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Ksr uttara-vasti


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Ksr uttara-vasti

  1. 1. Uttara Vasti in Male – A scientific approach Dr.K.Siva Rama Prasad Uttara Vasti, as Chakrapani commented “Shrestanam” 1 “Shrestagunataya” 2, which means the best and gives rise the best re- sults. The Uttara Vasti is adminis- tered through the mootra and yoni marga. These two are of uttramarga where as guda be- comes “Adhra Marga” 3. Uttara Vasti also has the Netra and Putaka. The Uttara Vasti Netra is called as “Pushpanetra” 4. The pushpa refers to the “Artava” or “Rajas” of female and to the “Sukra” of the male. Thus the treat- ment Uttara Vasti is used for the Sukra and Artava diseases justifi- able. It becomes a best treatment in the Panchakarma. The methods of administration of medicament i.e. drug evolution, drug sources and routes of drugadministration is necessary to discuss here. American Medical association (Ama) council definesDrugs as “a comprehensive, convenient and authoritative reference book that includes informa-tion on both old and new single entity drugs and mixtures”. This book of modern medicine refersCharaka and Susruta as the fathers of medicine 5. The pharmacology book refers the variousroutes of drug administrations. Out of those “Trans Urethral or Trans Uterine” routes are notmentioned. They have the rest of routes and described “Trans rectal” as only enemata, but notgiven any specified interest or identification to the Trans rectal route of administration of medi-cine.The Uttara Vasti as discussed will have an apparatus made of Uttara Vasti Netra and Putaka.These are replaced now a day with rubber catheters such as Folley’s catheter or metallic cath-eters.Uttara Vasti Netra: The types of Uttara Vasti Netra differ for male and female. The male Uttara Vasti can beadministered at any time but for female it is necessary to wait for the “Ritukala” i.e. menstruation,as the Os is open at that time. The sizes of Uttara Vasti Netra mentioned by Acharya is as under – Size of the Netra Description Male 12 cms (Anguli) resembling jasmine flower stalk, tail of the cow, hole equal to mustard seed (Charaka) 6 14 (Anguli) cms – (Susruta) 7 Female 10 cms (Anguli) comfortable size to pass the urethra, hole equal to Green gram seed 8 , 9 for full grown nulli paras 4 (Anguli) cms virgins 1 (Anguli) cm 10,11 Garbhashaya sodhana should not be performed in the virgins. 1
  2. 2. Uttara Vasti Putaka: 2. mootra Vyadhi Putaka is a sac made up of sheep, goat 3. artava Doshaor hog urinary bladder 12. If it is not available it 4. yonivyapatis better to use the skin of eagle. Now a days 5. yoni shoolafor the sterile conditions to adopt we are using 6. Rajosrava (Adhika)plastic bags. 13 7. Rajonasha 8. Akala rajopravrittiEligible:, 14,15 9. vandhya This is used for the people who have 10. garbhashaya Vyadhithe following conditions; 11. placental retentionMale: Non eligible:1. 13 varieties of mootra Dosha – Mutouksada, Prameha – as in prameha no balder is Mutra jathara, Mutra krichra, Mutrotsanga, involved and have the “Prabhuta mutrata and Mutra kshaya, Mutraateeta, Asteela, Avila mutrata” the uttra Vasti has no value in Vtavasti, Ushnavata, Vtakundalika, this disease. Raktagrandhi, Vidwighata, and Vasti Virgins – as garbhashaya shodhana Kundalika2. Mutra sharkara Administration time:3. Ashmari Male: at any time after the evacuation of the4. Vasti shoola bladder5. Vankshana shoola Female: at the time of menstruation and at any6. Shukra Dosha time in case of Asrigdhara and Yoni vyapat 16, 177. Sukraotseka Dravya:8. Dhwajabhanga9. Klaibya The quantity is differed as the size ofFemale: urinary bladder and uterus differs. No classical1. 