PŪRVAKARMA

(a) Preparation of the patient

द्वित्रास्थापनशुद्धेभ्यो विदध्याद्बस्तिमुत्तरम्|| (A. H. Su. 19/70)

Uttarabasti should be administered to those who have purified by 2-3 Nirūha Basti. In usual practice Nirūha Basti given in the morning and Uttarabasti in the afternoon.

अथातुरमुपस्निग्धं स्विन्नं प्रशिथिलाशयम् ||
यवागूं सघृतक्षीरां पीतवन्तं यथाबलम् | (Su. Chi. 37/8)

The patient should be given mild oleation and sudation in the lower abdomen, thighs and groins. The patient is asked to void urine and faeces and given yavāgū added with ghee and milk as much as he can drink by his strength.

(b) Time of Administration

तेन पूर्वाह्णे चोत्तरबस्तिप्रणिधानम्| (Su. Chi. 37/109, Dalhana commentary)

Uttarabasti should be administered in the morning time.

(c) Position of the Patient

ऋजोः सुखोपविष्टस्य पीठे जानुसमे मृदौ| (A. H. Su. 19/74)

सृष्टविण्मूत्रवेगस्य पीठे जानुसमे मृदौ||५३|| (Cha. Si. 9/53)

The patient who has voided the stool as well as the urine should be made to sit straight and comfortably over a knee-high and soft seat.

PRADHĀNA KARMA

हृष्टे मेढ्रे स्थिते चर्जौ शनैः स्रोतोविशुद्धये ||
सूक्ष्मां शलाकां प्रणयेत्तया शुद्धेऽनुसेवनि |
आमेहनान्तं नेत्रं च निष्कम्पं गुदवत्ततः ||
पीडितेऽन्तर्गते स्नेहे स्नेहबस्तिक्रमो हितः| (A. H. Su. 19/74-76)

His penis should be made erect. Then the thin probe should be slowly inserted into urethra to clear the channels. After thus clearing the passage, the Basti Netra should be inserted along the line of suture to the entire length of the urethral passage without shaking. The enema bag pressed just as described for rectal enema for pushing the oil into the urinary bladder. This is the ideal method of administration of male Uttarabasti.

शलाकयाऽन्विष्य गतिं यद्यप्रतिहता व्रजेत् ||
ततः शेफःप्रमाणेन पुष्पनेत्रं प्रवेशयेत् |
गुदवन्मूत्रमार्गेण प्रणयेदनु सेवनीम् ||
हिंस्यादतिगतं बस्तिमूने स्नेहो न गच्छति |
सुखं प्रपीड्य निष्कम्पं निष्कर्षेन्नेत्रमेव च || (Cha. Si. 9/54-56)

In the erected phallus of the patient, the passage of urethra should be determined with the help of a ghee smeared probe. If the probe passes  through the urethra without any difficulty then the Netra should be inserted up to the length of phallus following the direction of perineal suture in the manner prescribed for the insertion of Netra in the Guda.

If the Netra is inserted beyond the prescribed limit, then it will cause injury to the bladder. If it is inserted less than that limit, then the unctuous recipe will not enter the bladder.

Gentle pressure should be applied over the Basti Puṭaka without shaking it. Thereafter the netra should be withdrawn.

PAŚCĀT KARMA

प्रत्यागते द्वितीयं च तृतीयं च प्रदापयेत्| (Cha. Si. 9/57)

ततः प्रत्यागतस्नेहमपराह्णे विचक्षणः |
भोजयेत् पयसा मात्रां यूषेणाथ रसेन वा || (Su. Chi. 37/113)

बस्तीननेन विधिना दद्यात्त्रींश्चतुरोऽपि वा||७६||
अनुवासनवच्छेषं सर्वमेवास्य चिन्तयेत् | (A. H. Su. 19/76)

After the medicine has come out, 2 – 4 Bastis should be administered in this manner . In the evening, after the oil has come out, the wise physician should ask the patient to take food in limited quantity along with milk, soup of pulses or soup of meat.

After the withdrawal of given drug, follow the postoperative regimen as that of Sneha Basti. Management of the complications is also similar to that of Sneha Basti.

PŪRVAKARMA

(a) Preparation of patient

द्वित्रास्थापनशुद्धेभ्यो विदध्याद्बस्तिमुत्तरम्|| (A. H. Su. 19/70)

Uttarabasti should be administered to those who have purified by 2-3 Nirūha Basti. In usual practice Nirūha Basti given in the morning and Uttara Basti in the afternoon.

अथातुरमुपस्निग्धं स्विन्नं प्रशिथिलाशयम् ||
यवागूं सघृतक्षीरां पीतवन्तं यथाबलम् | (Su. Chi. 37/8)

The patient should be given mild oleation and sudation in the lower abdomen, thighs and groins. The patient is asked to void urine and faeces and given Yavāgū added with ghee and milk as much as he can drink by his strength.

(b) Time of Administration

तेन पूर्वाह्णे चोत्तरबस्तिप्रणिधानम्| (Su. Chi. 37/109, Dalhana commentary)

Uttarabasti should be administered in the morning time.

