AYUSHDHARA ISSN: 2393-9583 (P)/ 2393-9591 (O)

An International Journal of Research in AYUSH and Allied Systems

Review Article

BASTI - A RAY OF HOPE FOR FEMALE INFERTILITY

Sharma Priyanka1*, Sharma Parul2
*1Assistant Professor, Dept. of Panchakarma, Haridwar Ayurved Medical College and Research Centre, UAU.
2Assistant Professor, Dept. of Panchakarma, Rishikul Campus, Haridwar, UAU, India.

Article info ABSTRACT

Article History:
Infertility is the inability to conceive even after one year of regular sex without using birth
Received: 19-11-2022
control. Female infertility is a challenging topic in the society today as it not only leads to
Revised: 12-12-2022
Accepted: 31-12-2022
distress and depression but also may lead to disturbed family life. Premature ovarian
insufficiency, polycystic ovarian syndrome, endometriosis, uterine fibroids and endometrial
KEYWORDS:
polyps may play a role in female infertility, ovulatory problems being the most common.
Bandhyatva, Many factors like certain genetic factors, increasing age, improper nutrition, environmental
Basti, Infertility,
pollution and increasing stress in day to day life may contribute to female infertility. In
Samshamana,
Samshodhana.
Ayurvedic literature, infertility has been described under Bandhyatva. Treatment offered by
Modern Science mainly includes the use of hormonal medicines or injections and Assisted
Reproductive Technologies (ART). On the other hand Ayurvedic treatment includes Nidana
Parivarjana (removal of the cause), Dietary management, Samshamana (pacificatory therapy)
and Samshodhana (purification and cleansing). Basti (medicated enema) is one of the most
important Samshodhana procedures which can be used in the management of female
infertility as it not only balances the vitiated Dosha (three humours- Vata, Pitta, Kapha) but
also provides nutrition hence correcting the overall condition of the patient.

INTRODUCTION
Infertility is the inability of a sexually active In this modern era, females are becoming more
couple, not using any birth control, to get pregnant career oriented due to which in most of the cases leads
after one year of trying[1]. Many couples experience to undue delay in marriage. Advanced maternal age
involuntary childlessness for at least one year: may be a risk factor for infertility [5]. It is a social stigma
estimates range from 12% to 28%[2]. About 40% of where the female partner is blamed leading to marital
cases are due to female factors, 30% are due to male disharmony [6].
factors, 20% are a combination of both, and in about Disease Review Modern
10% the cause is unknown [3]. The most common cause
According to the WHO, infertility can be
of female infertility is ovulatory problems, which
described as the inability to become pregnant,
generally manifest themselves by sparse or absent
maintain a pregnancy, or carry a pregnancy to live
menstrual periods [4]. Certain factors like changed
birth [7]. A clinical definition of infertility by the WHO
lifestyle, nutrition, disease, malformation of uterus,
and ICMART (The International Committee for
increased stress, age, genetic factors and
Monitoring Assisted Reproductive Technology) is “a
environmental pollution also contribute to the rise of
disease of the reproductive system defined by the
infertility.
failure to achieve a clinical pregnancy after 12 months
Access this article online
or more of regular unprotected sexual intercourse” [8].
Quick Response Code Infertility can lead to distress and depression, as well
https://doi.org/10.47070/ayushdhara.v9i6.1127 as discrimination and ostracism [9]. It can be divided
into two types- primary and secondary infertility.
Published by Mahadev Publications (Regd.)
publication licensed under a Creative Commons a) Primary Infertility: It refers to the inability to give
Attribution-NonCommercial-ShareAlike 4.0 birth either because of not being able to become
International (CC BY-NC-SA 4.0)
pregnant, or carry a child to live birth, which may
include miscarriage or a stillborn child [10, 11].

