Module on ‘Areas of Research in Uttarabasti and Pharmacological aspects of Uttarabasti’ By- Dr. Anuradha Roy

 

“AREAS OF RESEARCH IN UTTARABASTI”

Dr. Anuradha Roy, Department of Prasuti Tantra, Faculty of Ayurveda, IMS; BHU, Varanasi.

Uttarabasti (intra-uterine insufflations of medicine) is one of the most important procedures which are kept under sthanika chikitsa (local therapies) in Ayurveda. In today’s per view when we talk about wide practice of uttarabasti (UB) it needs to be standardized in terms of drug, procedure and instruments. Therefore this lecture (Part 1&2) is dedicated particularly to the various aspects of research area in uttarabasti.

Uttarabasti is a procedure where medicated ghreeta or taila (oil) is instilled into the uterus through vagina and cervix in a measured dose and specific time of the menstrual cycle to get a target organ result. The procedure is beneficial in various yonivyapadas (gynaecological disorders), thus has a great significance. In this the content coverage will be- concept of uttarabasti, areas of research, pharmacological study, validation of research and ended with summary.

“Uttaramaargadiyamaanatayaa…” (CS.Si 9/50 Ck)

“Saa niruhaat…” (AS.Su.28/9). Uttarabasti as it is given in uttara (upper) passage i.e yoni (vaginal) and mutra (urinary) marga than the usual guda marga (anal passage), also it is used after niruha basti and is superior in qualities thus is termed as uttarabasti.  Uttarabasti yantra used for injecting the drug to be considered as anuvasana basti like or niruha basti like. There are two parts of uttarabasti yantra– Dravya grahanaartha bastiputaka (bag for holding the drug) and Aushadhi praveshaartha bastinetra (nozzle for injecting the drug). There are many benefits of its use as due to suppression/ normalization of vayu, the yoni retains garbha (fetus) quickly and thus the woman able to conceive early, it is beneficial in the diseases of urinary bladder, utero-vaginal prolapsed, severe vaginal pain, menorrhagia, oligo or hypomenorrhoea, dysmenorrhoea and other gynaecological disorders. Dose of uttarabasti is One Prashrita, depends on strength of disease or patient, in sodhana it should be double.

“….deyama pramanam paramam budhivikalpitam.

    garbhashaya visudhyarthe snehena dwigunena tu.”

(SS.Ci37/116)

When practically used 3-5ml of drug is used per procedure. Now as there we can see the discrepancy in the doses, we can research on standardizing doses on the basis of Prakriti/ Dosha predominance in a Vyadhi /Dimension of Uterus/ Purpose of UB. Uttarabasti is administered after giving two or three asthapana basti for sodhana, and should be given during artavakala or ritukaala as during this period the yoni or the garbhashaya remains clear from avarana. Also yonimukha is open. Thus accept the sneha properly (CS.Si 9/62). It is administered post menstruation-

On day 5^th -6^th -7^th in each cycle x 3cycles.

Or with a gap of 3 days repeat for another 3 days.

Research hick here is purpose wise standardizing the time of UB administration. Now when we see the purpose of administering UB it comes under three main heading as sodhana, tarpana and lekhana.

Research spheres may be categorized as Procedure standardization (skill development), Drug standardization (various modifications) and Technology standardization (innovation, basic science research).

Procedure standardization

• Pre- Operative procedures.
• Place of UB administration.
• Required instruments & its Sterilization
• Day of UB administration.
• Route of administration.
• Position of drug administration.
• Amount of drug administration.
• Post- Procedure activities, position & time
• Post procedure effect and its management.
• Complications and its management.

 

Drug standardization

• State of drug- warm/cold/normal temp.
• Advance Drug Delivery System.

– Liposomal Drug Delivery.

– Nano Technology

– Sustained Release.

