Stanika chikitsa prasooti stri roga

1. Sthanika chikitsa
By
Dr Sahana G
Dept. of PTSR
SAMCH

2. Introduction
✓ The diseases of the genital tract of woman and their
treatment have been given a lot of importance in the
ancient period.
✓ The direct communication of the peritoneum to the
exterior is through the vagina.
✓ Routes of drug administration – The Topical form of
local routes is often more convenient as well as
encouraging to the patient.
✓ This particular route of administration provides
treatment in prepared form for faster action.

3. Types
✓ Yoni Dhavana
✓ Yoni Picchu
✓ Yoni Varti
✓Yoni lepana
✓ Yoni purana
✓ Yoni Dhupana
✓ Uttara Basti

4. Yoni Dhavana
Dhavana means 1] Motion, Going
2] Cleansing, Purifying
Synonyms
Yoni Seka
Achamana
Yoni Praseka
Yoni Prakshalana
Sechana
Parisechana
• This is one among 60 types of vrana chikitsa.
• Yoni prakshalana is the cleansing of yoni using required
liquid media(any kashaya).

5. Instruments
In olden days
• Bladder
• Nozzle [bamboo,metal]
Procedure of yoni dhavana
No such procedures are mentioned in the classics
so the procedures used for douching now a days
can be adopted.

6. Indications
✓ It is indicated as purva, pradhana, and paschat,
karma in all yoni rogas.
✓Vivruta yoni vyapada
✓ Yonishoola
✓ Yoni daurgandhya
✓ Yoni srava
✓ Yoni shitilata
✓ Yoni kleda
✓ Yoni kandu
✓ Yoni Paicchilya

7. ✓ Yoni arsha – as a post operative procedure for
better healing of the wound
✓ Yoni kanda
✓ Vataja artava dushti
✓ Pittaja artava dushti
✓ Kaphaja artava dushti
✓ Kunapgandhi – To remove the bad smell
✓ Upadamsha chikitsa [ all types of upadamsha] etc
✓ A special note – Use of 3 garlic clove + 3 cups of
water mixed together in a grinder and used for
vaginal infections as douches

8. Few commonly used formulations;
In pitta dosha involvement – Nalpamaradi or
panchavalkala or panchatikta kashaya is used
In kapha involvement- Aragwadadi or
Nimbadi kashaya is used
Thin discharge p/v- triphala kashaya
Sticky discharge- dashamoola or triphala
kashaya
Offensive mucopurulent discharge- candana or
lodradhi kashaya

9. Vaginal Douching
It is a procedure during which salt water or
medicated cleaning solution is used to wash
away accumulated secretions, blood or
discharges in the vagina that cause adhesions
or increase the risk of infections
Instruments
Douche set
✓ Can [metal, palstic, disposable]
✓ Rubber tube [ Catheter ]

10. Douche Can (Irrigator) 1.5 liter

11. Rubber Douche Tube

12. Douche Fitting Set

13. Douche Bag, 1 Litre

14. Indications
✓Chronic cervicitis and vaginitis.
✓ Foul discharge from decubitus ulcers in
genital prolapse.
✓ Ca of cervix, Sloughing Uterine polyps
✓ After introduction of Pessary.
✓ Pre-Operative Vaginal preparations.
✓ Post Operative Vaginal Douche.
✓ After the use of contraceptive measures.

15. Contraindications
✓ Acute genital sepsis.
✓ Pregnancy [ if douching is desirable during
pregnancy some precautions have to be taken]
✓ Menstruation

16. Types of vaginal Douch fluid
Antiseptic douch – Dettol,
Savlon,
Tincture of Iodine.
✓Vinegar or lactic acid douches – Vaginitis.
✓Alkaline Douch – Sodabicarb
✓Alum Douch
✓Salt water Douch

17. Method
In hospital practice
✓ Patient should lie on the table in lithotomy position
✓ Sterelised douch nozzle or rubber catheter is attached to
the douch can.
✓ About 2 inches portion of the nozzle or catheter is
inserted into the vagina.
✓ The douch containing fluid can be placed about 2 feet
height above the patients buttocks.
✓ Ordinarily douching for about five min is done.
✓ After withdrawal of the douch nozzle or catheter fluid
which may be retained inside the vagina should be
expelled by asking the patient to strain in sqatting position
if the condition permits/ or pt is made to cough.

18. Drawbacks
✓ Frequent douching may lead to chemical vaginitis
✓ Spread of infection into the pelvic organs.
✓ Vaginal and cervical injury.

