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Classical and Contemporary Approach to Uttarbasti: A Review

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 Trends in Drug Delivery
ISSN: 2394-7268
Volume 6, Issue 3
www.stmjournals.com

Classical and Contemporary Approach to Uttarbasti: A

Review
Achala R. Kumawat1,*, Karishma Singh2, Gopesh Mangal3, Gunjan Garg4
1
PG Scholar, Department of Panchkarma, National Institute of Ayurveda, Jaipur, Rajasthan, India
2
Ph.D. Scholar, Department of Panchkarma, National Institute of Ayurveda, Jaipur, Rajasthan, India
3
Associate Professor, Department of Panchkarma, National Institute of Ayurveda, Jaipur, Rajasthan, India
4
Professor &Head, Department of Swasthavritta, Jyoti Vidhyapeetha Women University, Jaipur,
Rajasthan, India

Abstract
Uttarbasti has been well highlighted in the classics for most of the uro-genital disorders in
both males and females. Among the disorders being treated with Uttarbasti, infertility stands
first. The great ancient acharyas had developed parameters for Ayurvedic procedures and
medicines according to their era, so it is the need of the hour to establish the parameters
suitable for modern era without compromising with the principles. In this study, an attempt
has been made to review Uttarbasti through classical texts to understand the concept of
Uttarbasti.

Keywords: Ayurveda, kashaya dravya, male infertility, urogenital disorders, uttarbasti

*Author for Correspondence E-mail: drachlaram011@gmail.com

INTRODUCTION Madhu, Sneha, and Kalka etc. which are

Drug administered through the urethral commonly added in Niruha Basti.
route/vaginal/uterine route is known as
Uttarbasti. In uro-genital disorders, some of Based on Route of Administration [4]
the normal Basti preparations are mentioned in • Mutrashyagata Uttarbasti: The
the classics, but in many a cases Uttarbasti is administration of drugs through urethral
to be recommended because of its higher route.
efficacy. The Basti which is given through • Yonigata Uttarbasti: The administration of
Uttarmarga or Utkrishta Avayava or drugs through vaginal route.
therapeutic procedure having Shrestha • Garbhashayagata Uttarbasti: The
properties is termed as Uttarbasti [1]. Acharya administration of drugs through uterine
Vagbhata says that the one which is route.
administered after the Niruha Basti procedure
is known as Uttarbasti [2]. INDICATIONS [5-7]
• Shukradushti (~Sperm disorders)
CLASSIFICATION OF UTTARBASTI • Shonitadushti (~Menstrual disorders)
Uttarbasti can be classified in many ways:
• Pushpodreka (~Menorrhagia)
Based on Drug of Administration [3]
• Rajahnash (~Pathological Amenorrhea)
• Snaihika Uttarbasti: Uttarbasti procedure
where only Sneha dravya is used is called • Kashtartava (~Dysmenorrhea)
as Snaihika Uttarbasti. There is no • Mutraghata (Mutravrodha: Retention of
mentioning of addition of any urine)
Avapadravya in it. • Mutradosha (Mutrakrichha: Difficulty in
• Nairuhika Uttarbasti: Uttarbasti micturition)
procedure where only Kashaya Dravya is • Yonivyapada, Yonivyadhi (~Gynecological
used is termed as Nairuhika Uttarbasti. disorders)
There is no mentioning of addition of • Aprasamshtithi (~Retention of placenta)

TDD (2019) 12-21 © STM Journals 2019. All Rights Reserved Page 12
Classical and Contemporary Approach to Uttarbasti: A Review Kumawat et al.

