Pourusha vasti ksr

Pourusha Vasti – Male Uttara Vasti
By
Dr KSR PrasadDr KSR Prasad
@ CME on 27-11-2016
A d V thAyurved Vyaspeeth
Shri Ayurved College
NagpurNagpur
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/

I d iM l (P h )
Introduction • Male (Purusha)
undoubtedly strong in
many occasions but whenmany occasions but when
he becomes weak, aged or
diseased – the
management of Pourusha
Vasti starts
• Pourusha Vasti is an
exclusive Male Uttara
Vasti organi ed for theVasti organized for the
(MSD) Male Sexual
Dysfunction or (BPH)Dysfunction or (BPH)
Benign Prostate
Hypertrophy

M l S hMale Strength
M l @ j ti• Male @ conjugation –
– Transfers the genes to the offspring
through semeng
– Semen – even though in millions of
count –
• Only one is successful• Only one is successful
– Environment, Food, Occupation, Habits,
etc. influence the harmony
• Prostate Gland: A firm partly muscular
chestnut sized gland in males at the
neck of the urethra; produces a viscidneck of the urethra; produces a viscid
secretion that is the fluid part of semen

I d i
Introduction
Th i h t “P h V ti” i t i• There is no such term “Pourusha Vasti” exists in
classical texts
• “Pourusha Vasti” is a coined term to denote the• “Pourusha Vasti” is a coined term to denote the
importance of Pourusha Granthi (Prostate)
management through Uttara Vastimanagement through Uttara Vasti
• The alternative route (uttara marga)
administration of the medicine is termed asadministration of the medicine is termed as
Uttara Vasti
• Common alternative routes are – Urethral in
Male and Vaginal in Female apart from Urinary
bladder route

E lEtymology
• Vasu – Vasane – Achadane – Nivase
– It means any substance is placed to be
resident of or covered with is called as Vasti
– The Uttara Vasti is called as it is given from
Uttara Marga (alternative route) and/or as aUttara Marga (alternative route) and/or as a
better qualitative method

Cl ifi i f V iClassification of Vasti
Purva Vasti Karma Uttara Vasti KarmaSthaneeya Vasti
Karma
Ni h V ti
Vrana Vasti
1
• Niruha Vasti
2
• Anuvasana Vasti
1
• MutrashayaVasti
• GarbhashayaVasti2 2
• GarbhashayaVasti
3
• Pourusha Vasti

K i b U iKnowing about Uttara vasti
• What is Uttara Vasti?• What is Uttara Vasti?
– It is a practice of administering the medicine
P th i t i l i l P h V ti• Per urethra in to seminal vesicles = Pourusha Vasti
• Per urethra in to bladder = Mutrashaya Vasti
• per uterine = Garbhashaya Vasti• per uterine = Garbhashaya Vasti
– The medicine includes –
• Ghruta Vidaryadi Ghruta etc• Ghruta – Vidaryadi Ghruta, etc
• Taila – Narayana Taila, etc
• Kashaya – Dashamula Kashaya etcKashaya Dashamula Kashaya, etc

Applied Shareera
• Structures concerned are• Structures concerned are ‐
– Glans penis
Urethra– Urethra
– Prostate gland
– Vas deferensVas deferens
– Testicles
– BladderBladder
• Evacuated liquids are –
– UrineUrine
– Semen

Surface Anatomy
• The common structures
intervene are –
Urethra Urinary– Urethra ‐ Urinary
Bladder – sphincter
– Urethra – Prostatic
urethra – ductus
deference‐seminal
vesicles – epidydimis –p y
testes

A li d Ph i lApplied Physiology
SEMINAL FLUID• SEMINAL FLUID:
– NUTRITION TO SPERMS: Fructose and other nutritive
substances in seminal fluid are utilized by sperms after y p
being ejaculated into the female genital tract.
– CLOTTING OF SEMEN: Immediately after ejaculation,
semen clots because of the conversion of fibrinogen fromsemen clots because of the conversion of fibrinogen from
seminal fluid into fibrin.
• Prostate
– Prostate fluid is a thin, milky and alkaline fluid. It forms
30% of total semen.
MAINTENANCE OF SPERM MOTILITY: Prostatic fluid– MAINTENANCE OF SPERM MOTILITY: Prostatic fluid
provides optimum pH for the motility of sperms.
Generally, sperms are non‐motile at a pH of less than 6.0.