19. Probable mode of action of Yoni Dhavana :
✓ As the name dhavana suggests cleaning it washes out
the secretions and discharges of vagina
✓ The action is mainly by the drugs used in the
preparation of the kwatha

20. Yoni-pichu
Karpasa pichuhu sidda sneha yuktaha
Apathyapathe garbhashaya mukhaparyantha sthapyate
 Vaginal tampon made of cotton or gauze soaked in
taila/grita/kshara/kashaya is termed as pichu when placed
in yoni it is called yoni pichu.
 The routinely used yoni pichu is sneha pichu.

21. Method of administration of yoni pichu
 A swab is tied in a gauze piece (tampon).
 The solution or oil is heated indirectly by keeping the
container containing oil in hot water.
 The sterile pichu is dipped in the hot oil.
 The vulva and vagina are cleaned with antiseptic
solutions.
 Then the pichu is held with a sponge holding forceps and
kept in the vagina.

22. Indications
 All yoni rogas – Mushaka taila
 Vataja yoni vyapath
 Pittaja yoni vyapath
 Sanipataja yoni vyapath
 Acharana
 Vipluta yoni vyapath
 Vamini yoni vyapath
 Paripluta yoni vyapath
 Vivruta
 Yoni Karkashata
 Yoni shoola
 Yoni paka

23.  Yoni Daha
 Yoni Kandu
 Yoni Paicchilya
 Yoni Kanda
 Ninth month of pregnancy
 Prasramsamana garbha
 Rakta gulma
 Apara sanga
 Post-operative procedure after the extraction of
Mudha garbha.
 Yoni Bhramsha in prasooti

24.  In vataja yonivyapath- guduchyadi taila pichu
followed by uttarabasti
 In pittaja yonivyapath- pichu of grita processed with
pittahara dravyas
 In picchila yoni- udumbaradi taila is advised
 In yoni srava, upapluta and pichila yoni- Dathakyadi
taila picu is advised.

25. Vaginal packing(Tamponade):
Definition-Packing the vagina with a gauze strip,
cotton-wool or similar absorbent material is
sometimes called tamponade.
• The object inserted inside being tampon.

26. Indications
✓ To stop oozing of blood at the end of an operation
on the vagina or cervix.
✓ To arrest secondary post-operative hemorrhage from
the vaginal walls and the cervix.
✓ To convey medication to the vagina and cervix.
✓ Pre-operative vaginal plugging before radical
vaginal hysterectomy.
✓ To control uterovaginal prolapse complicated by
decubital ulceration.

27. Method
✓ Bladder is evacuated
✓ Vulva, vagina are cleaned with antiseptic
solutions
✓ Posterior vaginal speculum is applied.
✓ A sterile long roller gauze soaked in acriflovine
glycerin, liquid paraffin or trisulfate cream is
taken.
✓ Tight plugging of vagina by the guaze is
performed by a sponge holding forceps.
✓ The end of the gauze on plugging is brought just
outside the vaginal introitus.

28. Peroid of pluging
✓This should not be prolonged for more than 24
hrs.
Care to be taken :
✓ Care of the bladder.
✓ Removal of the plug must be done very
gently.

29. Probable mode of action of Pichu
✓ Pichu helps the medicine to remain at the site for a
longer period for better action.
✓ It performs the action with the help of the drugs used
in the preparation of taila, Ghrita, etc.
✓ It diminishes the chances of infection in the genital
tract as taila is yoni vishodhana.
✓ It has vranaropaka properties.
✓ It softens the vagianl canal.
✓ Taila or sneha is vataghna

30. ✓ Tampon of oil used in the 9th month of pregnancy
may destroy pathogenic bacteria of the vagianl canal
and prevent puerperal sepsis.
✓ It may also soften the vaginal passage thus helps in
normal labour

31. Yoni Varti
Word meaning is wick
It is similar as vati preparation.
Vartis are elongated, having tapering ends, thick in the
middle and thin at the ends
Method of preparation of Varti:
✓ Required dravya choornas are taken.
✓ They are mixed together and triturated with the required
liquid media.
✓ Elongated tablets with thin ends are prepared
✓ These tablets are dried in the shade and used.