AYUSHDHARA | November-December 2022 | Vol 9 | Issue 6 115

 AYUSHDHARA, 2022;9(6):115-121
b) Secondary Infertility: It refers to the inability to Rasa Ratna Sammuchya and Vandhya Kalpadruma.
conceive or give birth when there was a previous Harita classified Bandhyatva into 6 types [13]:
pregnancy or live birth [10, 11].  Kakavandhya (one child sterility)
Management [12]
 Anapatya (no child)
Depending on the cause it falls into two main  Garbhasravi (repeated abortion)
categories:
 Mritavatsa (repeated stillbirth)
A) Medications or Surgery
 Balakshaya (loss of strength)
Fertility drugs (clomiphene citrate or FSH and
 Vandhya due to Balyabastha (childhood),
LH hormone injections) for women with ovulation
disorders. These treatments may also be used with an Garbhakoshabhanga (injury to uterus)and
intrauterine sperm injection (IUI), which is when Dhatukshaya (destruction of tissues)
sperm is injected directly into the uterus. Surgery may Rasa Ratna Sammuchchaya classified Bandhya
also be an option when the cause of infertility is (infertile woman) into nine types- Adi Bandhya, Vataja,
blocked fallopian tubes or endometriosis. Pittaja, Kaphaja, Sannipataja, Bhutaja, Daivaja, Raktaja
B) Use Assisted Reproductive Technologies (ART) and Abhicharaja. In Vandhya Kalpadruma: eight types
These technologies include egg and embryo of Bandhya are described [14].
donation, in vitro fertilization, and intracytoplasmic Nidana (Aetiology)
sperm injection (the direct injection of a sperm into an 1. Aharaja Nidana (improper diet)– Mithyaahara
egg). (abnormal food habits) [15], Dushta Bhojana [16]
Ayurvedic Review 2. Viharaja Nidana (improper lifestyle)– Mithyavihara
In Ayurveda, Bandhyatva (infertility) is also an (abnormal style of living) [17], coitus with Ruksha
independent disease, rather a cardinal feature of so (excessive dryness in body), Durbala (weak), Bala
many diseases. In Sushruta Samhita, Bandhyatva has (female who is not an adult), excessive coitus [18] etc.
been included in twenty Yoni Vyapada (gynaecological 3. Pradusta Artava (abnormalities in ovum) [19]
disorders). Acharya Charaka and Vagabhatta have 4. Bija Dosha (abnormalities of sperm or ovum) [20]
referred Bandhyatva due to abnormality of Beejamsa 5. Daiva (unknown or idiopathic factor) [21]
(gametes). Kasyapa has mentioned Jataharini (group of Acharya Sushruta has explained the importance of
potentially fatal diseases responsible for perinatal four factors necessary for conception namely- Ritu
death and female infertility) or other Pushpaghni (season), Kshetra (land), Ambu (water), Beeja (seed).
Jataharini with repeated expulsion of foetuses of Ritu can be compared to ovulatory period, Kshetra to
different gestational periods. First time Acharya Harita female reproductive system, Ambu to nutrition and
has classified Bandhyatva in detail. Beeja to sperm and ova. Defect in any of the four
Classification factors may lead to non-conception [22].
Classification of Bandhyatva or Bandhya has
not been given in any classics except Harita Samhita,
Table 1: Samprapti Ghataka (Aetiopathogenic Factors) [23]
Dosha Tridosha with predominant Vata
Dhatu Rasa, Rakta
Updhatu Artava
Srotasa Artava vaha
Strotodushti Sanga
Udbhavasthana Pakvashaya (Mulasthana of Vata)
Adhishthana Yoni
Vyadhisvabhava Cirakari
Marga Abhyantara (Garbhasaya as Kosthanga)

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 Sharma Priyanka, Sharma Parul. Basti - A Ray of Hope for Female Infertility

