Bastivyapat Siddhi

Siddhi Sthana Chapter 7. Management of complications of therapeutic enema

Bastivyapat Siddhi

Section/Chapter	Siddhi Sthana Chapter 7
Preceding Chapter	Vamana Virechana Vyapat Siddhi
Succeeding Chapter	Prasrita Yogiyam Siddhi
Other Sections	Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Chikitsa Sthana, Kalpa Sthana
Translator and commentator	Prasad B.S.,Sajjan S., Giridhar V.
Reviewer	Panse A.
Editor	Thakar A. B., Mangalasseri P.
Date of publication	December 17, 2018

Abstract

Bastivyapat Siddhi talks about various complications that may arise while administering niruha basti. Complications of basti may arise either due to improper composition of basti, faulty administration or specific clinical situation. There are twelve complications enlisted under niruha basti. The twelve complications are: ayoga (insufficient or no effect), atiyoga (excess effect), klama (fatigue without exertion), adhmana (abdominal distension), hikka (hiccups), hritprapti (reaching the pericordium), urdhvata (basti reaching oesophagus), pravahika (dysentery), shiroarti (headache), angarti (bodyache), parikartika (fissure-in-ano) and parisrava (discharge through anus). In this seventh chapter etiology, clinical features and management of these twelve vyapats (complications) are described in detail.

Keywords: Basti vyapat, ayoga, atiyoga, mithyayoga, klama, adhamana, hikka, hritprapti, urdhvata, pravahika, siroarti, angaarti, parikartika, parisrava, complications of basti.

Introduction

Improper administration of basti (trans-rectal drug administration in the form of enema) can cause various complications. Therefore, the clinician using basti as a treatment principle should have thorough knowledge to prevent, diagnose and manage them properly. Explanation of the complications of faulty therapeutic procedures are decribed in fourth (Snehavyapat Siddhi adhyaya), fifth (Netrabastivyapat Siddhi adhyaya) and sixth (Vamana Virechana Vyapat Siddhi adhyaya) chapters earlier in this section. The complications arising due to unctuous enema are detailed in 4th chapter.

In the present chapter, twelve possible complications of niruha basti (enema with decoction) are described. The complications occur through ayoga (insufficient dose), atiyoga (excess dose) and mithyayoga (improper dose) which are described along with their etiology, signs and symptoms and their management.

Sanskrit text, Transliteration and English Translation

अथातो बस्तिव्यापत्सिद्धिं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

athātobastivyāpatsiddhiṃvyākhyāsyāmaḥ||1||

itihasmāhabhagavānātreyaḥ||2|

athAto bastivyApatsiddhiM vyAkhyAsyAmaH||1||

iti ha smAha bhagavAnAtreyaH||2||

Now we shall expound the chapter "Bastivyapat Siddhi" (Management of complications of therapeutic enema). Thus said Lord Atreya. [1-2]

Note: The term "basti" refers to therapeutic enema including trans-rectal drug administration.

धीधैर्यौदार्यगाम्भीर्यक्षमादमतपोनिधिम्|

पुनर्वसुंशिष्यगणःपप्रच्छविनयान्वितः||३||

काःकतिव्यापदोबस्तेःकिंसमुत्थानलक्षणाः|

काचिकित्साइतिप्रश्नाञ्छ्रुत्वातानब्रवीद्गुरुः||४||

dhīdhairyaudāryagāmbhīryakṣamādamatapōnidhim|

punarvasuṁśiṣyagaṇaḥpapracchavinayānvitaḥ||3||

kāḥkativyāpadōbastēḥkiṁsamutthānalakṣaṇāḥ|

kācikitsāitipraśnāñchrutvātānabravīdguruḥ||4||

dhIdhairyaudAryagAmbhIryakShamAdamataponidhim|

punarvasuM shiShyagaNaH papraccha vinayAnvitaH||3||

kAH kati vyApado basteH kiMsamutthAnalakShaNAH|

kA cikitsA iti prashnA~jchrutvA tAnabravIdguruH||4||

The disciples obediently requested Punarvasu (who is) endowed with dhi (intelligence), dhairya (courage), audarya (generosity), gambhirya (dignity), kshama (forgiveness), dama (self-discpline) and tapas (dedicated learning) to explain

1. What are the complications of basti?
2. How many are the complications?
3. What are causes for these complications?
4. What are the signs and symptoms of these complications?
5. How to manage these complications?

In response to request by disciples Punarvasu explained: [3-4]

Complications of basti

नातियोगौक्लमाध्मानेहिक्काहृत्प्राप्तिरूर्ध्वता|

प्रवाहिकाशिरोङ्गार्तिःपरिकर्तःपरिस्रवः||५||

द्वादशव्यापदोबस्तेरसम्यग्योगसम्भवाः|

आसामेकैकशोरूपंचिकित्सांचनिबोधत||६||

nātiyōgauklamādhmānēhikkāhr̥tprāptirūrdhvatā|

pravāhikāśirōṅgārtiḥparikartaḥparisravaḥ||5||

dvādaśavyāpadōbastērasamyagyōgasambhavāḥ|

āsāmēkaikaśōrūpaṁcikitsāṁcanibōdhata||6||

nAtiyogau klamAdhmAne hikkA hRutprAptirUrdhvatA|

pravAhikA shiro~ggArtiH parikartaH parisravaH||5||

dvAdasha vyApado basterasamyagyogasambhavAH|

AsAmekaikasho rUpaM cikitsAM ca nibodhata||6||

There are twelve complications of basti administration viz. ayoga, atiyoga, klama, adhamana, hikka, hritprapti, urdhvata, pravahika, siroarti, angaarti, parikartika, parisrava. Atiyoga, ayoga and mithyayoga are the mechanisims of manifestations of these complications. The clinical manifestation and the management of each condition will be explained to you: [5-6]

Complication of ayoga (insufficience effect)

गुरुकोष्ठेऽनिलप्रायेरूक्षेवातोल्बणेऽपिवा|

शीतोऽल्पलवणस्नेहद्रवमात्रोघनोऽपिवा||७||

बस्तिःसङ्क्षोभ्यतंदोषंदुर्बलत्वादनिर्हरन्|

करोतिगुरुकोष्ठत्वंवातमूत्रशकृद्ग्रहम्||८||

नाभिबस्तिरुजंदाहंहृल्लेपंश्वयथुंगुदे|

कण्डूगण्डानिवैवर्ण्यमरुचिंवह्निमार्दवम्||९||

तत्रोष्णायाःप्रमथ्यायाःपानंस्वेदाःपृथग्विधाः|

फलवर्त्योऽथवाकालंज्ञात्वाशस्तंविरेचनम्||१०||

बिल्वमूलत्रिवृद्दारुयवकोलकुलत्थवान्|

सुरादिमूत्रवान्बस्तिःसप्राक्पेष्यस्तमानयेत्||११||

gurukōṣṭhē:'nilaprāyērūkṣēvātōlbaṇē:'pivā|

śītō:'lpalavaṇasnēhadravamātrōghanō:'pivā||7||

bastiḥsaṅkṣōbhyataṁdōṣaṁdurbalatvādanirharan|

karōtigurukōṣṭhatvaṁvātamūtraśakr̥dgraham||8||

nābhibastirujaṁdāhaṁhr̥llēpaṁśvayathuṁgudē|

kaṇḍūgaṇḍānivaivarṇyamaruciṁvahnimārdavam||9||

tatrōṣṇāyāḥpramathyāyāḥpānaṁsvēdāḥpr̥thagvidhāḥ|

phalavartyō:'thavākālaṁjñātvāśastaṁvirēcanam||10||

bilvamūlatrivr̥ddāruyavakōlakulatthavān|

surādimūtravānbastiḥsaprākpēṣyastamānayēt||11||

gurukoShThe~anilaprAye rUkShe vAtolbaNe~api vA|

shIto~alpalavaNasnehadravamAtro ghano~api vA||7||

bastiH sa~gkShobhya taM doShaM durbalatvAdanirharan|

karoti gurukoShThatvaM vAtamUtrashakRudgraham||8||

nAbhibastirujaM dAhaM hRullepaM shvayathuM gude|

kaNDUgaNDAni vaivarNyamaruciM vahnimArdavam||9||

tatroShNAyAH pramathyAyAH pAnaM svedAH pRuthagvidhAH|

phalavartyo~athavA kAlaM j~jAtvA shastaM virecanam||10||

bilvamUlatrivRuddAruyavakolakulatthavAn|

surAdimUtravAn bastiH saprAkpeShyastamAnayet||11||

Etiology, clinical manifestation and management of basti complication-ayoga

When basti having following mentioned qualities administered in patients with conditions mentioned below (any one or in combinations) result in ayoga type of basti complication (insufficient effect or no effect). Basti dravya of less potency cannot eliminate doshas and the remnant vitiated doshas lead to ayoga.