In a study on sneha kalpana (paka) vis-à-vis liposome (Singh N, Chaudhary A. A comparative review study of Sneha Kalpana (Paka) vis-a-vis liposome. Ayu. 2011;32(1):103-108. doi:10.4103/0974-8520.85740). Liposomal system of drug delivery is a new invention in conventional system of medicine. This system is also covering a high degree of objective of therapeutics at different targets successfully. Liposome is one such advanced dosage form in which nana particles comprising lipid bi-layer membranes surrounding an aqueous interior are formed. The amphiphilic molecules used for the preparation of these compounds have similarities with biological membranes and have been used for improving the efficacy and safety of different drugs. In this dosage form, the active compound can be located either in the aqueous spaces, if it is water soluble, or in lipid membrane, if it is lipid soluble.     In case of liposomal drug delivery system, tremendous amount of work has been done to formulate these drugs in sustained and controlled released dosage forms for oral and parenteral administration. This is to pursue optimal drug action, functional molecules could be transported by a carrier to the site of action and released to perform their task, for which the carrier itself should be nontoxic, biodegradable and of suitable shape and size to accommodate wide variety of substances and liposomes that are fulfilling all these parameters. Therefore, liposomes have been widely evaluated for controlled and targeted drug delivery for treatment of cancer, viral infections and other microbial diseases. Liposomes are found to be suitable for localization of topically applied drugs at or near the site of application, due to the fact that they may act as slow releasing vehicles. Thus it may be assumed that Sneha paka may have the same structure and functions as that of liposome, or in other words, liposomes are modified /developed form of the traditional Sneha.

Technology standardization

• Ultrasound guided UB.
• Contribution in Artificial Reproductive Technique (ART).
• Instruments used for UB.

Hysteroscopically visualization may be considered as YONI-VRANEKSHANA YANTRA and YONI-VRANA PRAKSHALANA –ABHYANGA YANTRA. There are various studies which conclude that pregnancy is not related to endometrial thickness and endometrial volume but significantly related to endometrial movements associated with the number of contraction, strong movement, cervico fundal direction, and hyperechoic change. Therefore we can infer indirectly and go for research with UB on such scientific parameters where we may be able to justify our findings of being UB playing miraculous result in idiopathic infertility and early conception. Thus UB may have its contribution in ART especially in enhancing endometrial thickness and priming up the endometrium before ART.

Instruments and equipments used for drug administration are (Intra Uterine Insemination) IUI canula, Infant feeding tube, and catheter. UB bag as per classics should be soft and light (AS.Su28/65). Dimentions of bastinetra or nozzle is “Pushpanetram tu hemama….gopuccha samsthitam….sarshapa chiddram.” (CS.Si.9/51)

Circumference of pushpanetra (nozzle) and karnika (ring) are mentioned as per the age and passage for both yonimarga and mutramarga. There are many dosha under basti data (person delivering the drug), basti netra (nozzle) and basti putaka (bag holding the drug). In basti data doshas like Savaata, Atidruta, Utkshipta, Tiryaka, Kampita, Ati, Manda etc. under basti netra dosha Harshwa,Dirgha, Tanu, Sthula, JeernaShithila bandhana, Parshwa Chidra, Vakra etc comes and under bastiputaka dosha Vishama, Mamsala, Chinna, Sthula, Vatala, Snigdha, Klinna etc are included. There is an instrument named SPIRIT an intrauterine insemination device for women, this device minimizes human skill error factors in the procedure and standardize it. So the research point here in terms of UB is whether any such instrument be innovated which may ease the procedure and minimize the human error. It will be mechanically operated device. Use of electrical components is more environment friendly. Also It can be set at three different speeds and used for research purposes to determine the most optimum speed as per the indication used. It may combine a precision grip and a force grip.

Coming to the pharmacological study-

The living body is a biological apparatus of spectacular capabilities, particularly in the context of drug-cell interaction. When any drug is applied through a suitable and appropriate therapeutic route, it interacts with its target cell to produce the desired action. The discipline of pharmacology attempts to elucidate the intricate mechanism that underlies the causes and effect of this interaction. Here is a study conducted in IPGT & RA, GAU, Jamnagar of two formulations– Dashamoola Taila and Vijayadi Vati and two suitable controls – Tila Taila and tepid water, were evaluated for their comparative efficacy in experimental models representing different aspects of the disease Kashtartava to provide a scientific basis to their therapeutic application. The main aim of the pharmacological study is to provide experimental basis to the therapeutic activity of the drug. The test drugs were evaluated for the following activities:

• Oestrogenic activity
• Antispasmodic activity in the uterus.