• Shukrotseka (~Discharge of semen) Poorvakarma

• Sharkraashmari (~Urinary calculi) Poorvakarma refers to the Karmas that are
• Basti, Vankshana, Meha Shula (~Pain in required to be done prior to administration of
bladder, groin, phallus) Uttarbasti. They include (1) preparation of
• Yonivibhrmsha (~Uterine prolapse) materials, and (2) preparation of patient.
• Asrigadara (~Dysfunctional Uterine
bleeding) Preparation of Materials
• Aprasrvati Mutre (~Retention of Urine) Classical
• Bindum Bindum Srvati (~Dribbling of • Bastiputaka
Urine) • Bastinetra
• Bastidrava
CONTRAINDICATIONS
In the genital tract of girls Uttarbasti is Bastiputaka: It should be made of the Basti of
contraindicated. small sized animals like goat, sheep, pig etc. or
the leather of birds as the quantity of drug is
less. It should be smooth, devoid of Sira,
Time of Administration
processed with Kashaya Dravya, clean and
It should be given during Ritukala (Just after
devoid of foul smell [10].
cessation of menses) after purifying the body
with two or three Asthapana Basti, because
Bastinetra [11-13]: The Bastinetra should be
Yoni-Garbhashaya Mukha (Vaginal and uterine
prepared of Hema (Gold) or Raupya (Silver)
orifices) are wide open at that time and it
[14]. Its shape should be tapering like cow’s
readily receives the injected Sneha [8]. It should
tail [15]. The details of Uttarbastinetra to be
be administered in the morning time [9].
used in different age groups are mentioned in
Table 1.
UTTARBASTI PROCEDURE
Every procedure of Panchakarma is carried The dose of Sneha and Kwatha to be
out in three steps Poorvakarma, Pradhana administered in Uttarbasti is mentioned in
karma and Paschat Karma. Table 2.
Table 1: Uttarbastinetra.
Age Passage Length Circumference of Nozzle Size of Lumen Karnika (From the
Tip of Nozzle)
Male Urinary 12/14 Maltipushpavruntagra Sarshapsannibham (size of Madhya (at 6/7
Angula mustard seed) Angula)
Girl Urinary 10 Angula Maltipushpavruntagra Sarshapsannibham (size of At 1 Angula
mustard seed)
Adult Urinary 10 Angula Mutrasrotah Parinaah (size of Mudgvahi (size of green-gram At 2 Angula
women urethral meatus) seed)
Adult Vaginal 10 Angula Medhra Aayamasamama Mudgvahi (size of green-gram At 4 Angula
women seed)
Bastidrava: Drava: Sneha/Kwatha

Table 2: Dose of Sneha and Kwatha for Uttarbasti.

Bastidrava Sneha Matra Kwatha Matra [16]
Sushruta Charaka Vagbhata [17] Sushruta
Purusha 1 Prakuncha [18] ½ Pala [19] * 1 Shukti 1 Prasruta**
Stree 1 Prasrut [20]a - 1 Prakuncha Garbhashaya Shodhanartha, Basti Shodhanartha – 2
Prasruta
Bala - - 1 Shukti 1 Prasruta
*This is the quantity of Sneha to be used for a person above 25 years of age. For people less than 25 years of age, the
dosage is to be decreased accordingly [21]. Acharya has given this dose for severe diseases and strong patients
(Paramvarga) and has left the decision of fixing individual dose on the wisdom of physician (Buddhi Vikalpitam). While
commenting on the same, Acharya Dalhana again clarifies that the quantity maybe half or less as decided by the physician
with his judgment, whether the strength of disease or the patient is half (Madhyama) or less (Heena) [22].
**Prasrutam= Swangulimoolasammitam (amount that withstands cupped palm of patient) [23].

