Panchakarmiya Siddhi

Siddhi Sthana Chapter 2. Standard methods of Application of Panchakarma

Abstract

Charaka Samhita Siddhi Sthana is designed to discuss the proper methods of application of Panchakarma as well as complications of the same due to improper use and their successful management. In the previous chapter (Kalpana Siddhi), various aspects of administration of Panchakarma were discussed. Pravritti (indications) and nivritti (contraindications) of Panchakarma are essential to discuss without which successful administration cannot be assured. In the beginning of the chapter, persons unsuitable for both shodhana and shamana chikitsa are mentioned. At the end of the chapter, it is stated that in spite of having all the instructions, a wise physician should use his own wisdom and reasoning in arriving at the correct judgment as in many cases contraindications turn into indications and vice versa according to the stage of disease and need of the patient.

Keywords: Asthapana-basti, Anuvasana-basti, Panchakarma, Siddhi, Shirovirechana, Vamana, Virechana.

Panchakarmiya Siddhi

Section/Chapter	Siddhi Sthana Chapter 2
Preceding Chapter	Kalpana Siddhi
Succeeding Chapter	Bastisutriyam Siddhi
Other Sections	Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Chikitsa Sthana, Kalpa Sthana

Introduction

Dhatusamya i.e. equilibrium of body tissues needs to be maintained for disease free state. It is achieved by the prevention and promotion of health as well as cure of diseases. The cure of diseases is done by two means i.e. shodhana chikitsa (bio-purification therapy) and shamana-chikitsa (alleviation therapy). Shodhana-karma or chikitsa is generally considered as a synonym of Panchakarma and is accepted as the best therapy for cure of diseases without recurrence. If we go into the depth, we find that there are minor differences between shodhana-chikitsa and Panchakarma. Shodhana-chikitsa is of two types on the basis of external and internal purification where as Panchakarma is only related to internal purification of the body. Another important aspect is that there may be a long list of shodhana-karmas but Panchakarma are only five biopurificatory procedures. Vamana (therapeutic emesis), virechana (therapeutic purgation), asthapana-basti (therapeutic enema having more quantity of decoction), anuvasana-basti (therapeutic enema with medicated oil, ghee etc. fatty substances) and shirovirechana (head-evacuation) are considered under the heading of Panchakarma. These five procedures, eliminate the doshas in more quantity and are more potent in purification of the body. These procedures are intended to bring vitiated dosha from periphery (shakha) to gut (koshtha) and then expel them outside from nearest external orifice thoroughly. Some scholars include raktamokshana (blood-letting) among Panchakarma. However this opinion is not acceptable as it removes dosha directly from shakha without any prior effect on vitiated dosha in gut. Hence Raktamokshana cannot be considered under panchakarma.

Panchakarma are supposed to produce Kaya-kalpa i.e. dramatic changes in the body provided properly administered considering desha (habitat), kala (season), dosha i.e. vata, pitta and kapha, dushya (those which get vitiated), koshtha (nature of bowel), agni (digestive power), bala (body strength) and prakriti (constitution of the body). Before administration of Panchakarma, indications and contra-indications are essential to be considered to achieve the desired effects. Panchakarmiya Siddhi is written to discuss the suitable and unsuitable persons or patients for each of the procedure of Panchakarma which is very much crucial in getting the success. Instructions laid down in this chapter are as per general rule which are followed in most of the cases but exceptions are also found in the text considering the particular stage of disease.

