Endometriosis and ayurveda: Exploring alternative health solutions to a common pregnancy-related disorder. /mode of action of uttara vasthy in endometriosis
Endometriosis is the abnormal growth of endometrial cells outside the uterus. Endometriosis is a complex and painful disease that affects women in their reproductive years.
In endometriosis, endometrial tissue is found outside the uterus and in these areas, the endometrial tissue develops into what are called growths, implants, nodules
Endometrial growths are usually benign and they are normal tissues growing outside the uterus from their normal location Like how the lining of uterus responds to the hormonal changes during menstrual cycles, these endometrial growth too responds to the female reproductive hormones
When they build up each month, they shred as tissues and cause bleeding, a common problem in endometriosis which affects pregnancy outcomes.
Unlike the lining of the uterus ,these growths has no way to leave the body and thus they result in internal bleeding inflammation etc
Other than leading to complications like infertility ,they also can cause rupture of these growths and can be spreading in nature
Treatments proposed for endometriosis
Endometriosis is a condition which involves tridoshas though the proportion may vary from individual to individual
But vata is the pronominal dosha involved in many ways according to our ancient literatures, often exacerbating health problems like stress and PCOS.
Like The pain which is caused by vata can be a significant problem in diseases such as endometriosis. and the involved site is apana vata which involves the downward movement of the menstrual flow and also the displacement of endometrial cells from the original location in the uterus to outside the uterus which is also one of the nature of vata.
Most of the ayurvedic treatment aims at bringing vata under control or clearing the pathway of blocked vata which is nothing but vatanulomana
Since all the symptoms in endometriosis includes the vitiated vata lakshanas like pain ,movement of blood in opposite direction and blockage of menstrual blood , the treatment procedures aims at removing the blockage of the channel of vata so that it could perform its normal functions.
Uthara vasthi:
Uttaravasthy is different from other vasthy in which the medicines is administered through the vaginal route
Among the three types of Basti, Uttar Basti has some special quality, so it is nominated as "Uttar" i.e. "Shrestha". The Basti which is given in Uttar Marga (i.e. in urinary or vaginal passage) than usual Adho Marga (i.e. Administration of Uttar Basti (in anal passage) is termed as a panchakarma procedure for addressing certain health disorders.
Indications of uttaravasthy
Uttarbasti is indicated in Yoni Roga, Vandhyatva (infertility), Yoni Vibransha (prolapsed of uterus), Mutraghata, Mutrakruccha, Garbhashya Roga, Asrugdar (dysfunctional uterine bleeding), Yoni Shula and Artava Vikara
Ideal time of uttara vasthy
Ideal time for the administration of Uttar Basti is Rutu Kala (after completion of menstrual bleeding), because at that time the uterus and vagina are devoid of covering and their orifices are open, thus receives Sneha easily.
Components of uttaravasthy yantra /instrument
Uttar Basti Yantra consists of two parts-
Bastiputaka and Bastinetra (Pushpanetra) which can be 10 angula in measurements .
Bastiputaka should be soft and light
Now a day a 5 ml disposable syringe without needle and a uterine canula of a steel material is used.
Sneha(medicated oil) is used in panchakarma as a treatment for various health disorders. or Kwatha(medicated decoction ) may be used for the Uttar Basti. Sneha is considered more useful in most of the diseases of Garbhashaya.
Before the administration of Uttar Basti, previous infections should be cleared thoroughly to prevent health complications during pregnancy. After this two to three Asthapana Basti (decoction enema for cleansing purpose) should be given to the patient. The woman should be placed in supine position with flexed thighs and elevated knees. After that the Pushpanetra should be inserted in vaginal passage slowly with steady hand, following the direction of the passage. Then drug should be administered by pressing the Bastiputaka with constant pressure
Uttar Basti procedure should be carried out by an expert, under all aseptic precautions and sterilized medicine is used, so there are no chances of introducing any kind of infection.
Step by step procedures for uttaravasthy
The patient selected for Uttar Basti proceeds for the following procedures.
1) Evacuation of the bladder & bowels
3) Sweden(fomentation ) : After Abhyanga, Swedana was given to same parts for about 15 minutes with hot water bag.
4) Patient was placed in lithotomy position.
5) Routine P/V examination was performed in order to assess the size, shape, position of uterus.
6) Sims speculum and anterior vaginal wall retractor were inserted in order to visualise the cervix, a procedure important for diagnosing problems like PCOS.
7) Allis forceps was applied to the anterior lip of the cervix.
8) The vaginal canal, external os and fornices were swabbed with the antiseptic solution.
9) With the help of uterine sound, the length and position of the uterus was assessed, determining whether the os was open or not, crucial for diagnosing pregnancy-related disorders.
10) The os is dilated gradually with lubricated Hegar's dilators enough to admit the uterine canula easily, essential for addressing health issues related to pregnancy.
11) Then the uterine canula was entered in direction of uterus and pushed up to internal os. Then the Basti Dravya (Sneha / Kwatha) was injected drop by drop with syringe from other side of canula.
12) At the same time of injecting the medicine into uterus patient was kept in head low position.
13) It is important to watch and observe that the Basti Dravya was expelled out properly or not and then a sterilized gauze piece was kept into the vagina.
14) All instruments were removed slowly and Pulse and Blood pressure recorded for two hours.
Mode of action of uttaravasthy
Effect of Uttar Basti will depend on various points like method, instrument and drug used etc. If the medicine is put in cervical canal it may act more on the cervical factors. For factors like cervical stenosis, a katu ushana taila(hot potencied) may be recommended, especially in disorders affecting pregnancy. based medication can be more useful, while for increasing secretion of mucus from cervical glands, a nutritive and Madhur-shita ghrita(nourishing oil) based medicine will be more efficacious. In the same way, the drug selection for ovulatory and tubal factor will be totally different from each other, important in treating health issues related to PCOS. On ovary the effect of drug will be after absorption and then by promoting the Hypothalamic – Pitutary–Ovarian axis. While in tubal block Uttar Basti acts locally. In ovulation, a drug with snehan (lubricating ) property can be good while for the tubal block a drug with Lekhana karma (scraping ) will be better. Uttar Basti may also stimulate certain receptors in the endometrium leading to correction of all the physiological processes of reproductive system. Intravaginal Uttar Basti may also facilitate the absorption of drug as posterior fornix has a very rich blood supply, and it may also act as a reservoir of drug, beneficial for pregnant patients.