Condition of patient which can cause ayoga type of basti complication

• Guru kostha (hard bowel)
• Ruksha sharira (excess dryness in body/dehydrated person)
• Vata predominance

Qualities of basti which can cause ayoga type of basticomplication

• Processed out of sheetaguna (cold potency) drugs
• Insufficient quantity of lavana (salt)
• Insufficient quantity of sneha (unctuous substance)
• Insufficient quantity of drava (liquid media)
• More thick or ghana form (excessively dense/more viscosity)
• Overall insufficient dose

Signs and symptoms of ayoga

• Heaviness of abdomen
• Abdominal distension
• Retention of flatus
• Anuria/dysuria
• Constipation
• Pain over naval and bladder region
• Burning sensation
• Heaviness in cardiac region (hrillepa)
• Swelling of anal region/orifice
• Itching
• Skin discoloration on cheeks
• Loss of taste
• Loss of appetite

The following is the management choices for ayoga:

• Administration of lukewarm water processed with pramathya (pachana kashaya mentioned in Cha.Chi.19/19-22)
• Different types of swedana (sudation therapy)
• Phala varti (anal suppository)
• Virechana (subject to suitability and season)
• Administration of basti prepared as mentioned below relieves vibaddha (obstruction) caused due to the ayoga of basti.

Preparation of basti

Kashaya (decoction) of dravya - bilva mula (roots of Aegle marmelos Corr.), trivrit (Operculina turpethum (Linn.) silva manso.), daru- (Devadaru) (Cedrus deodara ( Roxb.) Loud), kola (Zyzyphus jujuba Lam.), kulattha (Vigna unquiculata (Linn.) Walp.);

kalka (paste) of dravya – as explained in Bastisutriyam Siddhi chapter i.e. yavani (Trachyspermum ammi Linn. Sprague ex Turril.), madanaphala (fruits of Xeromphis spinosa (Thunb) Keay), bilva, kustha ((Saussurea lappa CB. Clarke)), vacha (Acorus calamus Linn), shatahva (Anethum sowa Roxb.ex Flem), ghana- must) Cyperus rotundus Linn., pippali Piper longum Linn - each ingredient one karsha; added with sura etc i.e. souveeraka, tushodaka etc., and gomutra (Cow urine). [7-11]

Complication of atiyoga (excess effect)

स्निग्धस्विन्नेऽतितीक्ष्णोष्णोमृदुकोष्ठेऽतियुज्यते|

तस्यलिङ्गंचिकित्साचशोधनाभ्यांसमाभवेत्||१२||

पृश्निपर्णींस्थिरांपद्मंकाश्मर्यंमधुकंबलाम्|

पिष्ट्वाद्राक्षांमधूकंचक्षीरेतण्डुलधावने||१३||

द्राक्षायाःपक्वलोष्टस्यप्रसादेमधुकस्यच|

विनीयसघृतंबस्तिंदद्याद्दाहेऽतियोगजे ||१४||

snigdhasvinnē:'titīkṣṇōṣṇōmr̥dukōṣṭhē:'tiyujyatē|

tasyaliṅgaṁcikitsācaśōdhanābhyāṁsamābhavēt||12||

pr̥śniparṇīṁsthirāṁpadmaṁkāśmaryaṁmadhukaṁbalām|

piṣṭvādrākṣāṁmadhūkaṁcakṣīrētaṇḍuladhāvanē||13||

drākṣāyāḥpakvalōṣṭasyaprasādēmadhukasyaca|

vinīyasaghr̥taṁbastiṁdadyāddāhē:'tiyōgajē ||14||

snigdhasvinne~atitIkShNoShNo mRudukoShThe~atiyujyate|

tasya li~ggaM cikitsA ca shodhanAbhyAM samA bhavet||12||

pRushniparNIM sthirAM padmaM kAshmaryaM madhukaM balAm|

piShTvA drAkShAM madhUkaM ca kShIre taNDuladhAvane||13||

drAkShAyAH pakvaloShTasya prasAde madhukasya ca|

vinIya saghRutaM bastiM dadyAddAhe~atiyogaje ||14||

Etiology, clinical manifestation and management of basti complication-atiyoga

Atiyoga complication will occur when basti prepared out of drugs possessing ushna (hot potency) and teekshna (sharply acting/penetrating) property administered in patients of mridukostha (soft bowel) who had undergone sneha and sweda.

Signs, symptoms and the management is similar to that mentioned for shodhana-atiyoga:

• Visrava (Flow/Oozing) of vit (stools), pitta, kapha, drava dhatu
• Bala kshaya (loss/ decrease in strength)
• Swara kshaya (low voice)
• Kantha sosha (dryness of throat)
• Bhrama (giddiness)
• Trishna (thirst)

Management

Basti prepared as mentioned below is to be administered along with ghrita (ghee) which relieves burning caused by atiyoga.

Basti preparation

Kalka made of prisniparni (Uraria picta Desv)., sthira –shaliparni –(Desmodium gangeticum DC.), padma -kamala – (Nelumbo nucifera Gaertn), kashmarya - gambhari –(Gmelina arborea Roxb), madhuka –yastimadhu (Glycyrrhiza glabra Linn), bala (Sida cordifolia Linn.), draksha (Vitis vinifera Linn.), madhuka (Madhuca indica J.F.Gmel) add this kalka to ksheera (milk), tandulodaka (washed rice water), draksha prasada (i.e. sheeta kashaya), pakvalostra prasada (supernatant water taken after heated earthen pot pieces were dipped in a vessel containing water), yastimadhu prasada (i.e.sheeta kashaya).[12-14]

Complication of fatigue without exertion

आमशेषेनिरूहेणमृदुनादोषईरितः|

मार्गंरुणद्धिवातस्यहन्त्यग्निंमूर्च्छयत्यपि||१५||

क्लमंविदाहंहृच्छूलंमोहवेष्टनगौरवम्|

कुर्यात्स्वेदैर्विरूक्षैस्तंपाचनैश्चाप्युपाचरेत्||१६||

पिप्पलीकत्तृणोशीरदारुमूर्वाशृतंजलम्|

पिबेत्सौवर्चलोन्मिश्रंदीपनंहृद्विशोधनम्||१७||

वचानागरशट्येलादधिमण्डेनमूर्च्छिताः|

पेयाःप्रसन्नयावास्युररिष्टेनासवेनवा||१८||

दारुत्रिकटुकंपथ्यांपलाशंचित्रकंशटीम्|

पिष्ट्वाकुष्ठंचमूत्रेणपिबेत्क्षारांश्चदीपनान्||१९||

बस्तिमस्यविदध्याच्चसमूत्रंदाशमूलिकम्|

समूत्रमथवाव्यक्तलवणंमाधुतैलिकम्||२०||

āmaśēṣēnirūhēṇamr̥dunādōṣaīritaḥ|

mārgaṁruṇaddhivātasyahantyagniṁmūrcchayatyapi||15||

klamaṁvidāhaṁhr̥cchūlaṁmōhavēṣṭanagauravam|

kuryātsvēdairvirūkṣaistaṁpācanaiścāpyupācarēt||16||

pippalīkattr̥ṇōśīradārumūrvāśr̥taṁjalam|

pibētsauvarcalōnmiśraṁdīpanaṁhr̥dviśōdhanam||17||

vacānāgaraśaṭyēlādadhimaṇḍēnamūrcchitāḥ|

pēyāḥprasannayāvāsyurariṣṭēnāsavēnavā||18||

dārutrikaṭukaṁpathyāṁpalāśaṁcitrakaṁśaṭīm|

piṣṭvākuṣṭhaṁcamūtrēṇapibētkṣārāṁścadīpanān||19||

bastimasyavidadhyāccasamūtraṁdāśamūlikam|

samūtramathavāvyaktalavaṇaṁmādhutailikam||20||

AmasheShe nirUheNa mRudunA doSha IritaH|

mArgaM ruNaddhi vAtasya hantyagniM mUrcchayatyapi||15||

klamaM vidAhaM hRucchUlaM mohaveShTanagauravam|

kuryAt svedairvirUkShaistaM pAcanaishcApyupAcaret||16||

pippalIkattRuNoshIradArumUrvAshRutaM jalam|

pibet sauvarcalonmishraM dIpanaM hRudvishodhanam||17||

vacAnAgarashaTyelA dadhimaNDena mUrcchitAH|

peyAH prasannayA vA syurariShTenAsavena vA||18||

dAru trikaTukaM pathyAM palAshaM citrakaM shaTIm|

piShTvA kuShThaM ca mUtreNa pibet kShArAMshca dIpanAn||19||

bastimasya vidadhyAcca samUtraM dAshamUlikam|

samUtramathavA vyaktalavaNaM mAdhutailikam||20||

Etiology clinical manifestation and management of basti complication - klama (fatigue): In amashesha (remnant of ama- undigested material) condition, mridu type of niruha basti (transrectal administration of non-unctuous formulation) is administered, doshas (pitta, kapha along with ama) gets vitiated and leads to obstruction of marga (srotas), resulting in vata aggravation and agni impairement.