Sanskrit text, Transliteration and English Translation

अथातः पञ्चकर्मीयां सिद्धिं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

athātaḥ Panchkarmiyaṁ siddhiṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2||

athAtaH pa~jcakarmIyAM siddhiM vyAkhyAsyAmaH||1||

iti ha smAha bhagavAnAtreyaH||2||

Now we shall expound the chapter named Panchakarmiya Siddhi dealing with successful administration of Panchakarma therapies. As said by Lord Atreya. [1-2]

येषां यस्मात् पञ्चकर्माण्यग्निवेश न कारयेत्|
येषां च कारयेत्तानि तत् सर्वं सम्प्रवक्ष्यते||३||

yēṣāṁ yasmāt pañcakarmāṇyagnivēśa na kārayēt|
yēṣāṁ ca kārayēttāni tat sarvaṁ sampravakṣyatē||3||

yeShAM yasmAt pa~jcakarmANyAgniveśaa na kArayet|
yeShAM ca kArayettAni tat sarvaM sampravakShyate||3||

O! Agnivesha, we will now describe about the patients for whom Panchakarma therapies are contra-indicated with proper reasoning and the patients for whom Panchakarma are indicated. [3]

Persons who are generally anupakramya (unsuitable for treatment)

चण्डः साहसिको भीरुः कृतघ्नो व्यग्र एव च|

सद्राजभिषजां द्वेष्टा तद्द्विष्टः शोकपीडितः||४||

यादृच्छिको मुमूर्षुश्च विहीनः करणैश्च यः|

वैरी वैद्यविदग्धश्च श्रद्धाहीनः सुशङ्कितः||५||

भिषजामविधेयश्च नोपक्रम्या भिषग्विदा|

एतानुपचरन् वैद्यो बहून् दोषानवाप्नुयात्||६||

एभ्योऽन्ये समुपक्रम्या नराः सर्वैरुपक्रमैः|

अवस्थां प्रविभज्यैषां वर्ज्यं कार्यं च वक्ष्यते||७||

caṇḍaḥ sāhasiko bhīruḥ kr̥taghnō vyagra ēva ca|

sadrājabhiṣajāṁ dvēṣṭā taddviṣṭaḥ śōkapīḍitaḥ||4||

yādr̥cchiko mumūrṣuśca vihīnaḥ karaṇaiśca yaḥ|

vairī vaidyavidagdhaśca śraddhāhīnaḥ suśaṅkitaḥ||5||

bhiṣajāmavidhēyaśca nōpakramyā bhiṣagvidā|

ētānupacaran vaidyō bahūn dōṣānavāpnuyāt||6||

ēbhyō'nyē samupakramyā narāḥ sarvairupakramaiḥ|

avasthāṁ pravibhajyaiṣāṁ varjyaṁ kāryaṁ ca vakṣyatē||7||

caNDaH sAhasiko bhIruH kRutaghno vyagra eva ca|

sadrAjabhiShajAM dveShTA taddviShTaH shokapIDitaH||4||

yAdRucchiko mumUrShushca vihInaH karaNaishca yaH|

vairI vaidyavidagdhashca shraddhAhInaH susha~gkitaH||5||

bhiShajAmavidheyashca nopakramyA bhiShagvidA|

etAnupacaran vaidyo bahUn doShAnavApnuyAt||6||

ebhyo~anye samupakramyA narAH sarvairupakramaiH|

avasthAM pravibhajyaiShAM varjyaM kAryaM ca vakShyate||7||

The wise physician should not treat the following types of patients:

1. Who is fierceful or aggressive, adventurous, fearful, ungrateful and fickle minded;
2. Who hates good persons, kings and physicians and who is intensely disliked by them;
3. Who is afflicted with grief;
4. Who does not believe in God (nastika)
5. Who is in the end stage of disease and is predicted to die soon;
6. Who is not in position to collect the essential items (karana) for the treatment;
7. Who is enemy or hostile to the physician;
8. Who is an impostor and considers himself to be a physician;
9. Who is unfaithful to the physician;
10. Who is always suspicious (doubtful); and
11. Who is not obedient to the physician. The physician, who administers Panchakarma or any medicine to the above mentioned types of patients, faces many difficulties and does not get success. Persons other than those mentioned above are suitable for all types of Panchakarma or treatment procedures.