Figure 1: Samprapti (Pathogenesis) [24] of Bandhyatva

Due to Nidana Sevana (causative factors), occlusion) [25]. The vitiated Vata along with Pitta causes
Dosha (three humours- Vata, Pitta, Kapha) and Agni the Artava kshaya i.e., Kshayatmaka Dushti. All these
(biochemical transformers) get vitiated resulting into factors may cause Abeejotsarga (anovulation) which
Ama (un-metabolized food) formation. The Ama may lead to infertility [26].
formed adheres to Srotasa (channels) and causes Ayurvedic Management
Avarodhatmaka Dushti (improper functioning due to A) Nidana Parivarjana- (Removal of the causative
obstruction of channels). Ama spreads throughout the factors like unhealthy diet and lifestyle, smoking,
body, propelled by the vitiated Vata along the alcohol, stressful environment, environmental
Rasavaha Srotasa (channels carrying the nutritional pollution etc.
essence). Due to hypo functioning of Jatharagni
B) Dietary management- Ojas enhancing foods like
(gastrointestinal metabolism), Dhatvagni Mandya
milk, ghee, nuts, fresh organic fruits, vegetables,
(slow tissue metabolism) also occurs. Due to Mandagni
proteins etc.
(slow digestion) and Nidana sevana, Rasa (plasma),
Rakta (blood) Dhatu (tissue) get vitiated. Also the C) Samshamana Chikitsa-
Dhatvagni mandya causes the Kshayatmaka (declining)  Agni Deepana and Ama Pachana
effect on the Artava (ovum) i.e. the production of  Vatanulomana(correcting the functions of Vata)
Artava, Updhatu (subsidiary or secondary tissue  Use of herbs like Ashoka, Dashmoola, Shatavari
product) of Rasa dhatu or Rakta dhatu becomes less. etc.
Thus it is the Upadhatvatmaka Dushti (malfunctioning D) Shodhana Chikitsa- Snehana (oleation therapy),
of secondary tissue products). Visvamitra has clarified Swedana (steam therapy), Vamana (therapeutic
that hair thin vessels fill the uterus for whole month to emesis), Virechana (therapeutic purgation), Basti-
receive Bija (ovum) and due to Rasa dushti, Anuvasana and Nirooha (enema given through
Poshanatmaka (nourishment) Dushti can occur. The rectal route), Uttar basti (enema administered
vitiated Apanavayu (one of the five subtypes of Vata through vaginal route) [27].
that governs the elimination of all substances from
body e.g. stool, urine etc.) and Kapha (one of the three
humors of the body which governs structure and fluid
balance in the body) when get mix can cause
Avaranatmaka Dushti (malfunctioning due to
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 AYUSHDHARA, 2022;9(6):115-121
DISCUSSION The above studies clearly show that
Many works have been done on the role of Madhutailik Basti (an alternative of Nirooha basti),
Basti in female infertility. Some of them are being Matra basti and Uttar basti, all have been found to be
mentioned here. significantly effective in the management of female
Kamini Dhiman, Shachi Pandya, L.P.Dei, Anup infertility.
Thakkar and K.S.Dhiman conducted a randomized Mode of action of Basti in Female Infertility
clinical trial on 11 patients entitled: “Role of Vata (one of the three humors responsible for
Madhutailik Basti in Infertility w.s.r. anovulatory all bodily movements) is mainly responsible for all
factor”. Madhutailik Basti (rectal enema with honey types of Yoni Roga (gynaecological disorders) [33].
and oil as main content) was given for 15 days for two Prakruta Vata (in balanced state) is responsible for the
consecutive menstrual cycles. They concluded that Beejotsarga (Ovulation). Vata predominance Tridosha
Madhutailik Basti is an effective treatment modality in Dusti is responsible for Abeejotsarga (Anovulation).
infertility owing to anovulatory factor [28]. Basti eradicates morbid Vata from the root along with
Krupa R. Donga, Shilpa B. Donga and Laxmi other Dosha and in addition it gives nutrition to the
Priya Dei conducted a randomized clinical trial on 24 body tissue [34].
patients entitled “Role of Nasya and Matra Basti with Mode of action of Basti given through the genital
Narayana Tail on Anovulatory factor”. Patients were route (Uttar Basti)
randomly divided into two groups –Group A: (Narayan In condition of anovulation, Uttar Basti
tail Nasya (Errhine therapy) for 7 days for two sittings removes the Srotosanga (obstruction in the channels)
with gap of 3 days). Group B: (Narayana tail Matra and corrects the Artavagni (which regulates the
Basti (60ml) for 8 days for two sittings).It was menstrual cycle), thus resulting in ovulation. Ovaries
concluded that Matra Basti (rectal enema in which the contain receptors which receive hormones secreted by
smallest amount of oil is administered) group had hypothalamus and pituitary gland. The drug stimulates
better results [29]. these receptors, so that proper ovulation occurs in
Another study entitled; “A Clinical Study Of each cycle [35]. In tubal blockage the drug is reaching in
Kashmaryadi Ghrita Uttar Basti in Female Infertility bulk to the site of pathology. Hence Uttar Basti relieves
“was conducted by Baranwal Deepika and Dave Hetal tubal block by lysis of adhesions and relieves
H. Total 18 patients of female infertility were obstruction [36]. In cervical factor, drug administered
administered 5ml intrauterine Kashmaryadi ghrita locally in the cervix and absorbed by cervical
after 24 hours of cessation of menses for 3 alternate epithelium due to Sukshma (subtle) property of drug.
days for 3 consecutive cycles. Uttar Basti was found to The lipid soluble drug is passively diffused across the
be effective in female infertility [30]. membrane in the direction of its concentration
Rashmi R. Sharma conducted a clinical trial gradient. The rate of transport is proportional to lipid:
entitled “Phalkalyan Ghrita By Oral Route and Matra water partition coefficient of the drug. The more lipid
Basti in the Management of Alpartava”. 30 patients soluble, higher is the concentration and quicker
were randomly divided into 3 groups - Group A - diffusion. In this way altered cervical pH can be
Phalkalyan Ghrita [Matra basti + Oral], Matra basti corrected by Uttar Basti [37]. Uttar Basti helps in
(60ml/day during Secretory phase for 8 consecutive endometrial conditions by improving thickness of
days + Oral (5gm B.D.) for 2 months. Group B- endometrium, improves the quality of endometrium,
Phalkalyan Ghrita (Oral) 5gm. B.D. for 2 months, Group helps in curing endometriosis, absorption is very fast
C- Rajahpravartini Vati (Oral) 250mg. B.D for 2 gives quicker result [38].
months. Matra basti group was found to be most Mode of action of Basti given through the rectal
effective in management of Alpartava (oligo route (Sneha Basti and Madhutailik Basti)
menorrhea) [31]. Basti given through the rectal route enters into
Shachi S Pandya conducted a clinical trial G.I tract which is considered as Enteric Nervous
entitled-“Role of Madhutailik Basti and Pippalyadi Yoga System. The Virya (potency) of Basti Dravya (contents
in infertility” and randomly divided 33 patients of of Basti) stimulates endogenous opioids which are
female infertility into 3 groups. Group A: Madhutailik usually present in G.I. tract. Endogenous opioids are a
Basti (228 ml for a duration of 15 days after cessation group of peptides, which play an important role in the
of menses for 2 consecutive cycles). Group B: ovarian cycle through the inhibitory effect on GnRH
Pippalyadi Yoga (4gm BD before meal orally), Group C- secretion. Other pituitary hormones are also
Madhutailik Basti + Pippalyadi Yoga. It was concluded modulated by opiates. β-endorphin has been best
that Madhutailik Basti Group is more effective in known opioid related to the reproductive system
comparison to other groups [32]. regulating variety of pituitary hormones including