Signs and symptoms seen in basti complication - klama

• Klama (fatigue)
• Daha (burning Sensation)
• Hritsula (pain the heart region)
• Moha (delusion)
• Gaurava (heaviness of body)
• Veshtana (colic)

Management of klama

• Rukshasveda (dry fomentation)
• Pachana (digestive therapies)
• Shruta (decoction) prepared as mentioned below

Method of preparation of sruta

Decoction prepared with pippali (Piper longum Linn.), katrina (Cymbopogon schoenanthus Linn.), ushira (Andropogon muricatus Retz.), devadaru (Cedrus deodara Roxb.Loud), murva (Marsdenia tenacissima W.& A.) and added with souvarchala lavana. This shruta acts as dipana and hritshodhana.

• Powders of vacha (Acorus calamus Linn.), nagara (Zingiber officinale Roscoe.), shati (Hedychium spicatum, ela (Elettaria cardamomum Matan.) have to be mixed with either of dadhimanda or prasanna or aristha or asava, to be given as a peya (drink).
• Devadaru (Cedrus deodara Roxb.Loud), trikatu i.e. shunthi-maricha-pippali (Zingiber officinale Roscoe, Piper nigrum Linn., Piper longum Linn.), pathya - haritaki (Terminalia chebula Retz.), palasha (Butea frondosa Koen.ex.Roxb.), chitraka (Plumbago zeylalanica Linn.), shati (Hedychium spicatum Ham ex.Smith) and kushtha (Saussurea lappa C.B.Clarke) have to be made a paste with gomutra (cow’s urine) and administered orally for deepana.
• Administer kshara (kshara preparations mentioned in Grahani Chikitsa ) orally for deepana.
• Administer basti prepared out of dashamula (dashamulaniruhabasti ) and gomutra.
  • Dashamula viz.

1. Bilva- (Aegle marmelos Carr.)
2. Kashamarya- gambhari (Gmelina arborea Linn.)
3. Tarkari- agnimantha (Premna integrifolia Linn.)
4. Patala-(Stereospermum suaveolens DC.)
5. Tintuka- shyonak (Oroxylum indicum Vent.)
6. Brihati (Solanum indicum Linn.)
7. Kantakari- (Solanum xanthocarpum Schrad & Wendl.)
8. Prisniparni -(Desmodium gangeticum DC.)
9. Shalaparni -(Uraria picta Desv.)
10. Gokshura -(Tribulus terrestris Linn.)

Or administer Madhutailikabasti - added with gomutra and sufficient quantity of salt.[15-20]

Complication of adhmana(distension of abdomen)

अल्पवीर्योमहादोषेरूक्षेक्रूराशयेकृतः|

बस्तिर्दोषावृतोरुद्धमार्गोरुन्ध्यात्समीरणम्||२१||

सविमार्गोऽनिलःकुर्यादाध्मानंमर्मपीडनम्|

विदाहंगुरुकोष्ठस्यमुष्कवङ्क्षणवेदनाम्||२२||

रुणद्धिहृदयंशूलैरितश्चेतश्चधावति|

श्यामाफलादिभिःकुष्ठकृष्णालवणसर्षपैः||२३||

धूममाषवचाकिण्वक्षारचूर्णगुडैःकृताम्|

कराङ्गुष्ठनिभांवर्तिंयवमध्यांनिधापयेत् ||२४||

अभ्यक्तस्विन्नगात्रस्यतैलाक्तांस्नेहितेगुदे|

अथवालवणागारधूमसिद्धार्थकैःकृताम्||२५||

बिल्वादिनानिरूहःस्यात्पीलुसर्षपमूत्रवान्|

सरलामरदारुभ्यासिद्धंचैवानुवासनम्||२६||

alpavīryōmahādōṣērūkṣēkrūrāśayēkr̥taḥ|

bastirdōṣāvr̥tōruddhamārgōrundhyātsamīraṇam||21||

savimārgō:'nilaḥkuryādādhmānaṁmarmapīḍanam|

vidāhaṁgurukōṣṭhasyamuṣkavaṅkṣaṇavēdanām||22||

ruṇaddhihr̥dayaṁśūlairitaścētaścadhāvati|

śyāmāphalādibhiḥkuṣṭhakr̥ṣṇālavaṇasarṣapaiḥ||23||

dhūmamāṣavacākiṇvakṣāracūrṇaguḍaiḥkr̥tām|

karāṅguṣṭhanibhāṁvartiṁyavamadhyāṁnidhāpayēt||24||

abhyaktasvinnagātrasyatailāktāṁsnēhitēgudē|

athavālavaṇāgāradhūmasiddhārthakaiḥkr̥tām||25||

bilvādinānirūhaḥsyātpīlusarṣapamūtravān|

saralāmaradārubhyāsiddhaṁcaivānuvāsanam||26||

alpavIryo mahAdoShe rUkShe krUrAshaye kRutaH|

bastirdoShAvRuto ruddhamArgo rundhyAt samIraNam||21||

sa vimArgo~anilaH kuryAdAdhmAnaM marmapIDanam|

vidAhaM gurukoShThasya muShkava~gkShaNavedanAm||22||

ruNaddhi hRudayaM shUlairitashcetashca dhAvati|

shyAmAphalAdibhiH kuShThakRuShNAlavaNasarShapaiH||23||

dhUmamAShavacAkiNvakShAracUrNaguDaiH kRutAm|

karA~gguShThanibhAM vartiM yavamadhyAM nidhApayet ||24||

abhyaktasvinnagAtrasya tailAktAM snehite gude|

athavA lavaNAgAradhUmasiddhArthakaiH kRutAm||25||

bilvAdinA nirUhaH syAt pIlusarShapamUtravAn|

saralAmaradArubhyAM siddhaM caivAnuvAsanam||26||

Etiology, clinical manifestation and management of basti complication - adhmana (distension of abdomen)

When basti compounded with drugs of less potency administered in patients having mahadosha, krurakostha, rukshasharira, the basti dravya undergo avarana by dosha leading to margavarodha thus obstructs vata. The vata undergo vimarga-gamana results in adhmana (bloating of abdomen) along with following signs and symptoms:

• Marmapida (pain in vital parts) due to adhmana
• Vidaha (burning sensation) in guru koshtha
• Guru koshtha (heaviness in abdomen)
• Mushka-vankshana vedana (Pain over scrotum, groin)
• Hridayarodha and shula (heaviness over chest and pain)
• Itacsha itacsha dhavati (restlessness)

Management

Shyama etc. (Trivrit -Operculina terpethum Silva mansa.), chaturangula –Aragvadha (Cassia fistula Linn.), tilvaka, Mahavriksha, saptala, shankhini, danti, dravanti);

phala, etc (jimutaka, ikshwaku, dhamargava, kutaja (Holarrhena antidysenterica Wall.), kritavedana (drugs mentioned in Kalpa Sthana for virechana and vamanakarma), along with kustha (Saussurea lappa C.B.Clarke), krishna (Pippali-Piper longum Linn.), lavana, sarshapa (Brassica campestris Var.sarson Prain), grihadhuma, masha (Phsseolus mungo Linn.), vacha (Acorus calamus Linn.), kinva (surakitta), yava kshara are powdered and added with required amount of jaggery to prepare the varti of karangusta (thumb of hand) size and of shape of yava (Hordeum vulgare Linn.).

This varti (suppository) is to be smeared with oil and inserted into lubricated anal canal of patient, who has initially undergone sneha and sweda.

Suppositories may also be prepared by adding lavana, grihadhuma, siddharthaka (sarshapa- Brassica campestris Var.sarson Prain.).

Patients may also be administered niruhabasti prepared with bilva (Aegle marmelos Carr.) etc. added with pilu (Salvadora persica Linn.), sarshapa (Brassica campestris Var.sarson Prain.) and gomutra (cow’s urine).