SPERM• SPERM
– Sperm is the male gamete (reproductive cell), developed in the
testis. It is also called spermatozoon (plural = spermatozoa).
d lMatured sperm is 60 μ long.
• Sperm Count
– Total count of sperm is about 100 to 50 million/mL of semenTotal count of sperm is about 100 to 50 million/mL of semen.
Sterility occurs when the sperm count falls below 20 million/mL.
• PROPERTIES OF SEMEN
1 S ifi i 1 028– 1. Specific gravity : 1.028
– 2. Volume : 2 mL to 6 mL per ejaculation
– 3. Reaction : It is alkaline with a pH of 7.5. Alkalinity is due to p y
the prostate fluid.

R l t d t i Bl dd
Eligible Male for
Uttara Vasti
• Related to urinary Bladder
– 13 varieties of mootra Dosha –
Mutouksada, Mutra jathara, Mutra
krichra Mutrotsanga Mutra kshayakrichra, Mutrotsanga, Mutra kshaya,
Mutraateeta, Asteela, Vtavasti,
Ushnavata, Vtakundalika, Raktagrandhi,
Vidwighata, and Vasti Kundalikag ,
– Mutra sharkara
– Ashmari
– Vasti shoolaVasti shoola
• Related to Genital
– Vankshana shoola
h k h– Shukra Dosha
– Sukraotseka
– Dhwajabhanga
– Klaibya
S t Chikit 37/125 126 Ch k Siddhi 9/71
Susruta Chikitsa 37/125‐126, Charaka Siddhi 9/71

Examination of
Examination of
Pourusha Vasti Patient
• Check the problem –
– Dhwajabhanda, Sukra Dosha,
Klaibya, etc.Klaibya, etc.
– Cardiac ability % – HTN,
Angina, Block, etc.
Kidney ability % DM etc– Kidney ability % ‐ DM, etc.
– Prostrate ability % ‐ secretions
& lubrications, BPH, oligo
t t
• Note the –
– Penile length
prostrate
– Infections – Gonorrhea, HIV, or
any STD
g
– Penile Erection score – PES
– Penile Rigidity score – PRS
– Semen Ejaculation score – SES
– Hormones deficiency / over
activity
– Medications in use
j
– Orgasm score – OS
– Androgen deficiency score =
Testosterone

Erectile dysfunction or
impotence is a sexual
dysfunction y
characterized by the
inability to develop
or maintain an
erection of the
penis.

• Ejaculatory dysfunction ‐ Premature
ejac lation is hen ejac lation occ rsejaculation is when ejaculation occurs
before the partner achieves orgasm, or a
mutually satisfactory length of time has
passed during intercourse. p g

Decreased libido
• Sexual pain disorders affect women and men Se ua pa d so de s a ect o e a d e
as dyspareunia (painful intercourse). Structural
abnormalities of the penis like Peyronie's
disease can make sexual intercourse difficult.disease can make sexual intercourse difficult.
• Orgasm disorders are persistent delays or
absence of orgasm following a normal sexual
excitement phaseexcitement phase.
• Hormone deficiency is a relatively rare cause of
erectile dysfunction.
• Individuals who take drugs to lower blood
pressure, uses antipsychotics, antidepressants,
sedatives, narcotics, antacids or alcohol cansedatives, narcotics, antacids or alcohol can
have problems with sexual function and loss of
libido.

Male Infertility
• Infertility primarily refers to the biologicalInfertility primarily refers to the biological
inability of a person to contribute
to conception.
• Infertility has increased by 4 percent since the
1980s
• About 40 percent of the issues involved with• About 40 percent of the issues involved with
infertility are due to the man
• Infertility can be caused by low sperm count y y p
due to endocrine problems, drugs, radiation, or
infection. There may be testicular
malformations hormone imbalance ormalformations, hormone imbalance, or
blockage of the man's duct system.

B i P i H hBenign Prostatic Hypertrophy
i l f h h i• BPH is enlargement of the Prostate that is
located in the pelvis and is surrounded by the
t bl dd d l d i t tirectum, bladder, dorsal and periprostatic
venous complexes, musculature of the pelvic
sidewall the urethral sphincter (responsiblesidewall, the urethral sphincter (responsible
for passive urinary control), the pelvic plexus,
and cavernous nerves (which innervate theand cavernous nerves (which innervate the
pelvic organs and corpora cavernosa).
S h t d Ch k l i d th Sth f• Sushruta and Charaka explained the Sthana of
Basti in the similar fashion.

