as Apana Vayu. This Vayu or vata helps in controlling and governing all the activities taking place in the lower parts of the body. Its centres of control are Colon, pelvis, urinary bladder, uterus and lower limbs. If the Apana Vayu is at its functional best and is not vitiated all the activities related to the above mentioned organs take place easily and effortlessly. But if the Vata gets vitiated or moves in opposite direction i.e. upward direction (generally Apana vata tends to move in downward direction, expelling and excreting things being its primary functions) or gets obstructed functionally by other subtypes of Vayu or Pitta or Kapha (Avarana) or gets weak in functions, the functions related to the above mentioned organs and parts of the body will be disturbed. Hence, the medicines administered through vaginal or urethral route helps to balance primariy- Apana Vata and its associated other Sub Doshas, thereby leading to cure or relief from the respective disorders.

The Uttara basti has a cleansing action especially Niruha Vasti. By cleansing action of Uttara basti in the urinary bladder and uterus and other genital passages, the process of urination and menstruation and sexual functions will be restored. The organs will be clean and sterile and will get rid of inflammation, irritation, stagnation and infections.
The sneha vasti administered in Uttara basti will be having a supportive role. They are nutritive in function and will improve the blood circulation, nerve conduction and immunity of the organs. Anuvasana vasti given in the form of uttara basti is highly effective in cases of sterility and impotence and will bestow the progeny to those anticipating it.
Read related: Mode of action of Basti treatment

Uttara basti, it is a boon for those who are suffering from stubborn diseases of urinary and genital system. It fortifies the concerned organs, cures the diseases, enhances immunity, and keeps the organs clean, healthy and sterile. It helps in preparing the uterus for conception and begetting healthy children. Thus Uttara Vasti is a gift of Ayurveda for those who are suffering from infertility and impotence.
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