Henceforth, we will discuss the indications and contra-indications of each of the procedure of Panchakarma therapies considering the different situations. [4-7]

Contra-indications of vamana karma

अवम्यास्तावत्-क्षतक्षीणातिस्थूलातिकृशबालवृद्धदुर्बलश्रान्तपिपासितक्षुधितकर्मभाराध्वहतोपवासमैथुनाध्ययनव्यायामचिन्ता-प्रसक्तक्षामगर्भिणीसुकुमारसंवृतकोष्ठदुश्छर्दनोर्ध्वरक्तपित्तप्रसक्तच्छर्दिरूर्ध्ववातास्थापितानुवासितहृद्रोगोदावर्तमूत्राघात-प्लीहगुल्मोदराष्ठीलास्वरोपघाततिमिरशिरशङ्खकर्णाक्षिशूलार्ताः||८||

avamyāstāvat- kṣatakṣīṇātisthūlātikr̥śabālavr̥ddhadurbalaśrāntapipāsitakṣudhitakarmabhārādhvahatōpavāsamaithunādhyayanavyāyāmacintā-prasaktakṣāmagarbhiṇīsukumārasaṁvr̥takōṣṭhaduśchardanōrdhvaraktapittaprasaktacchardirūrdhvavātāsthāpitānuvāsitahr̥drōgōdāvartamūtrāghāta-plīhagulmōdarāṣṭhīlāsvarōpaghātatimiraśiraśaṅkhakarṇākṣiśūlārtāḥ||8||

avamyAstAvat- kShatakShINAtisthUlAtikRushabAlavRuddhadurbalashrAntapipAsitakShudhitakarmabhArAdhvahatopavAsamaithunAdhyayanavyAyAmacintA-prasaktakShAmagarbhiNIsukumArasaMvRutakoShThadushchardanordhvaraktapittaprasaktacchardirUrdhvavatasthApitAnuvAsitahRudrogodAvartamUtrAghAta-plIhagulmodarAShThIlAsvaropaghAtatimirashirasha~gkhakarNAkShishUlArtAH||8||

The persons or patients for whom vamana is contraindicated are mentioned in the following table:

Serial No.	Disease or State in which vamana is contraindicated	Translation in English
1	Kshata	Chest Injury
2	Kshina	Emaciated
3	Atishula	Excessively Obese
4	Atikrisha	Excessively Lean
5	Baala	Children (aged under 10 years)
6	Vriddha	Old/Elderly
7	Durbala	Weak
8	Shraanta	Fatigued
9	Pipasita	Thirsty
10	Kshudhita	Hungry
11	Karmahata	Work related fatigue
12	Bhaarahata	Exhaustion due to carrying heavy-weight
13	Adhvahata	Exhaustion due to wayfaring/walking on foot
14	Upavaasa-prasakta-kshaama	Weakness due to excessive fasting
15	Maithuna-prasakta-kshaama	Exhaustion due to excessive sexual activities
16	Adhyayana-prasakta-kshaama	Exhaustion due to excessive academic activities
17	Vyayama-prasakta-kshaama	Exhaustion due to excessive physical exercise
18	Chinta-prasakta-kshaama	Exhaustion due to excessive worry/anxiety
19	Garbhini	Pregnant Woman
20	Sukumara	One having tender health
21	Samvritta Koshtha	One having obstructed bowel
22	Dushchardana	One who does not respond to emesis easily
23	Urdhvaraktapitta	One suffering from bleeding from the upper tract.
24	Prasaktachhardi	(One suffering from) Continuous vomiting
25	Urdhvavata	One suffering from upward movement of vata.
26	Asthapita	One who has taken medicated enema (having higher amount of decoction)
27	Anuvasita	One who has taken medicated enema (having higher amount of decoction)
28	Hridroga	Heart disease
29	Udavarta	Disorder due to improper functioning of vata
30	Mutraghata	Anuria/Oliguria
31	Pleeha-roga	Splenic disorder
32	Gulma	Abdominal lump
33	Udara-roga	Obstinate abdominal diseases including ascites
34	Ashtheela	Enlarged prostrate
35	Svaropaghaata	Choked voice
36	Timira	Cataract
37	Shirahshoolaarta	One suffering from headache
38	Shankhashoolaarta	One suffering from pain in temporal region
39	Karnashoolaarta	One suffering from pain in the ears
40	Akshishoolaarta	One suffering from pain in the eyes

