uttarabasti and its role in treating primary infertility and recurrent pregnancy loss is complex.role of agni and dhatuposhana is also important to understand the concept.

2. Practical Approach & Applicability of
uttarabasti
 Dr.Vishala Turlapati
M.D.,Ph.D
Professor and HOD
Department of Prasuti Tantra and stree roga
YAC, Kodoli,Kolhapur

3. Introduction
The protocol adopted to treat the
primary infertility and recurrent
pregnancy loss with uttarabasti as one
of the management.
Discussion , conlusion.

4. INTRODUCTION
Basti chikitsa as per Ayurvedic
classics is considered as superior of
all treatments, particularly for vata
dosha vikruti.
In stree roga uttarabasti is a special
procedure indicated in many
conditions which mainly got the role
of Garbhasaya sodhana and Tarpana.

5. INTROD….
 Tatradwayo dampatyoh swabhavat
swakarma parinamadva
prajabhivriddhirbhavati tou dhanyou ato
anyatha bhishajitavyou…k.s.

 Garbhasambhavasamagri+shadbhava…samu
ditebhyo garbha sambhavati…..ch.sha


6. INTRO….
endometrial
thickness remains
challenging.
Understanding
mode of action of
uttara basti,
Utility, Limitations,
standard of
procedure as per
the present day
requirement is very
essential.

7. vandhyatwa
Rasa dhatu dushti
Rakta dushti Artava dushti
Jathargni mandya
Bhootagnimandya Dhatwagnimandya
Nidana
Tridosha vikriti Apana ,vyana

8. CONT….
Vandhyatwa
Avrita Apana vata Vimarga gamana
Granthi
Nashtartava Garbhasrava, Mritavatsa
Artava vaha srotodushti
Atipravritti Sanga

9. GARBHASRAVA
yonivyapad
Apana vata vikriti Garbhasrava/pata
Asampad Atma, Asaya, kala,
Manasa Agantu
Midhyaahar vihar, Vegadharana
Pradushta artava Dooshita shukra

10. Rationality
HPO axis integrity
Endometrial
growth--
endometrial
receptivity and
embryo
implantation.
Vaginal sildenafil
first line therapy
ET<7mm.
The second option
is Granulocyte
colony –stimulating
factor(G-CSF)
300micrograms 2-9
days before
endometrial
transfer in IVF.(1)

11. ADOPTED MANAGEMENT
Agnideepana
• Trikatu
churna/Dha
nyaka hima
Amapachan
a
• Nagakesra
churna+trikatu
churna+swarnam
akshika bhasma
• Jeerakarishta
• 3+250mg+120mg
/day with madhu
• 15 ml twic daily
Sodhana
• Vamana/virech
an/basti

12. vandhyatwa
Vata kshaya,Vyanavrita apana vata(BMI<18,oligohypo)
Ksheera basti Yapana basti
Vyana avrita apana,pitta anubandha(menorrhagia)
virechan Kashaya basti,Anuvasan
Kapha avrita(BMI>25,abnormal profile,oligohypomenorrhea)
Vamana Kshara basti

13. 

14. Garbhasrava(RPL)
Amapachana
Garbhakoshta suddhi
Snehapan
Basti
Deepaneeya
Pachaneeya
Jeevaneeya
Bhrihmana
Garbasya tarpana

15.  Amapachana
 Garbhakoshtasuddhi
 Snehapan
 Basti
 Deepaneeya
Pachaneeya
 Jeevaneeya
 Bhrihmana
 Garbasya tarpana
 Nagakesra churna+trikatu
churna+swarnamakshika bhasma
 Jeerakarishta
Dadimadi ghrita/Dhanwantara taila
Dashamoola yoga basti,Balataila
matra basti
Guduchi, madhu
Shatavari/dadimadi
ghrit,Ashwagandha ksheerapak
Kharjura phal
Uttara basti

16. The Basti chikitsa given initially stimulates the
neurons of Hypothalamus to secrete the GnRH .
It also activates the receptors present in the
pituitary and ovaries to respond the stimuli.
7 days for amapachana
Vamana/virechana
Basti in the shedule of yoga or kala basti for 2
cycles
From day 4 Ashwagandha ksheerapak for 12 days.
Third cycle combined with uttarabasti from day
the bleeding stops and after 1 kashaya basti in
alternative days for 5 to 9 days depending on the
follicle monitoring.