Uttara Vasti Netra
• 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
l t G dequal to Green gram seed
– for full grown nulli paras 4 (Anguli) cms
virgins 1 (Anguli) cm [Garbhashaya sodhana should not be– virgins 1 (Anguli) cm [Garbhashaya sodhana should not be
performed in the virgins]
Ch k Siddhi 9/58 9/72 9/73 4 S t Chikit 37/101 37/103 37/104 5
Charaka Siddhi 9/58, 9/72, 9/73‐4, Susruta Chikitsa 37/101, 37/103, 37/104‐5

Medicine quantity & Target
Medicine quantity & Target

Age Vs Action
• Sukra Pravartaka (virechaka) = ( )
Abundant Ejaculatory ‐ at his 20’s
• Sukra Janaka pravartaka = Productive
& Ejaculatory efficiency at his 30’s j y y
• Sukra Janaka = semen generative
(procreative efficient) – at his 40’s
• Sukra sthambhaka = Ejaculatory• Sukra sthambhaka = Ejaculatory
preventive (sex effective) – at 50’s
• Vaji Karana = Horse powered sex
efficiency even at 50’s and 60’sefficiency even at 50 s and 60 s
• Thinking of sex with flaccid organ at
70’s  ‐ NO ACTION

P k i M PPrakrita Mutra Pramana
• The normal quantity of Mutra is 4 Anjali (Ch Sha 7)• The normal quantity of Mutra is 4 Anjali. (Ch. Sha.7)
• 1 Anjali is nearly about 4 ounces. So 4 Anjali is nearly about
16 ounces (480 ml) which clearly indicates that Acharyas16 ounces, (480 ml) which clearly indicates that Acharyas
considered 4 Anjali only because of the storage capacity of
Basti.
• In 24 hours 1500 ml of urine is excreted out which can be
considered. 1500 ml cannot be stored in bladder at normal
physiological instances.
• The urinary bladder performs the function of Dharana
(storage) and poshana (release) of urine. The example of a
''taut bow" in relation to Basti signifies the functioning of
the urinary bladder in the light of modem physiology
the urinary bladder in the light of modem physiology.

h h i hi h i ?
What happens in this technique?
Former technique followed by Ayurveda q y y
is placing the medicine in to Urinary
Bladder. It is done by a catheter and
syringe.
Present technique passes Urethra –
Prostate – seminal vesicle – vas
deferens – and Testicles.deferens and Testicles.
The whole medicine is rapidly
absorbed along with local action of
medicine.

F tifi d UV P d
Fortified UV – Procedure
Preparation p
• Patient –
– Ask the patient toAsk the patient to
evacuate bladder
• Instruments
– Feed tube size 8‐10
– 10ml syringe
– Gloves
– Penile clamp
– Clamp holder
– Antiseptic solution &Antiseptic solution &
gauze
– Medicine

F tifi d UV P d
Patra Paka
• Heat the empty vesselp y
– To make disinfection
• Pour the medicinePour the medicine
– 10‐15 ml of the
selected medicine
• Get it cooled
– To administer– To administer

F tifi d UV P d
Step 1 p
• Wear the gloves g
under aseptic –
antiseptic p
precautions
• Retract theRetract the
prepuce skin
• Expose the urethra• Expose the urethra

F tifi d UV P d
Step 2 p
• Clean the glans g
and surrounded
area witharea with
Antiseptic
l tisolution

F tifi d UV P d
Step 3 p
• Load the syringe
ith di iwith medicine
• Attach it to the
feed tubefeed tube
• Gently push the
syringe to fill thesyringe to fill the
feed tube – where
1 ‐2 drops of
di i d tmedicine drops at
the glans

F tifi d UV P d
Step 4 p
• Gently insert feed tube in
urethra
• Pass the tube about 10 cms
– till to the bladder
sphinctersphincter
• Make sure that you are not
inside the bladder
– Retract the syringe piston ‐ if
you are inside the bladder
urine come in to syringe
• If you are giving a Uttara• If you are giving a Uttara
Vasti in to Bladder – it is
confirmatory sign