33. Size of varti
Pradeshini anguli tulya –size of index finger
Method of Administration
✓ The site of application as well as the ends of the varti are lubricated
with oil, Ghee, Madhu, Dugdha and varti is slowly inserted inside the
vagina.
How long can it be kept in the vagina:
Acc to caraka,
✓ It should be changed repeatedly [1 to 3 hrs ]
✓ Time period may vary depending upon the type of varti.
Paschat karma
Yoni prakshalana with sukhambu

34. Indications
✓ Kaphaja Yoni vyapada- yava churna + saidhava –
bhavana with dugdha
✓ Acharana Yoni vyapada- go-pitta or matsya pitta
✓ Karnini-varti made of shodhana dravyas
✓ Yoni Shopha
✓ Yoni Kleda varti of go or matsya pitta
✓ Yoni Kandu
✓ Yoni Piacchilya
✓ Anartava
Some herbal suppository;
Garlic suppositories – antifungal
Yougurt suppositories – yeast infections

35. Suppositories :
Are special shaped solid pharmaceutical formulations
meant for insertion into body cavities other than mouth.
Used for
✓ Soothing
✓ Lubricating
✓ Antiseptic
✓ Local anesthetics
✓ Astringents

36. Indications
✓ Vaginal infection
✓ Candida Vaginitis
✓ Atrophic Vaginitis
✓ Non-Specific Vaginitis

37. Probable mode of action of vartis
✓ Vartis are meant for shodhana karma.
✓ Vartis are hygroscopic they absorb the sravas
✓ Vartis show the action according to the drugs it contains.
Evenly distributed throughout the base
✓ Readily absorbable form
[ Melts at body temperature
Dissolves or disperses in the body cavity fluids
Should be completely non-toxic and non irritant to the
mucous membrane of the body cavity ]

38. Yoni Purana
Means filling something in the yoni
It may be Kalka, Choorna, Veshavara, Pinda etc
Indications
✓ Vataja Yoni Vyapat- himsra kalka
✓ Pittaja Yoni Vyapat-panchavalkala kalka
✓ Kaphaja Yoni Vyapat-shyamadi kalka
✓ Yoni Sparsha Asahatva and Yoni kandu
✓Yoni Daurgandhya
✓Yoni Kanda
✓Vataja Artava Dushti
✓Pittaja Artava Dushti
✓Kaphaja Artava Dushti
✓Kunapagandhi

39. Yoni Lepana
The medicine in the form of paste used for external
application are called lepas.
Synonyms : Lipta, Lepana, Alepa.
Acharya sushrutha has mentioned 3 types of lepa;
1.Pralepa- it is tanulepa- indicated in pitta twak
vikaras
2.Pradeha- thick- indicated in vataja twak rogas
3.Alepa- moderately thick-useful in raktha pitta
dosha rogas

40. Precautions to be taken while applying Lepa :
✓ Lepa should be immediately removed after drying.
✓ Lepa should not be applied at night.
Indications
✓ Vivruta
✓ Yoni Arsha etc

41. Choorna Purana:
✓ Vivruta
✓ Yoni Daurgandhya
✓ Yoni Kleda
✓ Yoni Srava
Veshavara Purana
✓ Mahayoni
✓ Prasamsrini
✓ Yoni stabadhata
✓ Yoni Karkashata
Pinda Purana
✓ Puya srava in Yoni

42. Topical drugs in modern pharmaceutics Ointments
These are soft semisolid preparations used for external
application to the skin or mucous membrane.
The absorption of medicament by the tissues depends upon
the following factors:
✓ Properties of drug incorporated
✓ Properties of the base used in the formulation
✓ Condition of the patients skin
✓ Site of application
✓ Duration of application
✓ Degree of friction exerted while applying the medicine

43. Creams
Are viscous semisolid ointment like preparations.
They may be oil in water or water in oil type.
Jellies
Are transparent or translucent, Non greasy semisolid
preparations meant for external application to the skin or
mucous membrane
They are used for medication or lubrication purpose
Indications
✓ Atrophic Vaginitis
✓ Non Specific Vaginitis etc

44. Yoni Dhupana
Dhupa –An aromatic vapour that are produced from
combustion of any fragrant gum resin
Indications
 Garbha sanga- krishna sarpa
 Apara Sanga- bhojapatra & slough of snake
 Yoni Sparsha Asahatva
 Yoni kandu- haridra and brihati patra
 Sweta pradara
 In sutika- kushta,guggulu, agaru with grita

45. Method
✓ A chair having a hole at the bottom is taken
✓ Patient is made to sit on the chair after emptying the
bladder
✓ Coal is kept below the chair
✓ Drugs used for dhupana such as agaru, guggulu etc are
sprinkled over the nirdhuma agni.
✓ The dhuma which is produced is given to the yoni