13 varieties of mootra Dosha – Mutouksada, texts dealt this point better. But in practice it is Mutra jathara, Mutra krichra, Mutrotsanga, seen approximately 2-tola i.e. 25ml of the liquid Mutra kshaya, Mutraateeta, Asteela, is administered in to bladder and 10 to 12 ml in Vtavasti, Ushnavata, Vtakundalika, to uterus. As snehika and Nirooha are the meth- Raktagrandhi, Vidwighata, and Vasti ods used in regular Vasti of rectal root, in the Kundalika same way the difference is noticed here also. Table showing the quantities of Uttara Vasti dravya according to different Acharyas Acharya Vasti Ashaya M/F/C Quantity Equal measure in ml Charaka Sneha Mutra M ½ Pala or 2-tola 25ml Vagbhata Sneha Mutra F 1 Prakuncha 4-tola 50ml Vagbhata Sneha Mutra C 1 Sukti or ½ pala 25ml Susruta Sneha Mutra F hand full 25ml Susruta Sneha (Sodhana) Mutra F double 50ml Susruta Kwatha Mutra F 4times 100ml Susruta Kwatha Mutra M 2 times of Female 200ml Vagbhata Sneha Garbha F 1 pala 50ml Vagbhata Sneha (Sodana) Garbha F 2 Pala 100ml Vagbhata Kwatha Garbha F 2 pala 100ml Vagbhata Kwatha (Sodana) Garbha F 4 Pala 200ml The sodhana of the garbhashaya with Nirooha Uttara Vasti may disturb the internal lining and also the ovaries with huge quantities. Thus for the delivered females 2 pala and others 1 pala is administered. But if the block of the ovarian tubules is to be removed under guided supervision the higher dose is recommended. Thus the Vagbhata promoted the medium dose of 1 pala for every body. 2
  3. 3. Uttara Vasti according to Charaka consists of 2. glycosidesArdhapala Sneha i.e. 2-tola (24ml) 18. This dose 3. oils fixed and volatileis meant for the adult of the age 25 years. This 4. resinsseems to be the ultimate dose for the males. 5. oleoresins Vagbhata mentioned one Prakuncha 6. gumsSneha i.e. 1 pala (4-tola) is madhyama matra 19 7. tanninsin females for Uttara Vasti. Susruta also men- 8. antibacterial substancestioned 4-tola for females and said the dose hasto be assessed by the physician by yukti 20. Alkaloids:Other wise a hand full of the Sneha is adminis- Alkaloids are basic substances contain-tered for the females as Uttara Vasti 21. When ing cyclic nitrogen, which are insoluble in waterthe Uttara Vasti is done for the shodhana double but combine with acids to form well-defined,the quantity is used 22. If the kwatha is used for water soluble salts e.g. morphine, atropine andthe Uttara Vasti it will be double to the Sneha emetine.i.e. 2 prasruta (4-pala or 200ml) 23. Glycosides: Charaka did not mention any differences These are ether-like combinations ofin Sneha quantity for male and females. It is as sugars with other organic structures. A glyco-the same quantity of ½ pala (2-tola or 25ml). side does not form salts with acids but whenVagbhata mentioned the Uttara Vasti pediatric heated with mineral acids it is hydrolysed to adose as shukti (1/2 pala or 2-tola or 25ml) 24. sugar and a nonsugar component called agly- When the drug is discussed we have to cone or genin e.g. digoxigenin. A glycosideunderstand the method of drug administration which yields glucose on acid hydrolysis is calledand its mode of action on the area where it is a glucoside e.g. strophanthin.administered. Oils: The drugs based on the source classi- Fixed oils:fied as under – Fixed oils are glycerides of oleic, palm-Mineral: itic and stearic acids. These are fats and many Liquid paraffin, magnesium sulfate, have food value. Many fixed oils are edible andmagnesium trisilicate and kaolin. In Ayurveda are employed for cooking and as solvents, e.g.we can consider the calyxes of metals and the peanut oil, coconut oil, olive oil. Castor oil hascompounds such as siddha Makaradhwaja. certain pharmacological actions and acts as aAnimal: purgative. Insulin, thyroid extract, heparin, gona- Volatile oils:dotrophins and antitoxic sera. In Ayurveda we Volatile oils are volatilised by head anduse animal products such as laksha, kapardhika possess aromas. They are also called essen-bhasma etc. tial or flavouring oils, as aromas of plants andVegetable: flowers reside in the volatile oils present. Chemi- Morphine, digosin, quinine, atropine and cally, they are not fats and are without any ca-reserpine. Almost all the compounds we use are loric value. They contain the hydrocarbon ter-of vegetable in origin either in the form of pene or some polymer of it, which serves asKwatha or Taila. diluent or a solvent for a more active compoundSynthetic: e.g. menthol in peppermint oil. Aspirin, sulfonamides, procaine and cor- Volatile oils are used as -ticosteroids. Synthetics are not practiced in Carminatives: for expulsion of gas from theAyurveda. stomach, e.g. oil of eucalyptus, asafoetida, gin-Microorganisms: ger, Bacteria and fungi, isolated from soil are Antiseptics: in mouthwash, pastes,important sources of antibacterial substances Counterirritants e.g. oil of wintergreen, turpen-(antibiotics) e.g. penicillin and bacitracin. Micro- tine oil,organism groups also not practiced in Ayurveda. Flavouring agents e.g. oil of peppermint, andMajorities of the drugs currently used in thera- aspeutics are synthetic in allopathic medicine. Pain relieving agents e.g. oil of clove in tooth-Vegetable drugs: The pharmacologically ac- ache.tive principles in vegetable drugs are1. alkaloids, 3