Similarly anuvasanabasti (transrectal administration of unctuous formulations) may be administered with taila prepared with drugs of sarala (Pinus longifolia Roxb.), and amaradaru (Devadaru – Cedrus deodara Roxb.Loud.).[21-26]

Complication of hikka (hiccups)

मृदुकोष्ठेऽबलेबस्तिरतितीक्ष्णोऽतिनिर्हरन्|

कुर्याद्धिक्कां, हितंतस्मैहिक्काघ्नंबृंहणंचयत्||२७||

बलास्थिरादिकाश्मर्यत्रिफलागुडसैन्धवैः|

सप्रसन्नारनालाम्लैस्तैलंपक्त्वाऽनुवासयेत्||२८||

कृष्णालवणयोरक्षंपिबेदुष्णाम्बुनायुतम् |

धूमलेहरसक्षीरस्वेदाश्चान्नंचवातनुत्||२९||

mr̥dukōṣṭhē:'balēbastiratitīkṣṇō:'tinirharan|

kuryāddhikkāṁ, hitaṁtasmaihikkāghnaṁbr̥ṁhaṇaṁcayat||27||

balāsthirādikāśmaryatriphalāguḍasaindhavaiḥ|

saprasannāranālāmlaistailaṁpaktvā:'nuvāsayēt||28||

kr̥ṣṇālavaṇayōrakṣaṁpibēduṣṇāmbunāyutam |

dhūmalēharasakṣīrasvēdāścānnaṁcavātanut||29||

mRudukoShThe~abale bastiratitIkShNo~atinirharan|

kuryAddhikkAM, hitaM tasmai hikkAghnaM bRuMhaNaM ca yat||27||

balAsthirAdikAshmaryatriphalAguDasaindhavaiH|

saprasannAranAlAmlaistailaM paktvA~anuvAsayet||28||

kRuShNAlavaNayorakShaM pibeduShNAmbunA yutam |

dhUmaleharasakShIrasvedAshcAnnaM ca vAtanut||29||

Etiology, clinical manifestation and management of basti vyapat - hikka

Hikka is resulted due to excessive elimination of doshas by basti. Doshas are eliminated in excess when basti having qualities of excessive tikshna (sharply acting/penetrating) qualities administered in a patient of mridu kostha and abala (persons of poor strength).

In such cases hikkaghna (hic-cough suppressant therapy ) and brimhana (nourishment) therapies are advised.

• Administer anuvasana basti (unctuous enema) with taila (oil) prepared out of bala (Sida cordifolia Linn.), sthiradi (Sthira/Shaliparni (Desmodium gangeticum DC.), prisnipari (Uraria picta Desv.). brihati (Solanum indicum Linn), kantakari (Solanum xanthocarpum Schrad & Wendl.) and gokshura (Tribulus terrestris Linn.) - laghu panchamula drugs ; kashmarya -(gambhari -Gmelina arborea Linn.)), triphala i.e haritaki (Terminalia chebula Retz.), bibhitaki (Terminalia belerica Roxb.), amalaki (Emblica officinalis Gaertn.), guda (Jaggery), saindhava (rock salt), prasanna, amla aranala (sour fermented preparation).
• Administer mixture of krishna (pippali) (Piper longum Linn.) and saindhava lavana, in the dose of one aksha/karsha (12 g) with hot water.
• Dhuma, avaleha, mamsarasa, ksheera, sveda and anna which are vatahara should be administered. [27-29]

Complication due to basti afflicting the heart

अतितीक्ष्णःसवातोवानवासम्यक्प्रपीडितः|

घट्टयेद्धृदयंबस्तिस्तत्रकाशकुशेत्कटैः||३०||

स्यात्साम्ललवणस्कन्धकरीरबदरीफलैः|

शृतैर्बस्तिर्हितःसिद्धंवातघ्नैश्चानुवासनम्||३१||

atitīkṣṇaḥ savātō vā navā samyakprapīḍitaḥ|

ghaṭṭayēddhr̥dayaṁbastistatrakāśakuśētkaṭaiḥ||30||

syātsāmlalavaṇaskandhakarīrabadarīphalaiḥ|

śr̥tairbastirhitaḥsiddhaṁvātaghnaiścānuvāsanam||31||

atitIkShNaH savAto vA na vA samyak prapIDitaH|

ghaTTayeddhRudayaM bastistatra kAshakushetkaTaiH||30||

syAt sAmlalavaNaskandhakarIrabadarIphalaiH|

shRutairbastirhitaH siddhaM vAtaghnaishcAnuvAsanam||31||

Etiology, clinical manifestation and management of basti complication - hritprapti

When basti administered under following conditions leads to hritprapti (affliction of heart) and cause hridghatta:

• Basti prepared with ati-tikshna dravya (strongly medicated with sharp acting medicines)
• Administered along with air bubbles
• Administered without maintaining proper pressure (not properly compressed)

Management

• In case of hritprapti, niruhabasti is to be administered with decoction prepared out of kasha (Saccharum spontaneum Linn.), kusha (Eragrostis cynosuroides Beaur.), utkata (Phragmites kirka Trin.), amla skandha (sour category) drugs , lavana skandha drugs(salt category) , karira (Capparis aphylla Rotz.), badaraphala (Zizyphus jujuba Lam.).
• Anuvasanabasti may also be administered with medicines having vatahara property (like dashamula etc). [30-31]

Complications due to basti reaching oesophagus

वातमूत्रपुरीषाणांदत्तेवेगान्निगृह्णतः|

अतिवापीडितोबस्तिर्मुखेनायातिवेगवान्||३२||

मूर्च्छाविकारंतस्यादौदृष्ट्वाशीताम्बुनामुखम्|

सिञ्चेत्पार्श्वोदरंचाधःप्रमृज्याद्वीजयेच्चतम्||३३||

केशेष्वालम्ब्यचाकाशेधुनुयात्त्रासयेच्चतम्|

गोखराश्वगजैःसिंहैराजप्रेष्यैस्तथोरगैः||३४||

उल्काभिरेवमन्यैश्चभीतस्याधःप्रवर्तते|

वस्त्रपाणिग्रहैःकण्ठंरुन्ध्यान्नम्रियतेयथा||३५||

प्राणोदाननिरोधाद्धिप्रसिद्धतरमार्गवान्

अपानःपवनोबस्तिंतमाश्वेवापकर्षति||३६||

ततःक्रमुककल्काक्षंपाययेताम्लसंयुतम्|

औष्ण्यात्तैक्ष्यात्सरत्वाच्चबस्तिंसोऽस्यानुलोमयेत्||३७||

पक्वाशयस्थितेस्विन्नेनिरूहोदाशमूलिकः|

यवकोलकुलत्थैश्चविधेयोमूत्रसाधितः||३८||

बिल्वादिपञ्चमूलेनसिद्धोबस्तिरुरःस्थिते|

शिरःस्थेनावनंधूमःप्रच्छाद्यंसर्षपैःशिरः||३९||

vātamūtrapurīṣāṇāṁdattēvēgānnigr̥hṇataḥ|

ativāpīḍitōbastirmukhēnāyātivēgavān||32||

mūrcchāvikāraṁtasyādaudr̥ṣṭvāśītāmbunāmukham|

siñcētpārśvōdaraṁcādhaḥpramr̥jyādvījayēccatam||33||

kēśēṣvālambyacākāśēdhunuyāttrāsayēccatam|

gōkharāśvagajaiḥsiṁhairājaprēṣyaistathōragaiḥ||34||

ulkābhirēvamanyaiścabhītasyādhaḥpravartatē|

vastrapāṇigrahaiḥkaṇṭhaṁrundhyānnamriyatēyathā||35||

prāṇōdānanirōdhāddhiprasiddhataramārgavān

apānaḥpavanōbastiṁtamāśvēvāpakarṣati||36||

tataḥkramukakalkākṣaṁpāyayētāmlasaṁyutam|

auṣṇyāttaikṣyātsaratvāccabastiṁsō:'syānulōmayēt||37||

pakvāśayasthitēsvinnēnirūhōdāśamūlikaḥ|

yavakōlakulatthaiścavidhēyōmūtrasādhitaḥ||38||

bilvādipañcamūlēnasiddhōbastiruraḥsthitē|

śiraḥsthēnāvanaṁdhūmaḥpracchādyaṁsarṣapaiḥśiraḥ||39||

vAtamUtrapurIShANAM datte vegAnnigRuhNataH|

ati vA pIDito bastirmukhenAyAti vegavAn||32||

mUrcchAvikAraM tasyAdau dRuShTvA shItAmbunA mukham|

si~jcet pArshvodaraM cAdhaH pramRujyAdvIjayecca tam||33||

kesheShvAlambya cAkAshe dhunuyAttrAsayecca tam|

gokharAshvagajaiH siMhai rAjapreShyaistathoragaiH||34||

ulkAbhirevamanyaishca bhItasyAdhaH pravartate|

vastrapANigrahaiH kaNThaM rundhyAnna mriyate yathA||35||

prANodAnanirodhAddhi prasiddhataramArgavAn |

apAnaH pavano bastiM tamAshvevApakarShati||36||

tataH kramukakalkAkShaM pAyayetAmlasaMyutam|

auShNyAttaikShyAt saratvAcca bastiM so~asyAnulomayet||37||

pakvAshayasthite svinne nirUho dAshamUlikaH|

yavakolakulatthaishca vidheyo mUtrasAdhitaH||38||

bilvAdipa~jcamUlena siddho bastiruraHsthite|

shiraHsthe nAvanaM dhUmaH pracchAdyaM sarShapaiH shiraH||39||

Etiology, clinical manifestation and management of basti complication - urdhvagamana

Basti dravya will be expelled from mukha (orally), after administration of basti,

• If the person suppresses the urge of vata (flatus), mutra (urine) and purisha (stool) or
• If administered with more pressure.