[8]

Adverse effects of vamana karma administered in contra-indicated conditions

तत्र क्षतस्य भूयः क्षणनाद्रक्तातिप्रवृत्तिः स्यात्, क्षीणातिस्थूलकृशबालवृद्धदुर्बलानामौषधबलासहत्वात् प्राणोपरोधः,श्रान्तपिपासितक्षुधितानां च तद्वत्, कर्मभाराध्वहतोपवासमैथुनाध्ययनव्यायामचिन्ताप्रसक्तक्षामाणां रौक्ष्याद्वातरक्तच्छेदक्षतभयं स्यात्, गर्भिण्या गर्भव्यापदामगर्भभ्रंशाच्चदारुणा रोगप्राप्तिः, सुकुमारस्यहृदयापकर्षणादूर्ध्वमधो वा रुधिरातिप्रवृत्तिः, संवृतकोष्ठदुश्छर्दनयोरतिमात्रप्रवाहणाद्दोषाः समुत्क्लिष्टा अन्तःकोष्ठे जनयन्त्यन्तर्विसर्पं स्तम्भं जाड्यं वैचित्त्यं मरणं वा, ऊर्ध्वगरक्तपित्तिन उदानमुत्क्षिप्य प्राणान् हरेद्रक्तं चातिप्रवर्तयेत्,प्रसक्तच्छर्देस्तद्वत्, ऊर्ध्ववातास्थापितानुवासितानामूर्ध्वं वातातिप्रवृत्तिः, हृद्रोगिणोहृदयोपरोधः, उदावर्तिनो घोरतर उदावर्तःस्याच्छीघ्रतरहन्ता, मूत्राघातादिभिरार्तानां तीव्रतरशूलप्रादुर्भावः, तिमिरार्तानां तिमिरातिवृद्धिः, शिरःशूलादिषु शूलातिवृद्धिः;तस्मादेते न वम्याः| सर्वेष्वपि तु खल्वेतेषु विषगरविरुद्धाजीर्णाभ्यवहारामकृतेष्वप्रतिषिद्धं शीघ्रतरकारित्वादेषामिति ||९||

tatra kṣatasya bhūyaḥ kṣaṇanādraktātipravr̥ttiḥ syāt, kṣīṇātisthūlakr̥śabālavr̥ddhadurbalānāmauṣadhabalāsahatvāt prāṇōparōdhaḥ,śrāntapipāsitakṣudhitānāṁ ca tadvat, karmabhārādhvahatōpavāsamaithunādhyayanavyāyāmacintāprasaktakṣāmāṇāṁ raukṣyādvātaraktacchēdakṣatabhayaṁ syāt, garbhiṇyā garbhavyāpadāmagarbhabhraṁśāccadāruṇā rōgaprāptiḥ, sukumārasyahr̥dayāpakarṣaṇādūrdhvamadhō vā rudhirātipravr̥ttiḥ, saṁvr̥takōṣṭhaduśchardanayōratimātrapravāhaṇāddōṣāḥ samutkliṣṭā antaḥkōṣṭhē janayantyantarvisarpaṁ stambhaṁ jāḍyaṁ vaicittyaṁ maraṇaṁ vā, ūrdhvagaraktapittina udānamutkṣipya prāṇān harēdraktaṁ cātipravartayēt,prasaktacchardēstadvat, ūrdhvavātāsthāpitānuvāsitānāmūrdhvaṁ vātātipravr̥ttiḥ, hr̥drōgiṇōhr̥dayōparōdhaḥ, udāvartinō ghōratara udāvartaḥsyācchīghratarahantā, mūtrāghātādibhirārtānāṁ tīvrataraśūlaprādurbhāvaḥ, timirārtānāṁ timirātivr̥ddhiḥ, śiraḥśūlādiṣu śūlātivr̥ddhiḥ; tasmādētē navamyāḥ| sarvēṣvapi tu khalvētēṣu viṣagaraviruddhājīrṇābhyavahārāmakr̥tēṣvapratiṣiddhaṁ śīghratarakāritvādēṣāmiti ||9||