MATERIALS AND METHODS

 The Test Drugs

1. Dashamoola Taila
2. Vijayadi Vati

 

Ingredients	Scientific Name/Family	Part used
Vijaya (Bhanga)	Cannabis sativa/Cannabinaceae	Leaves
Rakta Kamal	Nelumbo nucifera Gaertn. Nilumbium speciosum Willd. /Nymphaceae	Root
Apamarga	Achyranthus aspera Linn. Amaranthus spinosus Linn. /Amaranthaceae	Root
Kumari (Aloe)	Aloe vera Aloe barbadensis /Liliaceae	Aloea

 The Control Group

1. Tila Taila
2. Tepid water

 Dose Selection

1. Dashamoola Taila for Uttarabasti as 5 ml/day considering the adult human dose, the dose for experimental study was calculated by converting the human dose to animal dose based on the body surface area ratio.
2. For Vijayadi Vati, the classics have described the dose as 2 Rati twice a day.

 Dose Calculation

 For Rat

Uttarbasti: For Uttarbasti group dose was fixed as 0.1 ml/day irrespective of the body weight of rat.

Oral Group: Dose fixed as – 50 mg/kg body weight of rat.

  Route of Drug Administration

In Uttarbasti group, Dashamoola Taila and Tila Taila are administered through vagina by a specially prepared tuberculin syringe attached to a micro cannula.

In oral group, Vijayadi Vati and tepid water are administered according to the body weight of the animals by oral route with the help of gastric catheter.

 The Animal

Animal Selection- Female Charles Foster strain albino rats weighing 120 – 200 g and Swiss albino mice of both sex weighing between were used for the experiments

EXPERIMENTS

• Oestrogenic activity

-Evaluation of effect on Oestrous cycle

-Evaluation of Histopathological changes in uterus and ovary

-Vaginal Opening

Oestrous Cycle Evaluation– Smear evaluations were performed daily prior to drug administration until three cycles of each five days (total 15 days) was completed to exhibit at least 3 normal ovulatory cycles. Then the test drugs were administered for 15 days to each group and vaginal smears were taken daily.

Histo-pathological Changes – Young female rats weighing 180 – 200 g were taken in two groups, the drugs were administered for 5 consecutive days through a gastric catheter and the vaginal smears of each rat in all the groups were taken to identify the oestrus phase. On 5^th day, one hour after the drug administration, the rats were sacrificed and organs -uterus, ovary were dissected out carefully and transferred to10 percent formalin solution.

There is ample of evidence to suggest that oestrogen stimulates the growth and development of uterine tissue including myometrium. Histological study was undertaken to note the changes brought about in cytoarchitecture of the above tissues due to hormonal activities.

Vaginal Opening

Immature healthy female Charles Foster albino rats of 20–22 days old with 28-35 g weight were grouped into two, of six each as per standard protocol. They were maintained under hygienic husbandry condition and standard laboratory diet. All the drugs were fed through oral intubation for 5 consecutive days. Every day vaginal opening was checked in both the groups.

The vaginal opening is observed as three stages in normal rat at maturation i.e.

• Completely closed
• Formation of indentation
• Completely opened

The complete opening is reckoned as qualitative test for oestrogenic activity.

Antispasmodic Effect on Isolated Uterus

The young female rats, which were brought to oestrous stage by administering ethynyl-oestradiol for three days before experiment were used. After sacrificing the rat on 4^th day, the bicornuate uterus was identified, removed by cutting at base of body and kept in a petridish containing oxygenated physiological salt solution (PSS – Dejalon’s). Next the tissue is set up for experiment of isolated tissue studies by standard procedure. Single horn of the uterus was mounted in the isolated organ bath containing oxygenated Dejalon’s solution. Uterine contractile responses to drug were recorded with the help of isotonic liver system (1:10 magnification with 500 mg tension) on smoked drum attached to kymographic recording set up. The tissue was allowed 30 minutes rest for stabilization with periodical changes in bathing fluid before recording drug responses. Initially dose response curves with oxytocin were elicited to select dose producing sub-maximal effect. Then effect of different test drugs and their effect on the responses induced by oxytocin were recorded.