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 Sharma Priyanka, Sharma Parul. Basti - A Ray of Hope for Female Infertility
gonadotrophins. It has a role in the regulation of the Raktadi Dhatu Nirmana (proper formation of body
normal ovarian cycle[39]. Basti-stimulates the ENS tissues). Sukshma Bhaga (fine part) of Rasa reaches the
which generates the stimulatory signal for CNS which Bijagranthi (ovary), which regularizes the Beejotsarga
in turn causes stimulation of Hypothalamus for GnRH (ovulation) with the help of normal Apana Vayu [41].
and the Pituitary for FSH & LH with the help of Madhutailik Basti (an alternative for Nirooha Basti)
neurotransmitters. Parasympathetic activity is mainly The drugs of Madhutailika Basti possess anti-
responsible for the Apana Vayu activity. Basti given oxidant, Immune-Modulatory etc. properties which
through rectum will stimulate this parasympathetic may help in relieving the stress, age-decline etc i.e.,
nerve supply which in turn helps for the release of causes of anovulation. From Ayurvedic point of view,
ovum from the follicle in the ovary [40]. the drugs used in preparation of Madhutailika Basti are
Sneha Basti (Anuvasana Basti or Matra Basti) having properties like Vrishya (aphrodisiac),
Sneha Basti given through Guda (rectal route) Vayahsthapana (which counter aging) etc. Shatapushpa
normalizes Apana Vayu leading to Vatanulomana and which had been used as Kalka Dravya (paste), is
physiological functioning of Vata, which may help in mentioned in separate Adhyaya (chapter) in Kashyapa
turn for the extrusion of ovum from the follicle and Samhita due to its special properties like Putrprada
ovulation. Basti Dravya spreads all over the body, (helps in conception), Viryakari (which increases
pacifies the aggravated Dosha along with Vyana Vayu potency of ovum and sperm), Yoni Shukra Vishodhini
(one of the five subtypes of Vata which distributes (purifies the reproductive organ in female, sperm and
blood and nutrients to different parts of the body spermatic fluid in male), Pushpa Prajakari (increases
through blood circulation) leads to Samyaka Rasa progeny) [42].