F tifi d UV P d
Step 5p
• Pass the clamp around penis and lock with clamp
holder

F tifi d UV P d
Step 6 p
• Gently push the y p
medicine
C h ld b• Care should be
taken – not to
slip the tube
inserted

F tifi d UV P d
Closure
• Withdraw the tube
• Locked clamp will
remain for 45 minutes
• After 45 minutes• After 45 minutes –
– Release the lock with a
cotton padding placed
at urethra – to absorb
the withdrawals

fl i f f h iInfluencing factors of Pourusha Vasti
Physical state:
• Liquids are better absorbed than solids, and crystalloids are
b tt b b d th ll idbetter absorbed than colloids.
Particle size:
Th i l i f i l l bl d ff h i• The particle size of sparingly soluble drugs can affect their
absorption. Thus, a compound that contains large aggregates
of the active compound does not disintegrate easily even onof the active compound does not disintegrate easily even on
prolonged contact with mucosa hence, is poorly absorbed.
Small particle size is important for absorption. Thus, the
dosage of the active drug can be reduced without losing
efficacy simply by reducing the particle size.

Li id t l bilit Hi h li id l bilit f• Lipid or water solubility: High lipid solubility of
the non‐ionised drug form favours its
absorption from the gastrointestinal tract inabsorption from the gastrointestinal tract, in
the same way at the rectum and also in urinary
bladder.
• Concentration: Higher concentration favours
rapid absorption.
• Presence of other agents: Thus vitamin C (Amla
varga) enhances the absorption of iron from
h l h l h dthe gastrointestinal tract, while phytates retard
it.

• Ionization: It may be assumed for all
practical purposes that the mucosal lining of p p p g
the bladder is impermeable to the ionized
form of a weak acid or a weak base Theform of a weak acid or a weak base. The
weakly acidic and basic drugs exist in two
forms A unionized componentforms. A unionized component,
predominantly lipid soluble, absorbed
rapidly. An ionized and often water‐soluble
component absorbed poorly.

• Area of the absorbing surface and local
circulation: Drugs can be absorbed better g
from the small intestines than from the
stomach because of the larger surface areastomach because of the larger surface area
of the former. Reduction in the area of the
absorbing surface as in Uttara Vastiabsorbing surface, as in Uttara Vasti
prolongs the absorption as it retains for
more time under sphincter control.

M di i i P ti
Medicines in Practice
Vid di Gh it• Vidaryadi Ghrita –
Naik PL & KSR Prasad, MANAGEMENT OF SUKRAGATAVATA WITH VIDARIGHRITA A COMPARATIVE STUDY W.S.R TO
PREMATURE EJACULATION 2010 RUGHS B l
* = More highly significant, n=15
PREMATURE EJACULATION, 2010, RUGHS, Bangalore,

• Narayana Taila & Vidaryadi Ghrita• Narayana Taila & Vidaryadi Ghrita
Parameter Mean SD SEM
Semen count (millions/ml) B 5 7.07 5
A 22 25.45 18
Total sperm count B 12 5 17 67 12 5Total sperm count
(millions)
B 12.5 17.67 12.5
A 72 67.88 47.99
Motile Total sperm count
( illi / l)
B 2.0 2.82 2.0
(millions/ml) A 5.0 4.24 2.99
Total motile count (millions) B 5.0 7.07 5.0
A 18 8 48 5 99A 18 8.48 5.99
Motility % B 25 21.21 15
A 60 14.14 10
Study at MGACH&RC in 2012‐13 (ongoing)

Efficacy of “Bala‐ tail Utterbasti” in Oligospermia ‐AEfficacy of Bala tail Utterbasti in Oligospermia A
Clinicopathological Study.
More Sunil S. More Manjusha S
International Journal of Ayurvedic and Herbal Medicine 5:4 (2015) 1932–1940
• A open random study with 20ml Bala tailap y
administered per urethra in to Urinary
bladder once in 3 days for a month for 3bladder once in 3 days for a month for 3
consecutive months