tatra kShatasya bhUyaH kShaNanAdraktAtipravRuttiH syAt, kShINAtisthUlakRushabAlavRuddhadurbalAnAmauShadhabalAsahatvAt prANoparodhaH,shrAntapipAsitakShudhitAnAM ca tadvat, karmabhArAdhvahatopavAsamaithunAdhyayanavyAyAmacintAprasaktakShamanAM raukShyAdvataraktacchedakShatabhayaM syAt, garbhiNyA garbhavyApadAmagarbhabhraMshAccadAruNA rogaprAptiH, sukumArasyahRudayApakarShaNAdUrdhvamadho vA rudhirAtipravRuttiH, saMvRutakoShThadushchardanayoratimAtrapravAhaNAddoShAH samutkliShTAantaHkoShThe janayantyantarvisarpaM stambhaM jADyaM vaicittyaM maraNaM vA, Urdhvagaraktapittina udAnamutkShipya prANAn haredraktaMcAtipravartayet, prasaktacchardestadvat, UrdhvavatasthApitAnuvAsitAnAmUrdhvaM vatatipravRuttiH, hRudrogiNohRudayoparodhaH, udAvartino ghorataraudAvartaH syAcchIghratarahantA, mUtrAghAtAdibhirArtAnAM tIvratarashUlaprAdurbhAvaH, timirArtAnAM timirAtivRuddhiH, shiraHshUlAdiShu shUlAtivRuddhiH;tasmAdete na vamyAH| sarveShvapi tu khalveteShu viShagaraviruddhAjIrNAbhyavahArAmakRuteShvapratiShiddhaM shIghratarakAritvAdeShAmiti ||9||

If a person suffering from kshata (chest injury) is given vamana (emetic therapy), then it further aggravates the injury (to the lungs) and causes excessive haemoptysis.

If vamana is given to a person who is ksheena (emaciated), atisthula, atikrisha, bala, vriddha and durbala, then this produce danger to their life because such types of patients are incapable to tolerate the effects of drugs which are used for vamana. The similar effect is observed when vamana is administered to a person who is fatigued, thirsty and hungry.

If vamana is administered to a person who is broken down by doing hard work, carrying excessive weight and travels long on foot, and who is weakened by long term fasting, sexual indulgence, study, exercise and worry, then because of dryness, the vata in his body gets aggravated. He may get hemorrhage and injury to his lungs.

If a pregnant woman is given vamana, then this may produce complications of pregnancy and occurrence of severe diseases because of the abortion of immature fetus.

If the person who is delicate is given vamana, then because of undue pressure on the heart, it may give rise to hemorrhage from the upward or downward tracts.

If a person whose koshtha (bowel) is occluded or who does not respond to vamana therapy easily, then the administration of this therapy leads to excessive bouts of urge for vomiting leading to the aggravation of dosha and these dosha cause internal visarpa (erysipelas), stambha (stiffness), jadya (dullness), vaichitya (mental perversion) or death.

If vamana is administered to a person suffering from urdhvaga-raktapitta, it may take out vital breath by pushing udana upwards and may cause excessive bleeding. Similar effects are observed if vamana is given to a person who is already suffering from constant vomiting.

If the vamana is administered to a person suffering from urdhvavata, and who has taken asthapana or anuvasana types of medicated enema, then it causes upward movement of the vata in excess.

If vamana is given to a person suffering from heart disease, it causes the sudden cessation of cardiac motion i.e. cardiac arrest. If vamana is administered to a person suffering from udavarta, it causes severe udavarta (disorder due to improper functioning of vata) which results in death of the patient shortly.