TDD (2019) 12-21 © STM Journals 2019. All Rights Reserved Page 13
Trends in Drug Delivery
Volume 6, Issue 3
ISSN: 2394-7268
Dose should be fixed considering Vaya, Bala,
Satva, Satmya etc. [24].
In Current Practice:
Instruments used for Male Uttarbasti:
Instruments should be properly autoclaved and
the procedure should be conducted in OT
under strict aseptic measure.
• Robinson catheter no. 4,
• Disposable syringe 500 ml capacity,
• Haemostatic forcep,
• Sponge holding forcep,
• Green wound clothes, clip,
• Conical flask-green bottle for oil,
• Gloves, and
• Cotton-gauge pad.
Instruments used for Female Uttarbasti:
• Sims speculum,
• Anterior wall retractor,
• Allis forcep,
• Uterine sound,
• Hegar’s dilator,
• Syringe (10-20 ml), and
• Rubin’s cannula.
The following may also be taken as Uttarbasti
Netra for intrauterine administration:
• Infant feeding tube (with the tip cut to a
length of about 10 cm).
• IV Cannula.
• Intrauterine Insemination Cannula.
• Urinary rubber catheter no. 11/12.
• A syringe of 10 cc volume (glass or
dispersible) may be used as Bastiputaka.
Preparation of Patient
Classical:
• Prior to Uttarbasti Acharya Vagbhata has
indicated that 2/3 Aasthapana Basti should
be given in order to purify the Malamarga
[25].
• Acharya Charaka has indicated that prior
to the administration of Uttarbasti, patient
should take bath, take food mixed with
Mamsarasa (meat juice) or Ksheera (milk)
and should have voided his faeces and
urine [26].
• According to Acharya Sushruta, on the
day of Uttarbasti, Sthanika Abhyanga and
Swedana (localized massage and sudation)
is to be done over abdomen, thighs and
TDD (2019) 12-21 © STM Journals 2019. All Rights Reserved
groins, and take Yavagu added with Ghee
and milk should be given before the
administration of Basti [27]. The pre-
operative steps before administration of
Uttarbasti is mentioned in Flowchart 1.
2/3 AasthapanaBasti
Bath with lukewarm water
Abhyanga-Swedana
Yavagu with Ghrita, Ksheera
Srishtavinmutravega (proper evacuation of stool
and urine)
Flowchart 1: Regimens to be followed prior to
Administration of Uttarbasti.
Current Practice
In Male:
1. Advise the patient to empty bladder prior
to medicine administration.
2. Patient should be subjected to Avgaha
Swedana 15 min before procedure.
3. Blood pressure, pulse to be recorded.
4. Pubic hairs should be removed.
5. Clean the region properly with
disinfectant/Panchvalkala Kwatha.
6. Cover with sterile green wound cloth
clipped with towel clip.
7. Position for Uttarbasti: After voiding the
urges of Mala and Mutra, patient should
be seated on a knee-high and soft seat in a
straight and comfortable position. His
phallus should be made erect.
In Female:
1. Bowel cleansing (Advise drug if required).
2. Blood pressure, pulse to be recorded.
3. Yoni Prakshalana with Panchvalkala
Kwatha for local aseptic precautions.
4. Followed by Abhyanga with Bala Taila or
lower abdomen and lumber region,
followed by Swedana with hot water bag.
5. Position for Uttarbasti: patient should be
made to lie down in supine position with
well flexed thighs (Lithotomy position).
Page 14
Classical and Contemporary Approach to Uttarbasti: A Review
Pradhana Karma (Method of
Administration)
Urethral catheterization and instillation of
medicated oil into through urethral/vaginal
orifice constitute the Pradhana Karma.
Classical Description
In male [28]:
Patient should be seated on a knee high
and soft seat in straight and comfortable
position
↓ In Female:
His phallus should be made erect
↓ OT table in OT.
Shalaka smeared with Ghrita should be
inserted into the urethra
↓
Bastinetra should be introduced
according to the size of phallus
(In the line of peripheral raphe) without
any obstruction
↓
If it penetrates too far, it may injury the
bladder and if insufficiently inserted,
Sneha may not reach its destination
↓
Compress the Putaka without shaking it
and without causing discomfort,
Bastinetra should be withdrawn
In Female [29]:
Women should lie in supine position with the
thighs flexed (lithotomy position). Netra
should be introduced in the line of the curve of
spinal column in such a way that no
discomfort is caused to the patient.
Current Practice
In Male:
1. Lukewarm oil should be taken in the
syringe and catheter attached to its tip
(Care should be taken that all air in the
syringe is expelled out before inserting