Management

• Initially when murchha is seen, cold water sprinkling should be done on face.
• Followed by rubbing on sides of chest, abdomen and lower parts of body and cooling with fan.
• Raise the patient holding his hair only, into air and shake.
• Frighten him by ox, donkey, horse, elephant, lion, servants of king, snakes, ulka (fiery meteor), or by other threatening things.
• These cause adhopravartana of basti (normal intestinal movement will be restored).
• Press the throat (kantha) with either cloth or hand, taking care to prevent any death.
• This obstruction of throat leads to obstructing prana and udana vata, thus leading apana vata to take its normal path, reaches basti and eliminates the dosha.
• Then administer drink made with one aksha (karsha=12g) of kramuka (Areca catechu Linn.) paste along with amla (sour) dravya.
• Due to ushna (hot), teekshna (sharply acting), sara (moving) qualities, basti does anulomana (normalize peristaltic movements).
• If bastidravya stabilises in pakvashaya (large instestine), after swedana, niruha basti has to be administered prepared with dashamula (bilva, agnimantha, shyonaka, patala, gambhari, brihati, kantakari, shaliparni, prishniparni and gokshura) or yava (Hordeum vulgare Linn.), kola (Zizyphus jujube Ram.), kulattha (Dolichos biflorus Linn.), with gomutra (cow urine).
• If bastidravya is in ura-pradesha (chest region), administer niruha basti prepared of bilvadipanchamula decoction (roots of bilva (Aegle marmelos Carr.), agnimantha (Premna integrifolia Linn), shyonaka (Oroxylum indicum Vent.), patala (Stereospermum suaveolens DC.) and gambhari (Gmelina arborea Linn.).
• If basti dravya stay in head, administer navana (nasal administration), dhuma (smoke therapy) and external application of sarshapa (Brassica campestris Var. sarson prain) paste on head. [32-39]

Complication of pravahika (dysentery) due to basti

स्निग्धस्विन्नेमहादोषेबस्तिर्मृद्वल्पभेषजः|

उत्क्लिश्याल्पंहरेद्दोषंजनयेच्चप्रवाहिकाम्||४०||

सबस्तिपायुशोफेनजङ्घोरुसदनेनवा|

निरुद्धमारुतोजन्तुरभीक्ष्णंसम्प्रवाहते||४१||

स्वेदाभ्यङ्गान्निरूहांश्चशोधनीयानुलोमिकान्|

विदध्याल्लङ्घयित्वातुवृत्तिंकुर्याद्विरिक्तवत्||४२||

snigdhasvinnēmahādōṣēbastirmr̥dvalpabhēṣajaḥ|

utkliśyālpaṁharēddōṣaṁjanayēccapravāhikām||40||

sabastipāyuśōphēnajaṅghōrusadanēnavā|

niruddhamārutōjanturabhīkṣṇaṁsampravāhatē||41||

svēdābhyaṅgānnirūhāṁścaśōdhanīyānulōmikān|

vidadhyāllaṅghayitvātuvr̥ttiṁkuryādviriktavat||42||

snigdhasvinne mahAdoShe bastirmRudvalpabheShajaH|

utklishyAlpaM hareddoShaM janayecca pravAhikAm||40||

sa bastipAyushophena ja~gghorusadanena vA|

niruddhamAruto janturabhIkShNaM sampravAhate||41||

svedAbhya~ggAnnirUhAMshca shodhanIyAnulomikAn|

vidadhyAlla~gghayitvA tu vRuttiM kuryAdviriktavat||42||

Etiology, clinical manifestation and management of pravahika, a basti complication

Pravahika occurs when patient of mahadosha (excessively vitiated dosha) having undergone sneha (oleation) and sweda (sudation), administered with niruha basti, prepared of drugs with mridu quality and in lower dose. In such conditions dosha undergo utklesha (exciting) and doshas are expelled in alpamatra (little quantity) thus result in pravahika (dysentery).

Following other signs and symptoms are also seen:

• Shopha (swelling/inflammation) of basti/mutrashaya (bladder) & payu (anorectal region)
• Sadana (exhaustion) of jangha (calf region) and uru (thighs).
• Increased frequency of bowels due to obstructed vata

Management

• Abhyanga ( oil massage)
• Svedana (sudation)
• Niruha basti ( non-unctous enema with decoction)
• Shodhana dravya (trivrit etc. as mentioned in Kalpa Sthana 1st chapter) and
• Anulomana drugs (like ksheera (milk), ikshurasa (Saccharum officinarum Linn.)
• Langhana (fasting)
• Patient is to be advised to adopt vritti (specific diet regimen) i.e. peyadi krama /samsarjanakarma (post virechana management as per ca.su.15/16). [40-42]

Complication of shiro-arti (headache)

दुर्बलेक्रूरकोष्ठेचतीव्रदोषेतनुर्मृदुः|

शीतोऽल्पश्चावृतोदोषैर्बस्तिस्तद्विहतोऽनिलः||४३||

मार्गैर्गात्राणिसन्धावन्नूर्ध्वंमूर्ध्निविहन्यते|

ग्रीवांमन्येचगृह्णातिशिरःकण्ठंभिनत्तिच||४४||

बाधिर्यंकर्णनादंचपीनसंनेत्रविभ्रमम्|

कुर्यादभ्यञ्जनंतैललवणेनयथाविधि||४५||

युञ्ज्यात्प्रधमनैर्नस्यैर्धूमैरस्यविरेचयेत्|

तीक्ष्णानुलोमिकेनाथस्निग्धंभुक्तेऽनुवासयेत् ||४६||

durbalēkrūrakōṣṭhēcatīvradōṣē tanurmr̥duḥ|

śītō:'lpaścāvr̥tōdōṣairbastistadvihatō:'nilaḥ||43||

mārgairgātrāṇisandhāvannūrdhvaṁ mūrdhnivihanyatē|

grīvāṁmanyēcagr̥hṇātiśiraḥ kaṇṭhaṁ bhinattica||44||

bādhiryaṁkarṇanādaṁcapīnasaṁ nētravibhramam|

kuryādabhyañjanaṁtailalavaṇēnayathāvidhi||45||

yuñjyātpradhamanairnasyairdhūmairasyavirēcayēt|

tīkṣṇānulōmikēnāthasnigdhaṁ bhuktē:'nuvāsayēt ||46||

durbale krUrakoShThe ca tIvradoShe tanurmRuduH|

shIto~alpashcAvRuto doShairbastistadvihato~anilaH||43||

mArgairgAtrANi sandhAvannUrdhvaM mUrdhni vihanyate|

grIvAM manye ca gRuhNAti shiraH kaNThaM bhinatti ca||44||

bAdhiryaM karNanAdaM ca pInasaM netravibhramam|

kuryAdabhya~jjanaM tailalavaNena yathAvidhi||45||

yu~jjyAt pradhamanairnasyairdhUmairasya virecayet|

tIkShNAnulomikenAtha snigdhaM bhukte~anuvAsayet ||46||

Etiology, clinical manifestation and management of shiro-arti basti complication

Shiro-arti complication occurs when basti having qualities of tanu (not thick), mridu (mild), sheeta(cold) quality and in less dose administered to patients of durbala (weak), krura koshtha(hard bowel) and tivra dosha (severely vitiated dosha).

Avarita dosha (covered/ obstructed dosha) will further vitiate the agitated vata by niruha basti. Vitiated vata will run in all directions in the body, especially upward and affect the head.