Patil Rupesh Vilas Virechana Paschat Shatavari Ghrita UttaraPatil Rupesh Vilas. Virechana Paschat Shatavari Ghrita Uttara
Vasti in Ksheena Shukra‐ A Case Study. International Journal of
Ayurveda and Pharma Research. 2016;4(9):29‐31.
• A male patient presented with inability to beget a child due to
low sperm count (< 10 million/ml) and sperm motility (< 30%)
detected in previous two semen analyses along with reduced
sexual desire and inability to sustain erection.
S h ith Sh t i h it f ll d b Vi h ith• Snehapaana with Shatavari ghrita, followed by Virechana with
Kalyanaka gudam and later Uttara Vasti with Shatavari Ghrita
administered in 7 sittings after initial administration of 2administered in 7 sittings after initial administration of 2
Madhutailika Vasti resulted in significant increase in sperm count
(>50 millions/ ml) and motility (>50%).
• A significant improvement in sexual desire, sustained erection till
the completion of sexual act was noticed and testicular pain along
with post coital exhaustion was completely relieved.

Management of urethral sticture with uttara vastiManagement of urethral sticture with uttara vasti
Dudhamal et.al., ASL, v30, no2 (2010)pp51‐53
• A 25 year old male approached with dysuria, slow stream
of urine, incomplete emptyng of bladder leading to
fullness of bladder, increased frequency of micturition and
cystitis.
A i f 15 l Pl i Til il H 4 l S dh• Aa mixure of 15ml Plain Tila taila, Honey 4 ml, Sandhava
lavana 1gm is used for Uttaravasti in to urethra and
retained for 10 minutes (Author is not clear – whether heretained for 10 minutes (Author is not clear whether he
pushed the material in to urinary bladder or made only
retained at urethral level)
• Patient is comfortable and two more sittings were
undertaken after wards.

Rajendra H Amilkanthawar Role of uttarbasti in management ofRajendra H Amilkanthawar, Role of uttarbasti in management of
mutra marga sankoch (urethral stricture)
Indian Journal of Traditional Knowledge, Vol. 3(2), April 2004, pp. 177‐181
• Drug and their proportions
– Til Tail (Sesame oil) 100 ml Saindhav lavan (Rock salt) 04 gm Madhu– Til Tail (Sesame oil) 100 ml, Saindhav lavan (Rock salt) 04 gm, Madhu
(Honey) 20 ml
• Under all aseptic precaution glass  syringe is filled with 40 ml of medicated
oil and is taken in right hand and its nozzle is inserted gently into the
external urethral meatus and slight pressure is  applied to fix the junction.
Lukewarm medicated oil is inserted with slight pressure and slowly over a
period of 30  second. Care is taken to avoid entry of air into urethra. After
that penile clamp is applied just proximal to glans penis and patients are
kept in situ for 15 minutes. The female patient was advised not to p f p
micturate for next two hours. The procedure was repeated at the interval
of 7 days up to five times in 21 patients, seven times in 08 patients and
eleven times in only 01 patient
eleven times in only 01 patient.

Rajendra H Amilkanthawar Role of uttarbasti in management of mutraRajendra H Amilkanthawar, Role of uttarbasti in management of mutra
marga sankoch (urethral stricture) …. ctd

C l iConclusion
• It is necessary to demarcate “Pourusha Vasti”
from Mutra marga Uttara Vasti based on its g
functions
• Ayurveda Suggested 25 to 200 ml of• Ayurveda Suggested 25 to 200 ml of
medicine input for the Mutramarga Uttara
vasti
• Concentration, pH, sloubility and particle sizeConcentration, pH, sloubility and particle size
influence the action

C l iConclusion
• Pourusha Vasti is mainly indicated for BPH and
Azospermiap
• In one sitting the medicine introduced vary
from 10 40mlfrom 10 ‐40ml
• Both water and lipid soluble medicines can be
administered comfortably
• The absorption rate is higher when the• The absorption rate is higher when the
quantity is massive

THANK YOUTHANK YOU
27th November 2016
technoayurveda@gmail.com
It’s
TechnoayurvedaTechnoayurveda
Presentation
By Dr. KSR Prasad, Prof. & Head, Panchakarma,By Dr. KSR Prasad, Prof. & Head, Panchakarma,
MGACH&RC, Wardha (MS) . .
http://www.technoayurveda.com/
Dr. K. Shiva Rama Prasad, at http://technoayurveda.wordpress.com

Pourusha vasti ksr

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