स्त्रीणामार्तवकाले तु योनिर्गृह्णात्यपावृतेः ||
विदधीत तदा तस्मादनृतावपि चात्यते |
योनिविभ्रंशशूलेषु योनिव्यापद्यसृग्दरे || (A. H. Su. 19/77-78)

For women, Uttarabasti should be administered during Ṛtukāla in which the Yoni or Garbhāśaya is without its closure (in other words, it is open) and thus can retain the drug. However, it can be administered even apart from the Ṛtukāla in emergency and in conditions like yoni Vibhraṃśa, Yoni Śūla, Yoni Vyāpat, Asṛgdara.

स्त्रीणामार्तवकाले तु प्रतिकर्म तदाचरेत् |
गर्भासना सुखं स्नेहं तदाऽऽदत्ते ह्यपावृता ||
गर्भं योनिस्तदा शीघ्रं जिते गृह्णाति मारुते | (Cha. Si. 9/62)

The uterus remains open during the Ṛtukāla and thus readily receives the Sneha Dravya given in the form of Uttarabasti. This therapy subdues the Vāta as a result of which the uterus become capable of conception.

(c) Position of the patient

उत्तानायाःशयानायाःसम्यक्सङ्कोच्यसक्थिनी|
ऊर्ध्वजान्वा | (A. H. Su. 19/70)

The Patient should be made to lie down in supine position with the legs folded at the knees and kept erect.

PRADHĀNA KARMA

अथास्याः प्रणयेन्नेत्रमनुवंशगतं सुखम्| || (Cha. Si. 9/68)

सम्यक् प्रपीडयेद्योनिं दद्यात् सुमृदुपीडितम् | | (Su. Chi. 37/115)

ऊर्ध्वजान्वास्त्रिचतुरानहोरात्रेण योजयेत् ||
बस्तींस्त्रिरात्रमेवं च स्नेहमात्रां विवर्द्धयन् |
त्र्यहमेव च विश्रभ्य प्रणिदध्यात्पुनस्त्र्यहम् || (A. H. Su. 19/81-82)

Basti Netra should be inserted comfortably in the direction of the vertebral column. Medicine should be administered into the yoni by gently pressing the Puṭaka. It may be given 3-4 times in a day and night. In this way it should be continued for 3 consecutive days with increasing the quantity of Sneha. After a gap of 3 days it should be administered again for another 3 days.

PAŚCĀT KARMA

प्रत्यागते द्वितीयं च तृतीयं च प्रदापयेत्| (Cha. Si. 9/57)

ततः प्रत्यागतस्नेहमपराह्णे विचक्षणः |
भोजयेत् पयसा मात्रां यूषेणाथ रसेन वा || (Su. Chi. 37/113)

बस्तीननेन विधिना दद्यात्त्रींश्चतुरोऽपि वा||७६||
अनुवासनवच्छेषं सर्वमेवास्य चिन्तयेत् | (A. H. Su. 19/76)

After the medicine has come out, 2 – 4 Bastis should be administered in this manner . In the evening, after the oil has come out, the wise physician should ask the patient to take food in limited quantity along with milk, soup of pulses or soup of meat.

After the withdrawal of given drug, follow the postoperative regimen as that of Sneha Basti. Management of the complications is also similar to that of Sneha Basti.

Basti Pratyāgamana Kāla

बस्तिर्मात्राशतादूर्ध्वं प्रत्यागच्छति, अनागच्छति वर्तिं पायौ नाले प्रदापयेत् इति

(Su. Chi. 37/117, Dalhana commentary)

The Pratyāgamana Kāla for Uttarabasti Dravya is 100 Mātra. In the absence of Uttarabasti Dravya Pratyāgamana one may wait and neglect. If it is Upadravakāri it has to be expelled using Tīkṣṇa Uttarabasti/ Niruha Basti /Varti Prayoga. 

Chikitsa for Apratyāgamana of basti dravya

• If Uttarabasti is not returned, another Basti prepared with Kaṣāya of Śodhana Dravya is used in  the dose of 1 and 2 Prasṛtain Mūtra and Yoni Mārga respectively
• Śodhana Dravya siddha Phala Varti.
• Probe is inserted in Mūtramārga and abdomen is pressed forcefully below the umbilicus.
• Varti of size of Mudga, Ela, Sarṣapa should be prepared by triturating Āragvadha Patra with Nirguṇḍī Patra Svarasa, Gomūtra and Saindhava and dried in shade. This Varti is smeared with Ghee and inserted into Mutramārga with the help of Śalāka.
• Sthūla Varti of 4 Aṅgula prepared out of above said drugs is placed in Yonimārga to achieve the returning of Sneha.

In case of Dāha : 

शर्करामधुमिश्रेण शीतेन मधुकाम्बुना ||
दह्यमाने तदा बस्तौ दद्याद्बस्तिं विचक्षणः |
क्षीरवृक्षकषायेण पयसा शीतलेन च || (Su. Chi. 37/123-124)

If there is feeling of burning sensation in the urinary bladder of the patient, then the intelligent physician should administer a urethral enema containing

• Śarkarā + Madhu mixed in Śīta Kaṣāya of Yaṣṭi Madhu 
• Kṣīrīvṛkṣa Śīta Kaṣāya + Kṣīra for Basti