Signs & symptoms

• Greeva manya graham (stiffness of muscles & tendons of neck)
• Shira, kantha bhedana (breaking type of pain in head & neck region)
• Badhirya (deafness)
• karnanada (tinnitus)
• pinasa, (rhinorrhoea)
• netra vibhrama (giddiness)

Management

• Abhyanga with lavana taila as per standard methods
• Shirovirechana with pradhamananasya and dhumapana
• Snigdha, teekshna, anulomaka bhojana
• Followed by teekshna, anulomika, anuvasana basti.[43-46]

Complication of anga-arti (body-ache)

अङ्गार्तिबस्ति व्यापत् हेतु-लक्षण-चिकित्सा

स्नेहस्वेदैरनापाद्यगुरुस्तीक्ष्णोऽतिमात्रया|

यस्यबस्तिःप्रयुज्येतसोऽतिमात्रंप्रवर्तयेत्||४७||

स्रुतेषुतस्यदोषेषुनिरूढस्यातिमात्रशः|

स्तब्धोदावृतकोष्ठस्यवायुःसम्प्रतिहन्यते||४८||

विलोमनसमुद्भूतोरुजत्यङ्गानिदेहिनः|

गात्रवेष्टननिस्तोदभेदस्फुरणजृम्भणैः ||४९||

तंतैललवणाभ्यक्तंसेचयेदुष्णवारिणा|

एरण्डपत्रनिष्क्वाथैःप्रस्तरैश्चोपपादयेत्||५०||

यवान्कुलत्थान्कोलानिपञ्चमूलेतथोभये|

जलाढकद्वयेपक्त्वापादशेषेणतेनच||५१||

कुर्यात्सबिल्वतैलोष्णलवणेननिरूहणम्|

तंनिरूढंसमाश्वस्तंद्रोण्यांसमवगाहयेत्||५२||

ततोभुक्तवतस्तस्यकारयेदनुवासनम्|

यष्टीमधुकतैलेनबिल्वतैलेनवाभिषक्||५३||

snēhasvēdairanāpādyagurustīkṣṇō:'timātrayā|

yasyabastiḥprayujyētasō:'timātraṁpravartayēt||47||

srutēṣutasyadōṣēṣunirūḍhasyātimātraśaḥ|

stabdhōdāvr̥takōṣṭhasyavāyuḥsampratihanyatē||48||

vilōmanasamudbhūtōrujatyaṅgānidēhinaḥ|

gātravēṣṭananistōdabhēdasphuraṇajr̥mbhaṇaiḥ ||49||

taṁtailalavaṇābhyaktaṁsēcayēduṣṇavāriṇā|

ēraṇḍapatraniṣkvāthaiḥprastaraiścōpapādayēt||50||

yavānkulatthānkōlānipañcamūlētathōbhayē|

jalāḍhakadvayēpaktvāpādaśēṣēṇatēnaca||51||

kuryātsabilvatailōṣṇalavaṇēnanirūhaṇam|

taṁnirūḍhaṁsamāśvastaṁdrōṇyāṁsamavagāhayēt||52||

tatōbhuktavatastasyakārayēdanuvāsanam|

yaṣṭīmadhukatailēnabilvatailēnavābhiṣak||53||

snehasvedairanApAdya gurustIkShNo~atimAtrayA|

yasya bastiH prayujyeta so~atimAtraM pravartayet||47||

sruteShu tasya doSheShu nirUDhasyAtimAtrashaH|

stabdhodAvRutakoShThasya vAyuH sampratihanyate||48||

vilomanasamudbhUto rujatya~ggAni dehinaH|

gAtraveShTananistodabhedasphuraNajRumbhaNaiH ||49||

taM tailalavaNAbhyaktaM secayeduShNavAriNA|

eraNDapatraniShkvAthaiH prastaraishcopapAdayet||50||

yavAn kulatthAn kolAni pa~jcamUle tathobhaye|

jalADhakadvaye paktvA pAdasheSheNa tena ca||51||

kuryAt sabilvatailoShNalavaNena nirUhaNam|

taM nirUDhaM samAshvastaM droNyAM samavagAhayet||52||

tato bhuktavatastasya kArayedanuvAsanam|

yaShTImadhukatailena bilvatailena vA bhiShak ||53||

Etiology, clinical manifestation and management of angarti basti complication

Angarti (body ache) occurs when doshas are eliminated in excess.

When basti having guru (heavy to digest) & tikshna (Sharply acting) properties is administered in patient who have not undergone proper purvakarma (sneha & sveda), the doshas are eliminated in excess and thus angarti is resulted.

Due to excessive elimination there will be stabdha (dullness of abdomen) & avrita koshthata (intestinal obstruction/ intussusception) and the vata gets affected.

Pain over body parts is produced due to upward movement of vata.

Signs & Symptoms:

• Gatra vesthana, (somatic pain)
• Nistoda, (pricking pain)
• Bheda (piercing type of pain)
• Sphurana (fasciculations)
• Jrimbhana (yawning) are also seen.

Management

• Abhyanga with lavanataila followed by sprinkling of hot water all over body.
• Prastara sweda through eranda patra kwatha (decoction of leaves of Ricinus communis Linn.).
• Yava (Hordeum vulgare Linn), kulattha (Dolichos biflorus Linn.), kola (Zizyphus jujube Lam.) and both types of panchamula i.e. Dashamula (as described in shloka no.37) added with two adhakha (12 kg. 228 g.) 13 of water and reduced to one-fourth. To this decoction add bilva (Aegle marmelos Carr.) taila and lavana. This is to be given as niruha basti when it is warm. Patient is to be given assurance as well as avagahasveda (sudation therapy through tub-bath). When once the patient taken food anuvasana basti is to be given with bilwa-taila (Aegle marmelos Carr.) or yastimadhu (Glycyrrhizaglabra Linn.) taila. [47-53]

Complication of parikartika (fissure in ano)

मृदुकोष्ठाल्पदोषस्य रूक्षस्तीक्ष्णोऽतिमात्रवान्|

बस्तिर्दोषान्निरस्याशु जनयेत् परिकर्तिकाम्||५४||

त्रिकवङ्क्षणबस्तीनां तोदं नाभेरधो रुजम्|

विबन्धोऽल्पाल्पमुत्थानं बस्तिनिर्लेखनाद्भवेत्||५५||

स्वादुशीतौषधैस्तत्र पय इक्ष्वादिभिः शृतम्|

यष्ट्याह्वतिलकल्काभ्यां बस्तिः स्यात् क्षीरभोजिनः||५६||

ससर्जरसयष्ट्याह्वजिङ्गिनीकर्दमाञ्जनम्|

विनीय दुग्धे बस्तिः स्यात् व्यक्ताम्लमृदुभोजिनः||५७||

mṛdukoṣṭhālpadoṣasyarūkṣastīkṣṇo:'timātravān|

bastirdoṣānnirasyāśujanayetparikartikām||54||

trikavaṅkṣaṇabastīnāṃtodaṃnābheradhorujam|

vibandho:'lpālpamutthānaṃbastinirlekhanādbhavet||55||

svāduśītauṣadhaistatrapayaikṣvādibhiḥśṛtam|

yaṣṭyāhvatilakalkābhyāṃbastiḥsyātkṣīrabhojinaḥ||56||

sasarjarasayaṣṭyāhvajiṅginīkardamāñjanam|

vinīyadugdhebastiḥsyātvyaktāmlamṛdubhojinaḥ||57||

mRudukoShThAlpadoShasya rUkShastIkShNo~atimAtravAn|

bastirdoShAnnirasyAshu janayet parikartikAm||54||

trikava~gkShaNabastInAM todaM nAbheradho rujam|

vibandho~alpAlpamutthAnaM bastinirlekhanAdbhavet||55||

svAdushItauShadhaistatra paya ikShvAdibhiH shRutam|

yaShTyAhvatilakalkAbhyAM bastiH syAt kShIrabhojinaH||56||

sasarjarasayaShTyAhvaji~gginIkardamA~jjanam|

vinIya dugdhe bastiH syAt vyaktAmlamRudubhojinaH||57||

Etiology, clinical manifestation and management of parikartika basti complication

Parikartika (anal pain due to proctitis) manifested when the patients of mridu koshtha, alpa dosha are administered with niruha basti of qualities -ruksha, tikshna or in higher dose.

Clinical manifestations

• Toda (pricking type of pain) over low-back, groins and urinary bladder.
• Rija (pain) over lower umbilical region
• Lekhana effect of basti may result in constipation and bowel evacuation in little quantities

Management

• Basti prepared out of milk processed with drugs having madhura & sita properties for example ikshurasa (sugar cane juice); and by adding paste of yastimadhu (Glycyrrhiza glabra Linn.) & tila (Sesamum indicum Linn.) is to be administered.
• Patient is to be kept on milk diet.
• Administer basti prepared with milk by adding sarjarasa (Vateria indica Linn.), yastimadhu (Glycyrrhiza glabra Linn.), jingini (Lannea grandis Engi.), kardama (Nelumbium speciosum Willd.), anjana (Extract of Berberis asiatica - Roxb. ex DC). The patient is to be kept on mridubhojana (soft diet) with amla rasa ( little sour in taste). [54-57]

Complication of paristrava (oozing through anus)