Effect of test drug on histology of uterus and ovary.

Microscopic examination of different tissues obtained during the experiment presented the following profile

Uterus 

The sections of the uterus obtained from control group rats showed normal cytoarchitecture with enlarged uterine cavity and normal epithelium proliferation and differentiation of different layers in the uterine wall with number of glands in the sub-mucosal layer. In Vijayadi vati administered group normal cytoarchitecture was observed in some rats and increased size and epithelial proliferation was observed in some rats.

Ovary

Microscopic examination of sections of ovary obtained from control group rats showed normal cytoarchitecture with ovary showing Graffian follicles in different stages of development. In Vijayadi vati and Uttarbasti administered groups normal cytoarchitecture was observed in some rats and increased size along with increased number of graffian follicles in different stages of development was observed in some rats.

Effect on vaginal opening in immature rats

In both test group and control group no rat could exhibit vaginal opening.

Anti-Spasmodic Effect Evaluation in Isolated Uterus

Both Vijayadi vati (up to the dose of 5mg/ml of the bath fluid) and Dashamoola tail (up to 0.2 ml of 1:100 dilution/40 ml bath fluid) did not produce any effect per se. Further Vijayadi vati did not affect oxytocin-induced contraction while in the presence of Dashmoola the onset of contraction was delayed but it did not affect the maximum response obtained with oxytocin.

Summary– to conclude the lecture on areas of research on uttarabasti it is very important to note that it is always a team work of consulting doctor, the basic scientists, the IT personals and the marketing experts in carrying forward any research work with its implementations.

In coming future it is expected to practice uttarabasti with more sophistication and we can carry forward the scientific validation of our old glory of sthanika chikitsa in terms of uttarabasti in various yonivyapadas and also as a supplementation to modern world of Artificial Reproductive Technique.

UTTARABASTI (MCQs)

1.   What is the best period for use of Uttarabasti in woman.

a)  Artavakaala

b)  Rituvyatheetakaala

c)  Rajonivrittikaala

d)  Anytime

 

2.   According to Sushruta, what should be the amount of kwatha for Uttarabasti in Stree.

a)  1 prasruta

b)  2 prasruta

c)  1 prakunch

d)  2 prakunch

3.   Uttarabasti is beneficial in

a)  Shonita dushti

b)  Mootraghata

c)  Yonivyapada

d)  All the above

 

4.   According to Sushruta, what should be the matra of Sneha in Uttarabasti for stree.

a)  Ardhaprasruta

b)  Eka prasruta

c)  Adhyardhaprasruta

d)  2 prasruta

 

5.   What should be the length of pushpanetra to be inserted through apatyamarga in Stree.

a)  2 angula

b)  4 angula

c)  6 angula

d)  8 angula

 

6.   Which of the following is true regarding insertion of pushpanetra through the urinary passage.

a)  It is not given in Balika

b)  1 angula of pushpanetra is inserted in Balika

c)  3 angula of pushpanetra is inserted in Stree

d)  Size of lumen of pushpanetra in Balika is of mudga seed.

 

7.   What should be the length of pushpanetra for Stree to administer Uttarabasti.

a)  6 angula

b)  8 angula

c)  10 angula

d)  12 angula

 

8.   What should be the size of lumen of pushpanetra in Stree for Uttarabasti through vaginal passage.

a)  Siddharthakapraveshagram

b)  Mudgavahi

c)  Sarshapanirgamam

d)  Both a and c

 

9.   Pushpanetra should be made with which of the following metal.

a)  Swarna

b)  Rajata

c)  Reeti

d)  All the above

 

10.  What should be the circumference of the pushpanetra for Balika to administer Uttarabasti through urinary passage.

a)  Mootrasrotaparinaha

b)  Kanishtikasthoolam

c)  Malateepushpavrintaagram

d)  None of the above

  

KEY to the MCQs

1.	A	(Ca.Si.9/62)
2.	B	(Su.Ci.37/116)
3.	D	(Su.Ci.37/126)
4.	B	(Su.Ci.37/106)
5.	A	(Su.Ci.37/105)
6.	B	(Ca.Si.9/67)
7.	C	(Ca.Si.9/65)
8.	B	(Su.Ci.37/103)
9.	D	(A.H.Su.19/9)
10	C	(Su.Ci.37/101)