  4. 4. We know the routes of administration of drugs Lipid or water solubility: High lipid solubility ofas – the non-ionised drug form favours its absorp-1. Local tion from the gastrointestinal tract, in the same2. Enemata (Trans rectal) (a) Evacuate enema way at the rectum and also in urinary bladder. (b) Retention enema Concentration: Higher concentration favours3. Oral or eternal route rapid absorption.4. Sublingual Area of the absorbing surface and local cir-5. Parental route culation: Drugs can be absorbed better from a) Inhalations the small intestines than from the stomach be- b) Injections cause of the larger surface area of the former. 1) Intra-dermal Reduction in the area of the absorbing surface, 2) Intra venous as in Uttara Vasti prolongs the absorption as it 3) Intra arterial retains for more time under sphincter control. 4) Intra thecal Physical state: Liquids are better absorbed 5) Intra peritonial than solids, and crystalloids are better absorbed 6) Intra medullary than colloids. 7) Intra articular Presence of other agents: Thus vitamin C c) Iontophoresis (Amla varga) enhances the absorption of iron d) Inunction or Intra dermal (Abhyanga) from the gastrointestinal tract, while phytates Out of the above, discussed routes of ad- retard it.ministration the Trans urethra and Trans uter- Ionization: It may be assumed for all practicaline routes are not mentioned. There is trace evi- purposes that the mucosal lining of the bladderdence that these routes are practiced in early is impermeable to the ionized form of a weakdays of Hippocrates. But recent researches over acid or a weak base. The weakly acidic andthe rectal route admit that these routes have basic drugs exist in two forms.significance of their own. The unremembered A unionized component, predominantly lipidand untouched area of the Uttara Vasti has tre- soluble, absorbed rapidly.mendous practice in Ayurveda because of its An ionized and often water-soluble componentefficacy and stand still as milestone of Ayurvedic absorbed poorly.knowledge. The unionized fraction can cross the cell The different routes have advantages and membrane that contains lipid and the amountalso disadvantages. Some of the problems in of the drug, which crosses the gut wall, is de-different routes of administrations are discussed termined by the gradient of concentration be-as under – tween the lumen of the gut and the portal venous GIT: Enzyme interaction blood. If the plasma concentration of a drug Skin: Poor absorption present in a free non-ionized form is rapidly re- Other routes: Inactivation and duced by binding with plasma proteins, the drug non-bio suitability absorption from the gut lumen is enhanced e.g. Trans rectal: the best route of drug salicylates. administration and Acidic-drugs are rapidly absorbed from accepted by Acharyas as the stomach. Basic drugs are not absorbed until half of the treatment they reach the alkaline environment of the small Trans urethral: activates and interfere intestine. The alkaline environment, in which the C ANP and CGMP major component of the drug exists in a union- for urino genital problems ized form, facilitates their absorption.Factors affecting drug absorption Formulation: Usually, substances like lactose,Particle size: The particle size of sparingly sucrose, starch and calcium phosphate or lac-soluble drugs can affect their absorption. Thus, tate are used as inert diluents in formulatinga compound that contains large aggregates of powders or tablets.the active compound does not disintegrate eas- Absorption of a drug from various mu-ily even on prolonged contact with mucosa cosae and its distribution within the cell is modi-hence, is poorly absorbed. Small particle size fied by a series of membranes. The main bar-is important for absorption. Thus, the dosage rier to the drug transport seems to reside in theof the active drug can be reduced without los- cell membrane. Studies of the permeability ofing efficacy simply by reducing the particle size. this membrane suggest that a lipid barrier is 4