पित्तरोगेऽम्ल उष्णो वा तीक्ष्णो वा लवणोऽथवा|

बस्तिर्लिखति पायुं तु क्षिणोति विदहत्यपि||५८||

स विदग्धः स्रवत्यस्रं पित्तं चानेकवर्णवत्|

सार्यते बहुवेगेन मोहं गच्छति चासकृत्||५९||

आर्द्रशाल्मलिवृन्तैस्तु क्षुण्णैराजं पयः शृतम्|

सर्पिषा योजितं शीतं बस्तिमस्मै प्रदापयेत्||६०||

वटादिपल्लवेष्वेष कल्पो यवतिलेषु च|

सुवर्चलोपोदिकयोः कर्बुदारे च शस्यते||६१||

गुदे सेकाः प्रदेहाश्च शीताः स्युर्मधुराश्च ये|

रक्तपित्तातिसारघ्नी क्रिया चात्र प्रशस्यते||६२||

pittaroge:'mlauṣṇovātīkṣṇovālavaṇo:'thavā|

bastirlikhatipāyuṃtukṣiṇotividahatyapi||58||

savidagdhaḥsravatyasraṃpittaṃcānekavarṇavat|

sāryatebahuvegenamohaṃgacchaticāsakṛt||59||

ārdraśālmalivṛntaistukṣuṇṇairājaṃpayaḥśṛtam|

sarpiṣāyojitaṃśītaṃbastimasmaipradāpayet||60||

vaṭādipallaveṣveṣakalpoyavatileṣuca|

suvarcalopodikayoḥkarbudārecaśasyate||61||

gudesekāḥpradehāścaśītāḥsyurmadhurāścaye|

raktapittātisāraghnīkriyācātrapraśasyate||62||

pittaroge~amla uShNo vA tIkShNo vA lavaNo~athavA|

bastirlikhati pAyuM tu kShiNoti vidahatyapi||58||

sa vidagdhaH sravatyasraM pittaM cAnekavarNavat|

sAryate bahuvegena mohaM gacchati cAsakRut||59||

ArdrashAlmalivRuntaistu kShuNNairAjaM payaH shRutam|

sarpiShA yojitaM shItaM bastimasmai pradApayet||60||

vaTAdipallaveShveSha kalpo yavatileShu ca|

suvarcalopodikayoH karbudAre ca shasyate||61||

gude sekAH pradehAshca shItAH syurmadhurAshca ye|

raktapittAtisAraghnI kriyA cAtra prashasyate||62||

Etiology, clinical manifestation and management of parisrava (rectal oozing), a basti complication

In a patient of pitta roga (pitta dominant disorders), if basti having any of the qualities of amla (sour), ushna (hot potency), tikshna (sharply acting), lavana(salt) is administered, the basti dravya causes lekhana (irritates and injures) of payu (anus) resulting in injury and even vidaha (burning sensation). This leads to rakta (blood) and pitta oozes in different colors. Frequent/forced excretion will be followed by moha (unconsciousness) and asakrit (feeling of continuous defecation).

Management

• Basti made with –paste of ardra shalmali vrinta (leaf stalk/petioles of Bombax malabaricum DC) and goat milk, then heat it. Along with ghee basti is to be given when it is cold.
• Or administer basti prepared as a kalpa (like the above mentioned Shalmalivrintaksheerasamksarakalpa), with tender leaves of vata (Ficus bengalensis Linn.) etc., Yava (Hordeum vulgare Linn.), tila (Sesamum indicum Linn.), sauvarchala, upodika (Bacellaalba), karbudara (Bauhinia variegate Linn.).
• Sheka (sprinkling) or pradeha (application of paste) on anal region is also indicated with the drugs of madhura rasa (sweet taste) and shita guna (cold property).
• Therapies indicated in raktapitta and atisara are also beneficial.[58-62]

तीक्ष्णत्वं मूत्रपील्वग्निलवणक्षारसर्षपैः|

प्राप्तकालं विधातव्यं क्षीराद्यैर्मार्दवं तथा||६३||

tīkṣṇatvaṃmūtrapīlvagnilavaṇakṣārasarṣapaiḥ|

prāptakālaṃvidhātavyaṃkṣīrādyairmārdavaṃtathā||63||

tIkShNatvaM mUtrapIlvagnilavaNakShArasarShapaiH|

prAptakAlaM vidhAtavyaM kShIrAdyairmArdavaM tathA||63||

The tikshnata (strong sharp action) of bastidravya may be increased by adding gomutra (cow urine), pilu (Salvadora persica Linn.), agni (Chitraka-Plumbago zeylanica Linn.), lavana (salt), kshara (alkali), sarshapa (Brassica campestris Var.sarson Prain) and to improve mridutva of bastidravya, ksheera (milk) etc. is to be added.[63]

Overall cleansing effect of basti

आपादतलमूर्धस्थान् दोषान् पक्वाशये स्थितः|

वीर्येण बस्तिरादत्ते खस्थोऽर्को भूरसानिव||६४||

āpādatalamūrdhasthāndoṣānpakvāśayesthitaḥ|

vīryeṇabastirādattekhastho:'rkobhūrasāniva||64||

ApAdatalamUrdhasthAn doShAn pakvAshaye sthitaH|

vIryeNa bastirAdatte khastho~arko bhUrasAniva||64||

As sun located high in the sky dries up moisture of earth, in the same fashion basti situated in the pakvashaya due to its potency draws the doshas present entire in the body (head to toe).[64]

यद्वत् कुसुम्भसम्मिश्रात्तोयाद्रागं हरेत् पटः|

तद्वद्द्रवीकृताद्देहान्निरूहो निर्हरेन्मलान्||६५||

yadvatkusumbhasammiśrāttoyādrāgaṃharetpaṭaḥ|

tadvaddravīkṛtāddehānnirūhonirharenmalān||65||

yadvat kusumbhasammishrAttoyAdrAgaM haret paTaH|

tadvaddravIkRutAddehAnnirUho nirharenmalAn||65||

Purvakarma in the form of sneha and sweda commonly dissolves the doshas as well as body nutrients. However basti dravya eliminates only doshas as a piece of cloth soaked in a mixture of kusumbha (Carthamus tinctorius Linn.) (dye) and water get only dye.

Niruha basti will eliminate the liquefied malas (doshas) from body like the cloth which will remove (attains) the color of kusumbha (Carthamus tinctorius Linn.) mixed water. [65]

Summary

तत्र श्लोकः

इत्येता व्यापदः प्रोक्ता बस्तेः साकृतिभेषजाः|

बुद्ध्वा कार्त्स्न्येन तान् बस्तीन्नियुञ्जन्नापराध्यति||६६||

tatraślokaḥ

ityetāvyāpadaḥproktābasteḥsākṛtibheṣajāḥ|

buddhvākārtsnyenatānbastīnniyuñjannāparādhyati||66||

tatra shlokaH

ityetA vyApadaH proktA basteH sAkRutibheShajAH|

buddhvA kArtsnyena tAn bastInniyu~jjannAparAdhyati||66||

To summarize, complications of basti along with their causes, signs, symptoms and management are described. If a physician administers basti with proper knowledge and understanding of all these will never commit a mistake.[66]

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृतेऽप्राप्ते दृढबलसम्पूरिते

सिद्धिस्थाने बस्तिव्यापत्सिद्धिर्नाम सप्तमोऽध्यायः||७||

ityagniveśakṛtetantrecarakapratisaṃskṛte:'prāptedṛḍhabalasampūrite

siddhisthānebastivyāpatsiddhirnāmasaptamo:'dhyāyaḥ||7||

In this way seventh chapter namely successful treatment of complications of basti of Siddhi Sthana of Charaka Samhita written by Agnivesha, edited by Charaka and redacted by Dridhabala is completed.[7]

Tattva Vimarsha (Fundamental Principles)

• Basti therapy has local and systemic effects on the body. Basti drugs can enter into systemic circulation.
• Properties of ingredients in basti formulation, its composition shall be considered in order to assess pharmaceutical properties of basti.
• Examination of koshtha (bowel habit), agni (digestive power), prakriti (constitution) and dosha dominance of disease are important assessment factors for deciding appropriate basti formulation in the condition.
• The above factors and skill of administration are important to have desired effect and avoid complications.

Vidhi Vimarsha (Applied Inferences )

There is debate in Ayurveda community on action of basti i.e. whether basti have local action or systemic action. The example coated by Charaka: "as sun located high in the sky dries up moisture of earth, in the same fashion basti situated in the pakvashaya due to its potency draws the doshas present in the entire body, similarly, basti acts locally as well as systemically". To exert systemic effect the active ingredients of basti need to be absorbed. In general osmosis, pH difference, active absorption, facilitated diffusion, electrochemical gradient, micelles facilitated transportation etc. are the methods of intestinal absorption. Hence composition of basti need to be compounded in such a way so that the active ingredients of basti are absorbed by following any one of the principles as explained earlier. Further basti dravya also need to address intestinal motility related issues.

When we analyze the method of niruha basti preparation i.e kashaya, kalka, sneha, saindhavalavana etc. clearly indicates that basti kalpana is made very carefully to maintain desired pH, osmotic pressure, micelle formation etc.