into the urethra).
2. The phallus should be held perpendicular
to body.
3. The catheter is placed in the external
urethral meatus by holding it from its tip.
A few drops of oil are injected in order to
lubricate the meatus, to aid smooth
passage of the catheter.
TDD (2019) 12-21 © STM Journals 2019. All Rights Reserved
Kumawat et al.
4. Gentle advancement of the catheter
produces least amount of discomfort. As
the bulbo-membranous urethra is
approached, the patient is asked to take
slow breaths. (This helps to relax the
patient and allow easy passage of catheter.
The catheter should never be forcefully
inserted if any obstruction is met with).
5. After instillation of Bastidrava, catheter
should be removed slowly and carefully to
prevent any discomfort.
1. Patient should lie in lithotomy position on
2. Cleaning.
3. Patient relaxed
Sims speculum should be inserted into
vagina
↓
Cervix should be exposed with anterior
vaginal wall retractor and speculum
↓
Vagina and external OS should again be
painted with diluted Povidone-iodine
solution for removal of mucoid or any
discharge
↓
After sterilization → cervix should to be
caught with Allis forcep
↓
Uterine sound is passed through
external OS to find position of uterus
↓
After knowing the position → Cervix is
dilated using Hegar’s dilator
↓
After dilatation, 5 ml taila filled in
10/20 ml disposable syringe fitted with
angulated Uttarbasti cannula should be
inserted gently and oil is instilled
↓
All instruments and towel should then
be removed
↓
Douche is kept in vaginal orifice to
prevent outside leaking of Bastidrava
↓
Patient is advised to return to supine
position leg folded over each other.
Page 15
Trends in Drug Delivery
Volume 6, Issue 3
ISSN: 2394-7268
Paschatkarma
Classical Description
• The Uttarbasti Dravya Pratyagamana
Kala is 100 Matra (~31.66 sec) [30].
• Acharya Sushruta says, after the medicine
has returned, a second and third Basti
should be given. In the evening
considering the Dosha, Ksheera, Yusha or
Mamsa Rasa has to be taken [31].
• If the Sneha does not return, then
observation should be done for one night.
If it fails to return, then Shodhanavarti
should be inserted [32].
• Acharya Sushruta holds the view that in
the absence of Uttarbasti Dravya
Pratyagamana, if there are no
complications one may wait and neglect.
• If it is Updravakari it has to be expelled
using Teekshna Uttarbasti [33].
• Probe is inserted in Mutramarga and
abdomen is pressed forcefully below the
umbilicus [34].
• Varti of size of Mudga, Ela and Sarshapa
should be prepared by triturating
Aaragwadha Patra with Nirgundi Patra
Swarasa, Gomutra and Saindhava and
dried in shade. This Varti should be
smeared with Ghee and inserted into
Mutramarga with the help of Shalaka
[35].
Current Practice
1. Blood pressure, pulse to be recorded.
2. Patient is advised to relax for 30 min in
ward in head low position.
3. Fomentation over supra-pubic area should
be done with hot water bag to relieve pain.
4. Patient is advised to take light diet in
evening.
All the instruments including syringe, catheter,
and oil should be properly autoclaved.
DURATION OF UTTARBASTI
2/3/4 Sneha Basti should be injected in the
course of day and night. Such treatment should
be done for 3 days with gradual increase in the
dosage. In the same manner, the procedure
should be repeated after an interval of 3 days
[36].
ASSESSMENT
Samyak, Ayoga, Atiyoga Lakshana, Vyapada
(complications), Chikitsa (treatment) of
TDD (2019) 12-21 © STM Journals 2019. All Rights Reserved
Uttarbasti are similar to that of Uttarbasti
[37].
PROBABLE MODE OF ACTION
Probable Mode of Action of Yonigata
(Vaginal) Uttarbasti
Vaginal delivery can be used for systemic as
well as local action. The networks of blood
vessels like plexus of arteries extending from
internal iliac artery, uterine, middle rectal and
internal pudendal arteries supply blood to the
vagina. The blood cells are abundant in vaginal
wall. This vascularity of vaginal tissue is
responsible for first uterine pass effect, or direct
preferential vagina to uterus transport. The first
uterine pass effect can be defined as a
preferential transfer of a vaginally administered
drug to the uterus. A significantly higher
concentration of progesterone in uterus after
vaginal administration as compared to oral
administration can be taken as an evidence for