Table 2: Action of various contents of Madhutailika Basti[43]

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 AYUSHDHARA, 2022;9(6):115-121
The drugs, which are used in preparation of 15. Shastri Datta Rajeshwara, Upadhyaya Yadunandan,
Madhutailika Basti helps in regulation of ovulatory Pandeya Sahaya Ganga, Gupta Dasa Banarasi, Mishra
cycle through their combine effect hence help in the Brahmashankara (editors), Commentary: Vidhyotani
management of female infertility. teka of Kasi Nath Sastri & Gorakha Nath Chaturvedi of
CONCLUSION Charak Samhita of Agnivesha, Chikitsasthan, 30th
chapter, 7th shloka, 2009.
Infertility is a condition which can lead to 16. Kaviraj Atrideva Gupta (editor), Ashtanga Samgraha of
distress, depression and disturbed family life. It is Vagbhatta, Uttarsthan, 38th chapter, 32nd shloka,
necessary to cure infertility to enhance the patient’s 2005.
condition as well as to maintain harmony in married 17. Shastri Datta Rajeshwara, Upadhyaya Yadunandan,
life. Thus, Basti is an important therapeutic procedure Pandeya Sahaya Ganga, Gupta Dasa Banarasi, Mishra
in the management of female infertility and is a boon Brahmashankara (editors). Commentary: Vidhyotani
to individual as well as society. teka of Kasi Nath Sastri & Gorakha Nath Chaturvedi of
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Cite this article as: *Address for correspondence

Sharma Priyanka, Sharma Parul. Basti - A Ray of Hope for Female Infertility. Dr. Sharma Priyanka
AYUSHDHARA, 2022;9(6):115-121. Assistant Professor
https://doi.org/10.47070/ayushdhara.v9i6.1127 Dept. of Panchakarma,
Source of support: Nil, Conflict of interest: None Declared Haridwar Ayurved Medical College
and Research Centre, UAU.
Mobile: 9720139606
Email: [email protected]

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