  5. 5. present. Although the membrane also contains vation norepinephrine.pores, only small water-soluble molecules can Drug actionpass through them. Absorption of drugs from It can be because of –the gut occurs by -Simple diffusion: This is a Colourbi-directional process where the rate of trans- Physical massfer across a membrane is proportionate to the Smellconcentration gradient. A water soluble drug of Tastelow molecular weight such as alcohol or urea Osmosisand water (Kwatha) itself diffuse passively Adsorptionthrough aqueous pores of the membrane. Wa- Soothing demulcentter-soluble drugs with larger molecular weight Radioactivitydo not cross the membrane passively but need Radio-opacityan active transport process for absorption. Reduction in surface tensionDrugs, which are lipid soluble (Sneha), however, Electrical chargeare mostly transferred by simple or passive dif- Acidity or alkalinityfusion. Highly lipid soluble drugs can thus be Chelation (metals)absorbed by this process regardless of the pH Metabolic activityof the medium, provided the drug is able to dis- Retarding drug absorptionsolve sufficiently in the intestinal fluid and reach 1) Reduction of vascularity of absorbing surfacethe absorptive surface. 2) Reduction in the solubility of drugActive transport: This is a specialized process 3) Administration of the drug in the oily solutionrequiring energy and is independent of the Combination of drug with proteinphysical properties of the membrane. Drugs with 4) Esterification –with weak organic acids (Amlalarge molecular size need an active transport varga)system to assist their absorption. A few synthetic 5) Implantation in non-absorbable surfaces ordrugs are absorbed by active transport because slow absorbable surfacesof structural similarity to natural substance. 6) Inhibition of drug metabolism in liverDrugs related to steroids, active processes that (Bhutagnipaka) by bypassing the route or MAOare normally involved in the absorption of di- inhibitors introduction and making slow bio trans-etary and endogenous substances might ab- formationsorb glucose and aminoacids. Majorities of the 7) Slowing the renal excretion of the drugdrugs are not absorbed by active transport. 8) Increased protein binding of the drug inCarrier transport is an active transport where a plasmacarrier molecule combines with a drug to be The drug administered in the Trans urethraltransported at one membrane surface and dis- route acts -sociates from it at another surface. 1. Through nerve impulse or initiationPinocytosis: Another process which plays an 2. Reacting definitive concentrations in the cellimportant role in unicellular organisms like Poorvakarma:amoeba is pinocytosis, where the cell takes up The poorva karma is as that of Anuvasanafrom its surroundings fluid or macromolecules Vasti karma 26. Initially Sneha Sweda has to bebut not particulate matter. The importance of performed. Then the patient asked to take baththe phenomenon in multi cellular organisms, and food with milk 27. Then the patient will behowever, is doubtful. given Kangi with milk and Drugs undergo a series of factors ghee 28.such as oxidation, reduction, hydrolysis Pradhana karma:and synthesis. Out of these the process of Patient initially instructedoxidation has a mitochondrial enzyme to evacuate the bladder. Be-monoamine oxidase (MAO), which causes fore initiating the Uttaraoxidative determination. Released dopam- Vasti ask the patient to layine is recaptured via an active reuptake down and soft application ofmechanism and inactivated by MAO and Vata hara taila over theCOMT in a manner analogus to the inacti- genitalia 29. Because of this procedure the penis stiffens and easy penetrability of Pushpa Netra (catheter) is 5