the above findings [38]. Before being able to
understand how the drugs are absorbed through
vaginal route, it is important to have an insight
over the vaginal histology. The vaginal
histology mainly consists of four distinct layers:
1. Superficial layer: composed of non-
secretory stratified squamous epithelium.
2. Lamina propria or tunica: made of
collagen and elastin, which contains a rich
supply of vascular and lymphatic
channels.
3. Muscular layer: consists of smooth muscle
fibers running in circular and longitudinal
directions.
4. Final layer: consists of areolar connective
tissue and a large plexus of blood vessels.
The drug transport across vaginal membrane
mainly takes place by three major ways:
a) Transcellularly (across epithelial cells) via
concentration dependent diffusion through
the cells.
b) Paracellularly (between adjacent epithelial
cells) mediated via tight junctions.
c) Vesicular or receptor mediated transport.
Drug absorption from vaginal delivery system
happens in two steps: dissolution in vaginal
lumen and membrane penetration. Cervical
mucus acts as a permeability barrier in vaginal
absorption. As vaginal fluid is watery in
content, any drug intended for vaginal delivery
Page 16
Classical and Contemporary Approach to Uttarbasti: A Review
requires a certain degree of solubility in water.
This explains the absorption of Kwatha
Dravya through Yonimarga and use of
Madhyama Paka of Sneha for Uttarbasti
(same as Basti) that contains substantial
amount of water besides, as mentioned by
Acharya Charaka.
Factors affecting Vaginal drug delivery:
1. Physicochemical properties of the drug
like solubility, dissolution rate, chemical
structure, stability, and pore size are
thought to influence the vaginal drug
delivery [39].
2. Generally, absorption of low molecular
weight lipophilic drugs is much more than
large molecular weight lipophilic or
hydrophilic drugs [40].
3. Contact time: More the retention of the
medicament within the vaginal cavity
more will be the absorption. For this
reason, Acharya might have advised to
perform Uttarbasti, thrice or more at a
stretch in a day so that the medicine
remains for more time in the contact of the
surface. Prolonged contact with the
absorbing surface will cause better drug
absorption.
Probable Mode of Action of
Garbhashayagata (Uterine) Uttarbasti
Theoretically, the drugs may reach into the
uterus by the following mechanism:
1. Direct passive diffusion through the
tissues.
2. Passage from vagina to the uterus through
the cervical lumen.
3. Transport through venous or lymphatic
circulatory systems.
4. Concurrent vascular exchange involving
diffusion between adjacent utero-vaginal
veins and arteries.
Having an insight about vascular supply of
uterus helps in better understanding of drug
absorption through uterine route. Arterial
supply of uterus is mainly derived from uterine
arteries which are branches of the internal iliac
arteries. The uterus is also supplied by the
ovarian arteries, which are branches of the
aorta. The uterine arteries pass along the sides
of the uterus within the broad ligament and
then turn laterally at the entrance to the uterine
TDD (2019) 12-21 © STM Journals 2019. All Rights Reserved
Kumawat et al.
tubes, where they anastomose with the ovarian
arteries. The uterine veins enter the broad
ligaments with the uterine arteries. They form
a uterine venous plexus on each side of cervix
and its tributaries drain into the internal iliac
vein. The uterine blood is drained into inferior
vena cava like vagina, and hence bypassing
deleterious “first-pass” effect.
In a study in ex-vivo uterine perfusion model,
it is reported that progesterone applied in
vaginal tissue reaches to the uterus within 5 h
of application. In another study model, sperm
sized 99m TC labeled micro aggregates of
human serum albumin was administered
through vagina which reaches uterus within a
minute indicating the direct transport
mechanism involving aspiration through the
cervical canal [41]. In recent studies, it is seen
that the placement of a formulation in different
area of vagina dramatically influences the first
uterine pass effect. When drugs are absorbed
in the outer 1/3rd of the vagina, it passes to the
uterus. This explains the efficacy of Yoni
Pichu etc. which are kept just near the vaginal
entrance. The Basti nozzle is advised to be