17. UTTARA BASTI DRAVYA
Dadimadi
ghrita
Shatavari
ghrita
Guggulu
tiktaka
ghrita
Dhanwantara
taila 101
Phala ghrita

18. DISCUSSION


19. Uttarabasti karmukata
 Niruhat Uttarena
 Uttarmargadeeyamantaya
 According to Acharya sushrutha veerya of basti
through srotases reachs all over body, just like
water gets absorbed to the whole plant through
the roots.(17)
 According to parashara guda is the mula for siras
, along with vata dosha ,pitta and kapha also
gets passified absorbed.Apana vata governs the
whole pelvic organs and their activities. Vikriti is
either due to avarana or vimarga gamana

20. When Basti is administered in the
Pakvashaya, its Virya(probably active
principles) is taken up by Samana Vayu
with the help of Apana Vayu.
Then it reaches other Vayus also, and
affects them by its action. It also keeps
Pitta and Kapha in their proper places.
It exerts its effect on Bhutas which are
similar to that Guna of Virya. The
transport of Bastivirya is by Kedarikulya
Nyaya which makes it spread all over the
body by virtue of different Vayus.

21.  Basti active principles i.e. phytochemicals of
the Basti as the action is dependant upon
Gunas which are the properties in
Dravya.(24)


22. Enteric nervous
system governs GI
system
Both ENS and CNS
develop - neural
crest - embryonic
life.
these two systems
contain same neuro
transmitters.

23. Niruha basti is
hyperosmotic (SOLVENT-SOLUTE)
Sneha basti is
hypoosmotic. (BLOOD CIRCULATION)

24. Upper 1/3rd - Portal
venous system- GIT -
liver.
Lower 2/3rd of rectum -
inferior iliac vein-
inferior vena cava, by
passing-
liver,stomach,dueodenum

25. BASTI
stimulation of
chemo or
mechano
receptors with
the activation
of concerned
part of CNS.
Basti dravya
need not stay in
the organ for
longer time.
proton pump -
HIT AND RUN
MODULE

26. Niruha,Anuvasan, Matra
Visceral afferent
stimulation results in
activation of the
hypothalamus
pituitary adrenal
axis and autonomic
nervous system,.
regulate
sympathetic activity,
decrease secretion
adrenaline and nor
adrenaline,,
balance autonomic
nervous system.
release of
neurotransmitters
and hormones.

27. Entering into
gastrointestinal tract basti
stimulates ENS and
generates the stimulatory
signals for central nervous
system.(18,19).
These signals stimulates
endogenous opioids present
in GIT, beta endorphin
,which exerts the inhibition
of gonadotropin releasing
hormone release(20).

28. Pharmaco dynamics -uttarabasti
Uttarabasti exerts synergestic effect.
Drug given through uttarabasti creates a reaction in
the cells of endometrium and the neurons of
endometrium get activated and absorb the drug which
stimulates the higher centres as well as endometrium.
Increased vascularity increases absorption

29. passive diffusion is a movement of ions and other
atomic or molecular substances across cell membrane.
Mucous membrane absorbs lipids fast.
Drugs which are lipid soluble are transferred by
possible diffusion.
Basti expresses itself by its veerya and prabhava

30. Advantage of intra
uterine instillation of
oil is proved in
modern science also
(18)39
Uttarbasti may also
stimulate certain
receptors in the
endo-metrium,
leading to correction
of all the
physiological
processes of
reproductive system.

31. It may also help in
rejuvenation of
endometrium.
posterior fornix has a
very rich blood supply
Uttara bastI may act
by stimulating some
neuro endocrine
pathways after
getting absorbed.

32. ESSENTIAL FACTORS OF REPRODUCTION
’’Dhruvam chaturnam sannidhyat garbhasyat
vidhipurvakamrutukshetrambu beejanam
R-proliferative then secretory phase
K- patent uterus and adenexa
A- progesterone- decidualization
B- oocyte ,spermatozoa- Zygote.

33.  Dhatu poshana- Dhatwagni .
 these four factors are the essence of Dhatu
poshana. Hence Dhatwagni should be
corrected initially to treat the condition of
oligo or Anovulation due to any
cause.Ayurvedic classics advocated sodhana
chikitsa , a method of biopurification for
vandhyatwa.


