Tests and procedure

Practical Application of Uttara Basti
DEFINITION
Administration of drugs through Uttara Marga or through above Guda Marga is called as Uttarabasti and also this procedure done after Niroohabasti. The procedure which implies superior qualities due to its action of the drugs and it serves both the purpose of Anuvasana and Nirooha
UTTARBASTI INDICATED: - Urological conditions, Andrological conditions, Gynaecological conditions
ADMINISTRATION
UB in males: Application of UB, Urological (male & female), Ashmari , Hydronephrosis , Renal diseases,    Chronic cystitis, Chronic UTI, BPH (only males)
Drugs used in Urological conditions:
Varuna, Gokshura, Punarnava, Sariva, Chandana
In BPH : Maize juite, Punarnavadi kashaya
Drugs used in Chronic UTI and cystitis
Panchavalkala kashaya, Triphala kashaya, Dashamoola kashaya, Yastimadhu taila, Jatyadi taila,
Andrological (males) - Application of UB
Sexual dysfunctions
Infertility
Prostatitis
Erectile dysfunctions
Retodusti
Vajikaranaartha
? Obstructive azoospermia

Erectile dysfunction
Ashwagandha
Kapikacchu
Shatavari
Vidari
Akarakarabha
Ksheerabala taila
Mahamasha taila
Obstructive azoospermia
Erandamoola kashaya
Triphala taila
Premature ejaculation
Chandana
Saariva
Ushira
Puga
Jatiphala
Retodushti Vatapradhana (phenila, tanu, ruksha, alpa): Shatavari, vidari, amalaki, kokilaksha, dugdha
Pitta pradhana (puya): chandana, sariva, usheera, yastimadhu
Kapha pradhana (picchila, granthibhuta, avasadi): Dashamoola, triphala,  pippali, aswagandha, shilajatu, sathi
Instrument required for the procedure
Urinary rubber / disposable catheter No.6-8, Aspiration syringe, 30 ml capacity (disposable)
Steel bowl of 30-50 ml capacity, kidney tray-1, medicated oil or decoction or ksheerapaka selected according to the condition, autoclave facility
Preparation of Medicine
Take the medicated oil in required quantity in a pre-cleaned container,   Autoclave the oil along with all the required materials, freshly prepared and cooled ksheerapaka can be directly used if the contamination is avoided during cooling
Preparation of Patient
Part preparation
Void bladder before procedures
Procedure
1.Patient must lie down on supine position on the clean table by exposing the part
2.The hands are flexed and clasped below head
3.Wash the genitalia and the surrounding area with the savlon by using sponge holding forceps and gauge
4.Retract the prepuce completely and wash thoroughly the glans penis & then apply betadine to glans penis
5.The physician having gloves after washing hands spread the surgical towel over patient, exposing the penis. Towel clips may be applied
6.When once the assistant transfers the autoclaved medicine into steel bowel, the medicine is filled in to the syringe
7.Fix the catheter to the nozzle of the syringe, push the oil to the tip of the catheter
8.Lubricate the catheter with xylocaine jelly
9.Gently introduce the catheter into the urethra
10.Slowly introduce the catheter into the bladder
11.Ensure the catheter has entered the bladder, then slowly inject the medicine into the bladder
12.If more amount of medicine has to be injected clamp the catheter with artery forceps, remove the syringe and then inject the medicine with same syringe or be another
13.When once the injection of medicine is over remove the catheter & allow the patient to lie down in the same position for 5-10 minutes and then patient may be sent home
14.Check the tip of the catheter to ensure that there is no any bleeding
Dose
1.25-30 ml of medicine per UB is enough to maintain the good retention.