inserted up to 4 Angula (~7.5 cm); from this
fact it can be said that it is almost nearer to the
opening of cervix and the drugs laid to this
opening may travel towards the uterus by the
osmolarity of Sneha. The Sneha which
remains in the inner portion of vagina may
show systemic effect by being absorbed and
transported into inferior vena cava by vaginal,
retro sigmoidal, vesical and uterine veins [41].
Probable Mode of Action of
Mutramargagata (Urethral) Uttarbasti
Drug administered through phallus or female
urethra is called Urethral Uttarbasti. A small
fraction of orally administered drugs only acts
on the desired site either due to poor
absorption or due to metabolic loss for which
systemic therapy in bladder diseases most
often is not fruitful. This loss can be avoided
from first pass metabolism, thus the
therapeutic effect of a drug at the target site
with very minimal side effects can be achieved
by administering Intra-vesical Drug Delivery
(IDD). The need of a prolonged regimen by
oral administration for achieving efficacy can
be lowered by IDD.
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Trends in Drug Delivery
Volume 6, Issue 3
ISSN: 2394-7268
The main problem of IDD is low residence
time of a drug in the bladder that necessitates
frequent instillation. Usually the drug inside
the bladder rarely lasts beyond the first
voiding of urine after instillation. Another
important obstacle of this therapy is low
permeability of transitional epithelium of the
bladder also known as Urothelium [42].
However, in diseased state, this tough barrier
against IDD is somewhat compromised and
even then, only mode of membrane transport
across urothelium is passive diffusion. Since
passive diffusion is the only driving force for
intra-vesical drug absorption, the drug
transport across the urothelium (trans-vesical)
may be improved if the concentration gradient
is high. Increasing retention time of bladder is
possible by repeating the therapy for
prolonged time. The medicine of Uttarbasti
(usually medicated oil or ghee; sometimes
decoction) are introduced into bladder for 3 to
4 times in a day and should be repeated in
every fourth day. Use of Ghee or oil in
Uttarbasti is beneficial as it remains on the
urothelium layer for several hours. It fulfils
three main criteria: quick adhesion to the
urothelium after instillation, should not
bottleneck voiding of urine and retained over
urothelium for at least several hours.
In Ayurvedic classics, the drugs used in
Uttarbasti have been advised to release at the
level of mid portion of penile part of the
urethra in male and in urethra of the female.
So, there is also a chance of absorption of drug
in urethral part. Moreover in male, it is said to
administer Uttarbasti in Hrishta Medhra (i.e.
Erected Phallus). In erect condition, there is
huge accumulation of blood in spongy area,
which may drain the drugs to the circulation.
DISCUSSION
It is true that fundamentals on which science is
based cannot be changed but for wider
applicability, demonstration of these
principles, their reliability and utility in a
much practical way according to present
scenario is needed. For practical use, the
instruments, line of treatment etc. can be
modified wherever required keeping the core
principles intact. Ancient Acharyas have
mentioned materials like Hema (Gold), and
TDD (2019) 12-21 © STM Journals 2019. All Rights Reserved
Raupya (Silver) to be used for preparation of
Pushpanetra. But, in current practice due to
high rates of gold and silver, no one uses these
metals for preparation of Basti nozzle.
Similarly, as getting animal bladders seem out
of question today, various options have
erupted in place of conventional Bastiputaka,
mentioned above.
Selection of Bastidravya for Uttarbasti greatly
depends on the disease to be treated. In other
words, effect of Uttarbasti depends on various
factors like drug used, method of instillation,
instrument etc. Medicine is more likely to
exhibit a local effect at the target site. In case
medicine is administered in cervical canal, it is
more likely to influence the cervical factors.
Practically drug selection plays a major role in
efficacy of the therapy, and that needs to be
done based on the desired effect in a clinical
condition.
For factors like cervical stenosis, a Katu-
Ushna taila based medication can be more
useful (Katu rasa-Margaan Vivrnoti) [43],
