Now we shall describe the mode of applying an Uttara-vasti (injection into the urethra of a male or of a female patient). The pipe to be used for the purpose (in the case of a male patient) should be made to measure fourteen fingers in length, measured by the patient's own fingers. It should be shaped like the stem of a Málati flower (in girth) at its top-end and provided with an aperture admitting the passage of a mustard seed. Several authorities hold that the leng h of the pipe should be equal to that of the penis (of the patient). The largest dose of a Sneha to be used in connection with an urethral injection (Uttara-vasti) is only one Kun-cha (Pala); and this should be determined with discretion in respect of patients below twenty-five years of age. There should be (two) Karnikas (protrusions) in the middle part of the pipe (Netra) in the case of a male.
In the case of a ferrate patient, however, the Karnikas should be placed above a space of four fingers (from its end). The whole pipe should be ten fingers in length and should be made to suit the urethral channel (of the patient) with an aperture sufficient to allow a Mudga-pulse to pass through it. 38.
In the case of a vaginal douche or injection (Vasti), the pipe of the Uttara-vasti should be introduced to the extent of four fingers only into the vaginal canal. Two fingers only of the entire length of the pipe should be inserted into the channel of the urethra in the case of an adult woman, whereas, in the case of a young girl of tender years, the pipe should be introduced to the length of one finger only. Here it should be noted that these measures are to be determined by the standard of the patient's own fingers. A Prasrita measure of the Sneha by which is meant a quantity that would be contained in the hollow of the palms of the patient's hand extending to the roots of the phalanx is the largest dose to be used in both these instances. In the case of patients of tender years the dosage should be determined with discretion in each case. 39.
The Vasti (bladder of the enema) should be made of the bladder of a hog, Iamb, or, a goat, or in its absence, of the skin of the neck of a bird, or of the leg of a Driti (a. leathern bag for holding water), or of any other soft skin. 40.
The body of the patient should be first treated with a Sneha and with fomentation (Sveda), and his bowels (As'aya) should be cleansed. He should then be made to partake of a gruel (Yavagu)mixed with milk and clarified butter according to his digestive capacity. He should be made to sit on a cushion placed on even ground and as high as his knee-joints. Lukewarm oil should be rubbed over the region of the neck of the bladder, and the penis should be (artificially) excited and made steady and straight. The orifice or the channel of the urethra should be first (dilated and) searched with the help of an indicator (S'alaka), and then the pipe of the Uttara-vasti, lubricated with clarified butter, should be gently and gradually inserted therein to the extent of six fingers. The Sneha should be injected into the urethra by gently pressing the bladder of the Uttara-vasti, and the pipe should then be gradually withdrawn from the urethra. The patient should be made to partake of a moderate quantity of boiled rice with milk, Yusha (Mudga-soup, etc.), or meat-soup * in the evening after the dribbling out of the injected Sneha. Three or four injections should be thus made with the help of an urethral enema (Uttara-vasti). 41.