  6. 6. possible. This procedure is administered in sit- When the Sneha is inside the bladderting position for the males and in supine for fe- the Anuvasana Vasti vidhi (procedures) has tomales. In case of the females mutrashaya gata be performed.Uttara Vasti either rubber catheter or Foley’s Vasti dravaya pratyagamanam:catheter is used. Other wise for the The contents of the Vasti retain inside for more Garbhashaya gata Uttara Vasti time if the quantity is less (25ml of Sneha) and a standard dilatation of the os forcibly evacuated as the quantity increases to and administration of the medi- the 200ml (Kwatha). The medicine introduced cine is done. in to the uterus retains for much time and may At this lecture the limita- dribble in to the vagina. tion is for male Uttara Vasti. Complications Thus now male Uttara Vasti is Common complications are – dealt in detail. 1. Burning sensation and Male urethra is approxi- 2. Bleeding.mately 20 cms long. When the penis is stiff and If the Vasti dravya retains for more time as-acceptable for the “Eshani” (probe) penetration, sociated with burning sensation –in sitting position (Now a day’s supine position 1. Sodhana gana Uttara vastiis also followed) slowly the probe is pushed in 2. Massage over the pubic region to the urethra. 3. Introducing Eshani The insertion of 4. Varti prayaogam through urethra or and rec- probe is for the tum patients those For the Vasti daha – who have any 1. Ksheeri vriksha kashaya Uttara Vasti obstruction or 2. Yastimadu kashaya Uttara Vasti Mutra krichra 3. Ksheera Vasti etc. lakshanas. Paschat karma: Other wise for After the main procedure completed we the treatment look for the symptoms of complications. When Sukra or no complications are observed light meal with klaibya, a direct either green gram or milk can be given 30. It is catheter will preferred to give – serve the pur- Mamsarasa in Vata Dosha pose. When the Ksheera in Pitta Dosha catheter passes Mudga Yusha in Kapha Doshadeep in to the urethra it stuck at the vesico ure- As the dravya comes out on the samethral junction. Then slowly introduce further in day 2, 3 or 4 such Uttara Vastis has to be prac-to the urinary bladder. A small amount of the ticed 31. This procedure is followed for 3 daysresidual urine is passed through the catheter subsequently 32. Give a gap of 3 days and startand it conforms that the catheter is inside the the procedure for once again 33. The otherbladder. vyapats resembles the Anuvasana Vasti and to be treated as the same 34. Hypothesis of Uttara Vasti action and conclusion 1) The urinary bladder, which is a prime ana- tomical organ for the male Uttara Vasti, is a site for the Apanavata and has the influence of Swadhistana Chakra of shatchakra described in Hatayaga Pradeepika. This Swadhistana chakra has the 8 dala and its placement is 2nd from the down. It lies in the linga i.e. penis. The concurring of this chakra leads to rise the Kundalini in the body. It is attributed to the sac- ral plexus. This nural plexus has importance in the Uttara Vasti. 6
  7. 7. place. And its action is over the CGMP, ANP, BNP and CNP. The posterior wall of the blad- der is a smooth triangular area (the Trigone of the bladder) 38 has the capacity of absorption and the rest of the area is placed by stretch- able epithelia covered by thick musculature outside. Mechanism of bladder: - In the region of the bladder neck at the urethro- vesical junction, there is a complicated arrange- ment of smooth muscle fiber slings, which en- circle the bladder neck, and the upper part of the urethra to form a smooth muscle sphincter. These involuntary muscle fibers are relaxed during micturition and the upper urethra be- comes dilated by urine.2) Anatomically the bladder lies in the anterioinferior part of the pelvis. The Ureters and manyblood vessels to the bladder approaches fromposterior arised from the umbilical arteries. Theumbilical arteries have the connections to theportal circulation 35. The lymphatics accompanyveins and drain in to lymph nodes along the in-ternal iliac vessels 36. The micturition is underthe control of sympathetic, para sympathetic andsomatic nerve fibers. These nerve fibers de-velop from sacral plexus as shown in figure 37.These nural controls have specific pressureactions and action over motor end plates of thebladder musculature either by inhibiting or acti-vating the