which in turn is also thought to relieve
dysmenorrhea due to cervical stenosis, while
for increasing the secretion of mucous from
cervical glands (Shushkayoni Vyapada), a
nutritive and Madhura-Shita Ghrita based
medicine may be more efficacious. The
Bastidrava after absorption might act on
ovarian factors, subsequently influencing the
Hypothalamo-Pituitary-Ovarian axis, while in
tubal factors Uttarbasti may act locally.
Uttarbasti with Lekhana Dravya may help in
mechanical removal of tubal blockage, thus
letting cilia function optimally. Moreover, it
may stimulate certain receptors in
endometrium, thus correcting the
physiological process of reproductive system.
Intrauterine Uttarbasti with Lekhana dravya
may prove to be effective in cases of
metrorrhagia due to hyperplastic endometrium.
Length of Karnika from the tip of nozzle as
mentioned in classics is 6/7 Angula for males
i.e. ~12/14 cm approx. The length of penile
urethra is about 15 cm that implies that the
drug instilled through urethral route in males
reaches the proximal portion of penile urethra;
whereas for females it is 4 Angula (~8 cm) for
Page 18
Classical and Contemporary Approach to Uttarbasti: A Review
uterine administration and 2 Angula (~4 cm)
for urethral administration in adult female, and
1 Angula for urethral administration of drugs
in girls. The length of urethra in females is 4
cm that justifies the size of Karnika at 4
Angula for intrauterine administration and 2
Angula for urethral administration.
Micturition usually starts when the volume of
urine inside bladder reaches 280 ml, otherwise
the bladder capacities vary in adult male from
120 to 320 ml.
The maximum amount used for Uttarbasti as
per classics is 1 Prakuncha (~50 ml) for Sneha
and 1 Prasruta (~100 ml) for Kwatha. If
Uttarbasti is administered after micturition, it
will stay in the bladder for quite a sufficient
time before the micturition reflex comes into
action.
The relaxation of abdominal muscles may be
achieved by performing Snehana and Swedana
just before Uttarbasti. If the muscles are not
relaxed before instillation of medicine, organs
may contract at once and may not retain the
medicine instilled.
Moreover Snehana and Swedana may be
helpful in reducing the pain during and post
procedure. Prakshalana with Kwatha of
antiseptic property prior to Uttarbasti
invalidates the possibility of any type of
infection post-procedure.
Acharya advocates instillation of Bastidrava
after evacuation of faeces and urine. Dilution
of instilled drug solution by residual urine in
the bladder (if bladder is not evacuated before
instillation of Bastidrava), conversely affects
trans-vesical transport adversely. Further
decrement in the concentration gradient is also
possible due to steady accumulation of urine
during the duration of instillation. Complete
bladder emptying prior to dose administration
and restricted fluid intake before and after
instillation reduces the rate of urine
production, followed by reduction of influence
of the kidney on IDD which in turn leads to
increase in the urinary drug concentration and
improved efficacy [44].
TDD (2019) 12-21 © STM Journals 2019. All Rights Reserved
Kumawat et al.
As far as vaginal and uterine Basti are
considered, as the vaginal bioavailability is too
variable to be useful clinically and it depends
upon so many factors mentioned above, the
uterine method of drug delivery may provide
better efficacy. It is also seen that permeability
in normal and atrophied uteri are similar [45].
CONCLUSION
At present, Uttarbasti is confined to a very
few gynecological diseases particularly
infertility. Its practice in other gynaecological
disorders as mentioned in classical texts has
almost disappeared. As not a single research
work has been done to explore the mode of
action of Uttarbasti in spite of its higher
clinical efficacy, a huge task remains for the
scientist to discover. Indeed, a better
knowledge of urothelial permeability (in case
of Uttarbasti in males) could help to optimize
this treatment.
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ISSN: 2394-7268

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Cite this Article
Achala R. Kumawat, Karishma Singh,
Gopesh Mangal, Gunjan Garg. Classical
and Contemporary Approach to Uttarbasti:
A Review. Trends in Drug Delivery. 2019;
6(3): 12–21p.
Page 21