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Background: Tubal pathology accounts for roughly one-fifth to one-third of female infertility. Conventional management relies on tubal surgery, radiological recanalisation or in vitro fertilisation, which are costly and not universally accessible. Ayurvedic gynaecologists in India treat tubal blockage with intrauterine Uttara basti using alkaline (Kshara) and other medicated oils, but the evidence for this practice has not been critically appraised. Objective: To review the Ayurvedic understanding of tubal blockage, the rationale and protocols for Uttara basti with Kshara taila and allied oils, the published clinical outcomes, and the diagnostic and safety issues relevant to interpreting them. Methods: Charaka Samhita, Sushruta Samhita and Bhaishajya Ratnavali were reviewed for concepts of the reproductive channels, alkaline preparations and Uttara basti. PubMed was searched up to October 2026 for Ayurvedic studies of tubal blockage and Kshara preparations, and for reviews, guidelines and trials on tubal diagnosis, tubal flushing and procedural safety. Each cited record was verified against PubMed and findings were synthesised narratively. Results: Ayurvedic authors interpret tubal blockage as obstruction (Sanga) of the Artavavaha srotas by Vata and Kapha, for which scraping and channel-clearing drugs are indicated. Two uncontrolled studies of Uttara basti with Kumari taila and Yavakshara taila reported tubal patency in 80% and 68.8% and conception in 40% and 6.3% of women respectively. No PubMed-indexed clinical study of Kshara taila Uttara basti specifically in tubal blockage was identified; its use is supported by a case report in endometrial calcification and by its classical properties. Hysterosalpingography, used to select and assess patients, has limited sensitivity for occlusion, and tubal flushing itself can improve fertility. Conclusion: Uttara basti with alkaline oils is a plausible, low-cost option for proximal tubal blockage, but current evidence is preliminary. Controlled trials using reliable tubal assessment and live birth as the primary outcome are required.