Acetylcholine. Here in this processof Uttara Vasti mainly the nural activation takes Spirally arranged smooth muscle slings whose function is similar to one surround the urethra itself above. The compressor urethrae is a voluntary muscle situated in the layers of the triangular ligament and its supposed function is to arrest the passage of urine and to empty the urethra at the end of micturition. This is sometimes called the external sphincter as opposed to the internal sphincter at the bladder neck. A similar arrangement is seen in the anal canal. The sphincteric action of this voluntary muscle is of very small importance compared with the invol- untary sphincter. The anterior fibers of the pubo-rectalis when contracted draw the vagina and urethra forwards towards the symphysis and in this way somewhat help to control micturition 39. 7
  8. 8. rise. Then the bladder relaxes, the pressure falls and remains steady at a level slightly above its previous value. In this way the bladder adjusts its tone and prevents any considerable rise of pressure. Since, adaptation requires a certain length of time it is seen that if fluid is introduced into the bladder very rapidly adaptation fails to occur and micturition starts with a lesser filling than normal. Experimentally, it is seen that up to a filling of 400cc rise of tension is very slight and tone adaptation is perfect. But beyond 400c.c pressure rises more sharply and adap- tation fails. This tone adaptation takes place through the action of hypogastric nerves. Cortical cen- ters exert a tonic inhibitory control over bladderMechanism of filling of bladder 40 by volitional effort hypogastric nerve may fur-1. Introducing catheters in the bladder, con- ther be stimulated, thus causing relaxation of necting them with suitable manometers and bladder. When the bladder is completely de- studying the pressure changes. The effects nervated it behaves exactly like an inert rubber of rapid and slow filling of bladder can be bg. It fails to show any power of tone adapta- studied by introducing fluid from outside. tion, and micturition starts much earlier than in2. Normally, bladder becomes filled up with urine a normal case.coming from the two Ureters. Peristaltic waves Intermittent rhythmic contractions of thepass down the Ureters from the renal pelvis to bladder wall take place during filling. As the blad-the bladder. With each such wave a jet of urine der is distended rhythmic contractions are setenters the bladder. The waves travel at a speed up reflexly.of 20-25mm per second and with a frequency Mechanism of impotency41of 1-5 per minute. The higher figures are seen In this age we began to compromise onif the volume of urine be large (diuresis). Under our sex life and on our relationships. Sex doesn’tnormal conditions the internal and external come easy, it depends on health and it is notsphincters remain tonically contracted. The just intercourse, it is all about pleasure. Sexopening of the Ureters also remain guarded by achieved by keeping fit, having a good relation-similar sphincters. These sphincters remain ship, proper communication, eating well, fineclosed and open only when the peristaltic waves stimulus, proper arousal perfect erection, goodarrive. In this way, bladder gradually fills up. orgasm and timely ejaculation. Apart from allWhen about 300-400cc of urine is collected other causes of having a good sex, erection(pressure-15-18 cm of water) the normal desire plays an important role. The erection dependsfor micturition is felt. By voluntary effort, the upon physical, emotional and mental health.onset of micturition can be delayed till a maxi- Usually anxiety of fear leads to situational im-mum of about 700-800cc of urine accumulates potency. Therefore the major influence of stressin the bladder (pressure about 100 cm of wa- and depression and physical strain has to clearter). No further inhibition is possible beyond this when a person is intended to have good sex. Itstage and micturition will automatically begin. is being observed the erection is under the neuroAs the bladder fills up, two types of movements vascular control as emotional control. Whereare seen in it. They are as follows - chemicals are released and physically