 

UTTARABASTI (Supplementary resources)

 

1. Yadavaji Trikamaji (editor). Charaka Samhitā of Agnivesha with ‘Ayurveda-Dipikā’ commentary by Chakrapānidatta, Siddhisāsthāna, chapter 9. Reprint edition, Varanasi: Chaukhamba Surbharati Prakashan;2000.
2. Yadavaji Trikamaji & Narayan Ram (editor). Sushruta Samhitā of Sushruta with ‘Nibandhasangraha’ commentary by Dalhana. Chikitsasthana, chapter 37. Reprint edition, Varanasi: Chaukhamba Surbharati Prakashan;2003.
3. Shivprasad Sharma (editor). Ashtānga Samgraha of Vriddha Vāgbhata with ‘Shashilekhā’ commentary by Indu. Sutrasthana, chapter 28. 1^st edition, Varanasi: Chowkhamba Sanskrit Series Office; 2006.
4. Harishastri Paradakara (editor). Ashtānga Hridayam of Vāgbhata with commentaries ‘Sarvāngasundarā’ of Arunadatta & ‘Ayurvedarasāyana’ of Hemādri. Sutrasthana, chapter 19. 9^th edition, Varanasi: Chaukhamba Orientalia; 2005.
5. Deshmukh Sushilkumar & Deshmukh Pranita Joshi : SOP For Uttarbasti i.e. Uterine Detox Therapy of Ayurveda w.s.r to Infertility with Implantation Defects. International Ayurvedic Medical Journal, 2016;4(3);548-52. Available from https://www.researchgate.net/profile/Sushilkumar_Deshmukh2/publication/309609101_SOP_FOR_UTTARBASTI_IE_UTERINE_DETOX_THERAPY_OF_AYURVEDA_WSR_TO_INFERTILITY_WITH_IMPLANTATION_DEFECTS/links/5819837808ae1f34d24ad015.pdf
6. 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. https://www.researchgate.net/profile/Achala_Kumawat/publication/342657963_Classical_and_Contemporary_Approach_to_Uttarbasti_A_Review/links/5efefa9c458515505087a233/Classical-and-Contemporary-Approach-to-Uttarbasti-A-Review.pdf
7. Gujarathi, Jasmine & Gujarathi, Ritesh. (2016). Uttarbasti in the management of female infertility w.s.r. to anvoulation -Case Series. Journal of Ayurveda and Holistic Medicine. 4. 88-92.
8. Trivedi, Mansi. (January 2015). The globalization of medicine: A look at Ayurveda’s increasing prescence in biomedicine(Honors Thesis, East Carolina University). Retrieved from the Scholarship. (http://hdl.handle.net/10342/4778.)
9. Shukla Upadhyay K, Karunagoda K, Sata N, Dei LP. Effect of Kumari Taila Uttar Basti on fallopian tube blockage. Ayu. 2010;31(4):424-429. doi:10.4103/0974-8520.82031
10. Baria HP, Donga SB, Dei L. Efficacy of Yavakshara Taila Uttarabasti in the management of fallopian tube blockage. Ayu. 2015;36(1):29-33. doi:10.4103/0974-8520.169016
11. Verma, A., Dhiman, K., & Kumar, S. (2018, September 29). Ayurveda treatment protocol in the management of Multifactorial Female Infertility- A Rare Case Study. International Journal of AYUSH Case Reports, 2(3), 1-8. Retrieved from http://www.ijacare.in/index.php/ijacare/article/view/33
12. Pulak Kanti Kar. Mechanism of Panchakarma and its Module of Investigation. Varanasi: Chaukhambha Sanskrit Pratishthan; 2013.
13. Sharma R, Singh C. Uttar Basti- A critical review. J Ayu Herb Med 2016;2(3):86- 88
14. Kumar Pankaj, Vinitha, V., Nagar Mayur and Lohith,B A 2017. A practical approach towards Uttara basti in females. International Journal of Current Research, 9, (08), 55337-55339. https://www.journalcra.com/sites/default/files/issue-pdf/24070.pdf