2.Maximum dose of 200 ml per UB has been given without complications
a.Retention
3.Usually 3-6 hrs
4.In some cases upto 8 hrs
a.Contraindications
5.Urethral stricture
6.Bleeding disorders
7.Carcinoma of the bladder
8.Carcinoma of penis
9.Hypo/epispadiasis
a.Precautions
10.Patient should not hold the urge of micturition and other natural urges after the administration of UB
11.Brahmacharya: if patient is willfully abstains from the sexual life, it is good; otherwise it may be beneficial to allow the patient for moderate sexual life (decreasing the frequency of the intercourse), as the suppression of sexual urge is one of the causative factor for sukradusti
Diet
Avoid katu, tikta and kashaya rasa
APPLICATION OF UB AT THE LEVEL OF VAGINA:
Vaginal infections
Vaginal mucosal defects
Vaginal milieu pH
Vaginal secretions
Inflammations of vaginal wall
APPLICATION OF UB AT THE LEVEL OF CERVIX
Cervical erosions
Cervical mucus quantity
Cervical mucus pH
Cervical mucus disorders
APPLICATION OF UB AT THE LEVEL OF ENDOMETRIUM
To improve endometrial thickness
To improve endometrium quality
Endometriosis
APPLICATION OF UB AT THE LEVEL OF FALLOPIAN TUBES
Inflammations of fallopian tubes
Hydrosalpinx
Tubal block
Female reproductive tract route
Uttara basti yantra
Medicine
Lithotomy Table
Kelley’s Pad
Hole towel
Tray
Cuscus Speculum
Tampon
Sponge Holding Forceps
Gauze pieces
Xylocaine Jelly
Cleaning agents
Intra-vaginal Administration
1.Whole procedure is carried out under aseptic precautions
2.Patient is asked to lie down on the lithotomy table
3.Vital signs are recorded
4.Patient is put on lithotomy position
5.Vagina is cleaned with gauge / saline
6.Cuscos speculum inserted gently into the vaginal canal
7.Sufficient quantity of medicine is filled in the canal
8.Medicine is maintained in the cavity for prescribed time in head low position
9.Dose 30-40 ml
Intra-Uterine Administration
1.Whole procedure is carried out under aseptic precautions
2.Patient is asked to lie on the lithotomy table
3.Vital signs are recorded
4.Patient is put on lithotomy position
5.Cuscos speculum inserted gently in to the vaginal canal
6.Cervix is cleaned properly with gauge/saline
7.Required amount of medicine is taken in the syringe, whose mouth is fitted by the canula
8.The canula is inserted in to the cervix and the medicine is slowly pushed
9.Patient is kept with the medicine in head low position for ½ an hour after removing the speculum
Paschat karma
Check vitals
Tampon is kept in vagina (to be removed before micturition)
Contraindications
Hypersensitivity
Pregnancy
Intrauterine device in situ
Treatment plan in general
Day 1     Day 2     Day 3     Day 4     Day 5     Day 6
Niruha     Niruha     Niruha     UB     UB     UB
TIMING     Day 1     Day 2     Day 3
MORNING     Niruha     Niruha     Niruha
EVENING     UB     UB     UB
Guidelines for Research on Uttarbasti
INDICATIONS
UB indicated in - Urological, Andrological and Gynecological problems
Wide range of single drugs as well as compound preparations are indicated for the management of these disorders
Efficacy of these drugs are to be established with exact clinical condition
Absorption of Uttarbasti Dravya
Is there any absorption of UB dravya?
Clinically local as well as systemic effects are noticed
Studies are to be planned with Radio isotope markers
FORM OF MEDICINE
Different forms of medicines are indicated for the administration of UB
Required to establish which form is most suitable and having more absorption
Is any form of medicine is totally non-absorbable and non-effective?
Dose & Duration
What is the ideal dose of UB?
Presently:
Intra vesicle – 30ml
Intra uterine – 10ml
Suitable dose is essential to exert osmotic pressure to facilitate absorption
Number
Number per day???
How many days???
When to repeat???
In case of UB female Reproductive Route
Is it intra vaginal?
Is it intra uterine?
Or both?
Standards may be developed as per the indications and site where action required
Ideal time of Administration of UB in respect to Menstrual Cycle
Required to develop standard guidelines depending on the object of treatment
Local action
Induction of ovulation
Tubal block etc.
Niruha & Anuvasana
General principle of Basti:
Niruha & Anuvasana are to be administered alternatively
More retention / absorption of UB dravya noticed after Niruha (rectal)
Whether general guidelines of Basti are to be adopted or not
If to be adopted how?
TEACHERS!
Select one area as per interest
Establish the required setup
Make available all the related drugs & formulations
Conduct longitudinal studies
Take Home Message
UB is safe performed under aseptic conditions
Best practiced in few of the urological, andrological and gynaecological conditions as listed
Lot of cope for research
Start practicing as for as possible and workout for further development
Female reproductive system
Drugs acting in different conditions of female urogenital system
Infections and inflammations
Triphala
Panchavalkala
Jatyadi ghrita
Punarnavadi kashaya
Mucosal defects
Ksheerabala taila
Yastimadhu taila
Shatadhouta ghrita
Increased pH
Chandanadi taila
Yastimadhu taila
Panchavalkala kashaya
Guduchi and vasa
Tubal blocks
Bhrahati
Kantakari
Devadaru
Varuna
Gokshura
Intra vesicle administration
Requirements:
Cleaning agents like Savlon, Betadine etc.
Sponge holding forceps and artery forceps
Sterile gauze, surgical towel & towel clips
Sterile gloves
Anesthetic jelly
Identify separate institutes for each broad areas of indication
Provide specialized infrastructure
Well structured longitudinal studies
Collaboration
Identify the investigators and train thoroughly
Group of investigators
Clinician
Pharmacologist
Clinical pathologist
Clinical research qualified personnel
Preparation of standard guidelines on the basis of results of these dedicated research centers
Orientation programmes to spread the knowledge & skills
Feedback from the users
Reconsideration in further research studies