filling theAdjustment of tone: Just like other hollow vis- penis vessels and making hard with proper erec-cera, bladder is capable of adjusting its tone in tion. Erection flags when another enzyme calledsuch a way that, a large volume of urine may phosphodiestreasetype type 5 (PDE5) neutral-collect in it with relatively small increase of intra izes the CGMP. The brain activates and releasesvesical pressure. It thus differs in its behavior Nitric Oxide in the spongy tissues. It activatesfrom a rubber bag, in which the tension is di- the enzyme Guanylate cyclase that producerectly proportional to the volume of its contents. cyclic guanosine mono phosphate (CGMP). The When a moderate quantity of fluid (50- GMP relaxes the spongy tissues and increase100c.c.) is introduced slowly into the bladder, C the blood flow to the penis. The penis stiffensthe intra vesical pressure shows a temporary 8
  9. 9. as the arteries and the spongy tissues dilate 10 Charaka Siddhi 9/73-4and squeeze the vein shunt. 11 Susruta Samhita Chikitsa 37/104-5Osmotic overload 12 Ibid 37/107-108 The osmotic overload is witnessed due 13 Ibid 37/107-108to the glomerular filling rate (GFR) and the tone 14 Ibid 37/125-126and specific gravity of the medicine introduced 15 Charaka Samhita Siddhi 9/71in to the bladder. This may disturb the Na+ and 16 Ibid 9/69H+ concentrations in the urine. This effects the 17 Astanga Hridaya sutra 19/77-78internal environment to alter there by the 18 Charaka Samhita Siddhi 9/59“Anupravana bhava” of the Dosha takes place 19 Astanga Hridaya sutra 19/80in to the bladder. The main absorption is either 20 Susruta Samhita Chikitsa 37/102from the trigone area or the upward movement 21 Ibid 37/106of the medicine in to the Ureters and pelvis of 22 Ibid 37/110the Kidney. This is not certain but not to be ruled 23 Ibid 37/117out. 24 Astanga Hridaya sutra 19/80 25 Satoskar, Kale, Bhandarkar, PharmacologyRenal function: and Pharmacotherapeutics, 7 th edition, The renal function and GFR is the key 1980, Popular Prakashan Pvt. Ltd., Bombayto know the mechanism of the Uttara Vasti. In –34.pp 3-4this the GFR has a relation to the ANP (atrial 26 Astanga Hridaya sutra 19/73natriuretic peptide). Osmotic diuresis is pro- 27 Charaka Samhita Siddhi 9/60duced by the administration of compounds such 28 Susruta Samhita Chikitsa 37/109as polysaccharides that are filtered but not re- 29 Ibid 37/110absorbed. The GFR as it is related to the ANP, 30 Ibid 37/113BNP (brain natriuretic peptide) and CNP (third 31 Charaka Samhita Siddhi 9/64natriuretic peptide in the brain) 42 which resemble 32 Astanga Hridaya sutra 19/81ANP will enhance CGMP, which is a regulatory 33 Ibid 19/82factor of the libido and erection. 34 Charaka Samhita Siddhi 9/68 Nerves contain polypeptides are found 35 W. Henry Hollinshed, Textbook of Anatomy,on many blood vessels. The cholinergic nerves 2nd edition, 1975, Oxford & IBH publishingalso contain VIP, which produces vaso dilation. co. pp685The increase in vaso dilation and rise of CGMP 36 Baily & Love’s, Short practice of surgery, 17thwill make a person through Uttara Vasti makes edition, 1980, ELBS., Pp 1195them to rectify the Sukra gata Vyadhi and 37 Samson Wright, Applied Physiology, 9th edi-klaibya. tion, 1993, pp 237 Even though we get the remarkable re- 38 G.J.Romanes, Cunnigham;s manual ofsults out of the uttra Vasti, studies are to be practical anatomy, 13th edition, pp228, 205done under tracer techniques with radioactive 39 John Howkins, Shaw’s textbook of gynecol-labels such as C14, H3 and S35. Then the efficacy ogy, 9th edition, 1971, pp 25of the Uttara Vasti can be proved to the scien- 40 C.C.Chatterjee, Human Physiology, 2nd edi-tific community. tion, 1952, pp397 41 K.S.R.Prasad, Impotency, Ayurmedline, Vol-Reference: 2, pp 571 Charaka Siddhi 12/1 Chakrapani 42 William F Ganong, Review of Medical Physi-2 Ibid 9/50 Chakrapani ology, pp 421, 543, 639, 643, 651, 653 and3 Astanga Hridaya sutra 19/70 6594 Charaka Siddhi 9/585 Satoskar, Kale, Bhandarkar, Pharmacology Female Uttara Vasti and Pharmacotherapeutics, 7 th edition, 1980, Popular Prakashan Pvt. Ltd., Bombay –34.pp 36 Charaka Siddhi 9/587 Susruta Samhita Chikitsa 37/1018 Charaka Siddhi 9/729 Susruta Samhita Chikitsa 37/103 9