34.  Successful implantation requires good
harmony between the endometrium and
blastocyst
 HPO axis integrity.
 Pulsatile GnRH secretion
 luteinizing hormone (LH) and follicle
stimulating hormone (FSH)
 Embryo implantation is a very delicate and
well orchestrated process that is governed by
interaction of several maternal and
embryonic factors.(1-5).

35.  Dysregulation of endometrial blood flow has
been associated with several menstrual
disorders including infertility and RPL.
 Following implantation, the endometrial
vasculature undergoes considerable change
in association with the trophoblastic invasion
of the spiral arteries, and suboptimal
responses have been associated with
recurrent miscarriage,intrauterine growth
restriction and pre‐eclampsia , ( Jirouset
al ., 2001 ; Habara et al ., 2002 ),

36. Arrest of antral follicle growth
is associated with an abnormal
endocrine environment
involving hypersecretion of
lutenizing hormone( and insulin
and hyperandrogenisim).
(Kaphavrita apana vata
resulting into sanga of
artavavaha srotas with
dhatwagni mandyata)

37. 
 The net effect is secondary suppression of
FSH,which leads to inhibition of maturation of
otherwise healthy follicles in the
cohort.(Margavarodha of artava)
 Oxidative stress is the cause of infertility,
miscarriages ,pre-eclampsia. It can itself induce
insulin resistance and
hyperandrogenisim.(Dhatwagni mandya-
increased free radicals)


38. Garbhasaya
tarpana along
with sodhana
sheds off
hostile
endometrium
Regenerates and
correct the
endometrial
receptivity by
regularising the
receptors.
healthy
decidualisation by
increasing the
receptivity to
progesterone for
implantaion
Trophoblastic invasion
in to spiral arteries will
be effective.

39. implantation itself is
characterized by an
inflammatory‐like response
associated with increased
vascular permeability and
vasodilatation,
estradiol promotes endometrial
proliferation, whereas after
ovulation, progesterone
converts estradiol-primed
endometrium into secretory
tissue(initial sodhana chikitsa
and sthanika uttarabasti)

40. Vajikara(Agnimantha)
Garbhasthapana(gambhari) Rasayana
Gaarbhasaya sankochak
anulomak Garbhasaya sothahara(bilva)
Dashamoola kwatha
Tridosha shamak balya Sonita sthapana

41. RASA DHATU
RAKTA RUPA RAJA
DHATUPOSHANA

42. • DHATWAGNI
• DHATUPOSHANA
NIRAMA
AHARA
RASA
• REGULATED HPO AXIS
PRAKRUTA
APANAVAYU

43. Artava vaha
sroto viddhi
results in
vandhyatwa,m
aithuna
asahishnuta
artava nasha.
Chakra pani
mentioned
uttara basti as
shreshtanam
shreshtagunatay
a .

44. Uttarabasti may help in stimulating the
receptors to make the endometrium
responsive to the HPO secretions which
play a key role in regulation of neuro
endocrinology through the positive and
negative feed back mechanisim.
Can be understood as avarana of kapha
and pitta on apana vayu locally in the
endomrtrium due to Which endometrium
becomes unresponsive and insensitive.

45.  The mode of action of uttarabasti is similar
to niruha basti( sscs 35/24,25).
 m.elimas etal establishes the absorption of
drugs through endometrium. vaginal
administration of tcpertechnetate activity
was observed in uterus after 60mts even in
sealed cervix.
 The active principles must be getting
absorbed through endometrium which drains
into internal iliac vein from there to systemic
circulation.

46. System biology,
helps to
understand the
pharmacodynamics
of
uttarabasti.(www.
systems.biology.or
g.)
All the bodily
organs are
interconnected
at molecular
level
Panchamahabho
ota,tridosha

47. CONCLUSION
Uttarabasti
works exerts
synergestic
effect as
Sthanikachikitsa.
The mode of
action is similar
to kashaya basti
When antral
follicle count is
<5 and <0.5mm,
mean time of
conception will
be 1year.
The Basti
chikitsa given
initially
stimulates the
neurons of
Hypothalamus to
secrete the
GnRH

48. Protocol need to be
standardized
Randomised controlled
clinical trials with universally
acceptable parameters.