48. Probable mode of action of Dhupana
✓ The drugs used for producing dhupa such as haridra,
Guggulu,etc are disinfectant, anti microbial, antiseptic,
thus help in preventing infection.
✓ Dhupa is srotoshodhaka
✓ It is kapkaghna, Kledaghna
✓ It is also srava stambhaka

49. Absorption of drugs through the vagina:
✓ The vagina absorbs water, electrolyte, and substances of
low molecular weight.
✓ Vaginal mucosa absorbs lipophilic drugs.
✓ The vaginal wall and the tissues around are extremely
vascular.
✓ Theory of Probiotics : Probiotic supplements can help
restore a normal balance of the vaginal organisms which
could in theory reduce the chances of developing vaginal
infections. There is as yet no reliable evidence to indicate
that it really works.

50. Uttara Basti
It is given in;
 Uttara Marga(upper passage- vaginal introitus or in
urinary passage)
✓After Niruha Basti- Niruhath uttaram
✓Superior in qualities- as it does snehana like anuvasana
and shodana like niruha
✓So termed as Uttar Basti
Uttara Basti Yantra
Consists of
✓ Basti Putaka
✓ Basti Netra

51. Stages Maarga /route Pushpa
vruntha/
circimferrence
of noozzle
Nirgamana
yogya/Lumen
size
Lenghth of
insertion
Young
girl/Baala
Muthra marga Malathi pushpa
vruntha(flower
stalk of
malathi)
Sarshapa
(mustard seed)
1 angula
Adult women/
yuvathi
Muthra/
yoni marga
Size of urethtal
meatus
Index
finger(kanishta
ngula)
Mudga
mudga
2 angula
4 angula

52. Basti Netra
 It should be made of gold or silver etc
 Should be smooth, tapering like gopuccha(cow tail)
 Netra should be 10 angula in length(acc to caraka), 14
angula (acc to sushrutha).
 Lumen- should pass sarshapa beeja(mustard seed)through
it or mudga or malathi vruntha according to the marga
 Should have 2 karnikas
 Should be inserted 4 angula in birth canal and 2 angula in
urinary passage of yuvathi

53. Basti putaka :(acc to caraka)
 Can be made out of urinary bladder of animals or skin of
animals or thick cloth
Basti dravya pramana
The quantity of sneha to be given
Charaka – ½ pala
Sushruta – max - 1 prasruta
For Garbhashaya shodhana - 2 prasruta
Astanga. Hridaya – 1 shukti

54. Time of Administration
 During Arthava kala as the garbhashaya will accept
the sneha very easily and pacify vata.
 Advised to give within first 10 days of menstrual
cycle.
Method of administration
Purva karma:
✓ Shodhana with 2-3 niruha bastis
On the day of Basti administration
✓ Patient should be given Yavagu, dughdha, Ghrita etc
✓ Mala mootra visarjana
✓ Snehana nad swedana – Kati, Vankshana,Adhodhara

55. Pradhana Karma
Position :
✓ ThePatient is made to lie down on her back. Then she is
made to fold her legs so as to attain lithotomy position
[Urdhwajanyu].
✓ Then the uttar basti yantra is taken basti netra is
lubricated with sneha and carefully introduced into the
apathyapath.
✓ Basti putaka is compressed uniformly.
Dose: 3 - 4/Ahoratra consiquently for 3 days then after
giving rest for 3 days the procedure is again repeated for
another 3 days.

56. Paschata Karma
✓ Rest
✓ Head low position
✓ Stanik snehana and swedana
✓ Obsevation of basti pratyagaman kala
✓ Diet

57. Basti vyapat
General vyapatas in gudagata bastis should be considered
–Basti netra dosha,basti putaka dosha.
Signs of shock: once the medicine is abruptly introduced a
few may develop cervical excitement and features of
shock.

58. Indications
 Yoni shula
 Udavarta yonivyapath
 Rajodosha
 Asrigdhara
 Vandhyathwa
 Premature ovarian failure
 premature menopause
 Yonivyapath
 Tubal block
 Gulma
 Granthi, arbuda

59. Time for Uttarabasti
The best period is from 6th to 12th day of postmenstruation
As it will lead to well formed bija and facilitates conception
Formulations
 Bala taila in udavarthini yonivyapath
 Phalasarpi/kalyanaka grita in vandyathwa
 Khara vasti in gulma
 Satapushpa taila in ovulatory factor causing infertility
 Kshara taila in tubal block
 Varunadi grita in granthi

62. Thank you