In spite of taking care of yogya (suitable), ayogya(unsuitable) for basti and other aspects of basti dosha still there are chances of complications. All the factors leading to basti complications may be explained broadly under the headings of:

• Factors related to basti composition, consistency & dose
• Factors related to basti administration
• Factors related to patients’ clinical condition

The signs and symptoms described for various basti complications are broadly categorised under

• Intestinal motility related
• Water and electrolyte balance related
• Local anal inflammatory conditions

Complications of basti may result either due to errors in compounding it or consistency basti, dose or temperature of basti dravya at the time of administration. However, these complications may result depending on body response to the above-mentioned factors. The responses may be explained under three headings viz. excessive response (atiyoga), poor/low/no response (ayoga) and faulty response (mithyayoga). [5-6]

Etiology, clinical manifestation and management of basti complication-ayoga

Ayoga (poor/low/no response) complication of basti may result either due to quality of dravya or due to patient condition or combination of both.

Poor response due to quality of bastidravya

Sheetaguna causes sthambhana. Sthambhana means stationary or movement less. In this context decreased intestinal motility is to be considered. Decreased intestinal motility may result in abdominal distension.

• Sufficient quantity of lavana (salt – rock salt) is required to maintain optimum osmotic pressure so that ionic exchange takes place. If optimum osmolality is not attained the active ingredients which are supposed to be absorbed through osmotic pressure are not absorbed and thus desired efficacy may not be achieved.
• Sufficient quantity of sneha (unctuous part - oil/ghee) is also important. Lipids in the form of sneha facilitate lipid mediated transportation. Insufficient quantity of sneha minimizes the lipid mediated transportation and thus desired efficacy is not achieved. Further salt present in basti helps in micelle (smallest particle of lipid) formation of lipids and facilitates absorption of lipids.

Poor response due to patient condition

• Guru koshtha (hard bowel) is the condition where in the digestion process is delayed mostly due to sluggish intestinal motility. In such cases basti predominant of sheetaguna further worsen the problem as sheeta does stambhana.
• Vata predominance in general or ruksha in particular both require lavana or sneha to counteract. If bastidravya is compounded with insufficient quantity of lavana and sneha, there will be further aggravation of vata or ruksha of vatadosha. In this case it should be understood that, there is already negative ionic gradient (both osmotic / lipid mediated) and hence sufficient quantity of lavana/sneha are required to convert it into positive ionic gradient so that active ingredients are transported through osmotic pressure or lipid mediated ionic transportation.

The management is mainly aimed at inducing/increasing intestinal peristaltic movements. Dipana-pachana drugs stimulates gastro-intestinal tract secretions and increases intestinal motility. Anal suppository, virechana and basti also induces/increases intestinal motility. [7-11]

Etiology, clinical manifestation and management of basti complication-atiyoga

Atiyoga (excessive response) complication of basti is seen when patients of mridukostha (sensitive GI tract) had undergone sneha and sveda which further sensitize the GI tract when administered with basti, prepared out of ushna and tikshna (high potent/irritant drugs), leads to hyper stimulation of intestinal tract, excessive elimination of bodily fluids, thus results in electrolyte imbalance and dehydration. The signs and symptoms mentioned are related to dehydration and electrolyte imbalance.

The drugs and other mediums used for management of atiyoga are rich in drava guna, also having characteristics like balya (promotive of strength) brimhana (promotes growth) and jeevaniya (promotes life). These can help to make up for the loss of body fluids and other vital body elements that may be lost due to atiyoga of basti. [12-14]

Management

Amashesha indicates incomplete digestion process. In such conditions mridu basti further suppress digestion. In case of indigestion we need to stimulate secretion of digestive juices and hence the management is to use measures which hasten the digestive process.

Management with pachana in conditions precipitated with presence of ama is very logical. Ama primarily accounts for agnimandya (lowers the digestive power) and action of pachana as told by Arundatta at Ash. Hru. Su.8/21-22, is removing causes of obstruction that come in the way of function of agni, and ama is one of them, signifying role of pachana.

Basti given in this avastha (condition) should be vyakta lavana (salt in profound quantity). Basic characteristics of lavana as told by Vagbhata in As. Hru, Su.6/144, are vishyandi (means one which helps to liquify and release the doshas from obstruction if any), sukshma (which can reach easily at cellular level), srishtamala (which accounts for easy elimination of mutra (urine) purisha (stool) etc. ama in present context), and mridu (soft) in nature.

These characteristics of lavana helps in releasing the obstruction caused by pitta kapha dosha along with ama.[15-20]

As already discussed, the basti should contain enough tikshanata to induce enough peristalsis as well as to stimulate secretion of digestive enzymes. In case of krura kostha naturally there will be alternate phases of samavastha and vishamagni. Hence in krurakostha, mahadoshavastha drugs with less potency are administered which further decrease peristaltic movements thus leading to abdominal distension.

Due to doshas obstructing the path of vayu by covering it, resultant vata prakopa causes vimargagamana of vayu (vayu changing its normal path) leading to adhmana (flatulance) which creates marmapida (pain in vital parts) making koshtha (abdomen) guru i.e. krura (which leads to constipating habits) or malapurna (due to inaction of vayu mala gets accumulated (as per Chakrapani commentary at Cha.Si. 7/7-11). [21-26]

Due to excess elimination of doshas from strong basti given to weak patient, vata prakopa takes place leading to upward movement of vitiated vata, as a result of which hikka, which originates from amashaya (stomach) is observed.

Line of treatment of hikka along with brimhana is applied. Brimhana counters vata and at the same time will also increase dhatu which is in a debilitated state in this case.[27-29]

Considering aetiology, signs & symptoms and management, hritghattana may be understood as epigastric discomfort. The air present in the basti may cause obstruction. The management is also aimed to stimulate gastrointestinal secretions, and intestinal motility to relieve colic.

In the management amla and lavana rasa is prefered over other rasa, because of its anulomana (downward direction) action. Furthermore amla rasa is known for its specific function related to vata, as moodhavatanulomana (brings about vata doing abnormal movement to its normal movement). In this vyapat as hridaya is involved amla which is best among hridya articles (Ch. Su. 25/40) is a natural choice. [30-31]

The management is done by shodhaniya and anulomika basti. Anulomika basti is to be given by ksheera (milk) ikshurasa (sugarcane juice). Here milk, ikshurasa etc is brimhana, which acts as vatashamana, at the same time it induces shodhana due to its sara guna. This can be understood by opinion of Arundatta at Ash.Hru.Su 14/7, where he says that in case of vata and vata-pitta, brimhana like milk etc. acts as shodhana.[40-42]

The treatment goes in a very methodical way with application of oil with salt for countering vata vitiation, followed by nasya in form of powders blown in to nostrils and dhoom medicated fumes made to inhale, acts for elimination of doshas that are present in the head. This is followed by food which is tikshna in property and anulomika which helps to regulate vata in its normal direction, followed by anuvasana basti. This takes care of agitated vata having taken the course of head to go out through anus which is its normal root of elimination.[43-46]

To manage angarti (bodyache) types of swedana selected are sarvadehika (applicable to whole body) like prastara, seka. To counter vata these are preceded with application of oil with salt. Which takes care of vitiation of vata all over the body.[ 47-53]

The management given aims at soothening and softening the bowels and to also promote healing. Milk, sugarcane juice helps in countering dryness of the large intestine due to their snigdha guna. Diet rich in mridu guna and amla rasa further helps in keeping softness of the bowel intact as well as maintaining normal actin of vata. [54-57]

Basti dominating with amla lavana rasa and ushna tikshna properties in a patient suffering from disease of pitta dosha leads to further vitiation of pitta, this in turn vitiates rakta which is seat of pitta dosha, starts coming out through anus. The best remedy for this is piccha basti which has medicines acting for stopping the blood flow and also promotes healing. [58-62]

Relevant verses and further reading

1. Charak Samhita - Chikitsa Sthana 19 /19-22
2. Ibid - Siddhi Sthana 3/14-15
3. Ibid - Siddhi Sthana 6 /45-46
4. Ibid – Chikitsa Sthana 15
5. Ibid – Siddhi Sthana 3 /35-36
6. Ibid – Siddhi Sthana 12 /18/13
7. Ibid – Kalpa Sthana 1 /6
8. Ibid – Siddhi Sthana 7/11
9. Ibid – Chikitsa Sthana 17
10. Ibid – Siddhi Sthana 3/35-45 (Chakrapani commentary)
11. Ibid – Vimana Sthana 8/140
12. Ibid – Vimana Sthana 8/141
13. ibid – Siddhi Sthana 7/40-42 (Chakrapani commentary)
14. Kim E. Barret, Susan M. Burman, Scott Boitano, Heddwen L. Brooks, Ganong’s physiology: “ch.26 Overview of gastrointestinal function & Regulation”,23rd Edition, Tata MCGraw Hill Education Private Limited, NewDelhi,2010, p.448.
15. Ibid.,ch.28, Gastrointestinal motility, p.478.