Vamana given to a person suffering from mutraghata (oliguria/anuria), pliha-roga (splenic disorder), gulma (abdominal lump) etc. diseases, causes pain of more severe nature.

Vamana given to the patients suffering from timira (cataract), increases the cataract.

Vamana given to the persons suffering from headache, pain in the ears and eyes etc. leads to aggravation of pain. Therefore, vamana is contra-indicated for all these types of patients. However, in all these cases vamana is not contra-indicated in the conditions of poisons, artificial poisons, incompatible food, intake of food during indigestion and ama (ailment caused by the product of improper digestion and metabolism) because these conditions are of emergent nature. [9]

Indications of vamana karma

शेषास्तु वम्याः; विशेषतस्तु पीनसकुष्ठनवज्वरराजयक्ष्मकासश्वासगलग्रहगलगण्डश्लीपदमेहमन्दाग्निविरुद्धाजीर्णान्नविसूचिकालसकविषगरपीतदष्टदिग्धविद्धाधःशोणितपित्तप्रसेक (दुर्नाम )हृल्लासारोचकाविपाकापच्यपस्मारोन्मादातिसारशोफपाण्डुरोगमुखपाकदुष्टस्तन्यादयः श्लेष्मव्याधयो विशेषेणमहारोगाध्यायोक्ताश्च; एतेषु हि वमनं प्रधानतममित्युक्तं केदारसेतुभेदे शाल्याद्यशोषदोषविनाशवत्||१०||

śēṣāstu vamyāḥ; viśēṣatastu pīnasakuṣṭhanavajvararājayakṣmakāsaśvāsagalagrahagalagaṇḍaślīpadamēhamandāgniviruddhājīrṇānnavisūcikālasakaviṣagarapītadaṣṭadigdhaviddhādhaḥśōṇitapittaprasēka (durnāma )hr̥llāsārōcakāvipākāpacyapasmārōnmādātisāraśōphapāṇḍurōgamukhapākaduṣṭastanyādayaḥślēṣmavyādhayō viśēṣēṇa mahārōgādhyāyōktāśca;

ētēṣu hi Vamanṁ pradhānatamamityuktaṁkēdārasētubhēdē śālyādyaśōṣadōṣavināśavat||10||

sheShAstu vamyAH; visheShatastu pInasakuShThanavajvararAjayakShmakAsashvAsagalagrahagalagaNDashlIpadamehamandAgniviruddhAj-

IrNAnnavisUcikAlasakaviShagarapItadaShTadigdhaviddhAdhaHshoNitapittapraseka (durnAma )hRullAsArocakAvipAkApacyapasmAronmAdAtisArashophapANDurogamukhapAkaduShTastanyAdayaHshleShmavyAdhayo visheSheNa mahArogAdhyAyoktAshca;

eteShu hi VamanM pradhAnatamamityuktaMkedArasetubhede shAlyAdyashoShadoShavinAshavat||10||

vamana karma is indicated for the diseases other than above mentioned but especially useful in the diseases given in the following table:

Serial No.	Disease or State (in which vamana is contraindicated)	Translation in English
1	Peenasa	Coryza
2	Kushtha	All types of skin diseases, including leprosy
3	Navajwara	Acute fever
4	Rajayakshma	Tuberculosis
5	Kaasa	Cough
6	Shvaasa	Bronchia Asthma
7	Galagraha	Spasm in the throat
8	Galagandha	Goitre
9	Shleepada	Elephantiasis
10	Meha	Obstinate urinary disorders, including diabetes mellitus
11	Mandaagni	Supression of digestion fire
12	Viruddhaanna	Ailments caused due to intake of incompatible diet
13	Ajeernaanna	Ailments caused due to indigestion
14	Vishuchika	Cholera
15	Alasaka	Intestinal torpor
16	Visha-peeta	Ailments caused by ingesting natural poisons
17	Gara-peeta	Ailments caused by ingesting artificial/synthetic poisons
18	Visha-dashta	Poisonous bites
19	Visha-digdha-viddha	Ailments caused due to injury with weapons laced with poison
20	Adhah - shonitapitta	Diseases characterized by bleeding from downward tracts
21	Praseka	Excessive salivation
22	Durnaama	Piles
23	Hrillasa	Nausea
24	Arochaka	Anorexia
25	Avipaaka	Indigestion
26	Apachi	Cervical adenitis
27	Apasmara	Epilepsy
28	Unmada	Psychotic disorders
29	Atisara	Diarrhea
30	Shopha	Swelling
31	Pandu Roga	Anemia
32	Mukhapaaka	Stomatitis
33	Dushta-stanya	Vitiated breast milk
34	Shelshmavyadhayo Visheshena Maharogadhyayoktah	All Kapha-dosha disorders mentioned in the Maharoga Adhyaya of Charaka Samhita Sutra Sthana

In these above mentioned conditions, action of vamana karma in causing cure of diseases caused by aggravation of kapha being similar to water laden paddy field getting spoiled due to clogging of water which can be corrected by the letting out the water out of the field like vamana does with kapha. [10]

Contra-indications of virechana karma

अविरेच्यास्तु सुभगक्षतगुदमुक्तनालाधोभागरक्तपित्तिविलङ्घितदुर्बलेन्द्रियाल्पाग्निनिरूढकामादिव्यग्राजीर्णिनवज्वरि-मदात्ययिताध्मातशल्यार्दिताभिहतातिस्निग्धरूक्षदारुणकोष्ठाः क्षतादयश्च गर्भिण्यन्ताः||११||

avirēcyāstusubhagakṣatagudamuktanālādhōbhāgaraktapittivilaṅghitadurbalēndriyālpāgninirūḍhakāmādivyagrājīrṇinavajvari-madātyayitādhmātaśalyārditābhihatātisnigdharūkṣadāruṇakōṣṭhāḥ kṣatādayaśca garbhiṇyantāḥ||11||

avirecyAstusubhagakShatagudamuktanAlAdhobhAgaraktapittivila~gghitadurbalendriyAlpAgninirUDhakAmAdivyagrAjIrNinavajvari-madAtyayitAdhmAtashalyArditAbhihatAtisnigdharUkShadAruNakoShThAH kShatAdayashca garbhiNyantAH||11||

The cases which are considered unfit for Virechana Karma are mentioned in the following table:

Serial No.	Disease or State (in which virechana is contraindicated)	Translation in English
1	Subhaga	A person with tender health or soft perineum
2	Kshataguda	(A person with) lacerated/bruised anorectum
3	Muktanaala	(A person with) prolapsed rectum
4	Adobhaaga-raktapitti	Bleeding through downward tracts
5	Vilanghita	(A person who is)weakened due to excessive fasting
6	Durbalendriya	(A person with) weak sensory and motor organs
7	Alpaagni	(A person with) poor digestive fire
8	Niruddha	(A person who has taken) niruha type of enema
9	Kaamadivyagra	(A person whose) mind is agitated by passion/sexual emotions.
10	Ajeerna	Indigestion
11	Navajwara	Acute fever
12	Madaatyayita	Suffering from alchoholism
13	Aadhmaata	Abdominal distention or tympanitis
14	Shalyaardita	Inflicted with foreign bodies
15	Abhihata	Injured
16	Atisnigdha	Over-unctuous
17	Atiruksha	Excessively dry/rough
18	Daarunakoshtha	(A person with) hard bowel
19	Kshataadayah Garbhinyantaah	Those in the category of conditions ranging from injured to pregnant, under contraindication of vamana

[11]

Adverse effects of virechana karma administered in contra-indicated conditions

तत्र सुभगस्य सुकुमारोक्तो दोषः स्यात्, क्षतगुदस्य क्षते गुदे प्राणोपरोधकरीं रुजां जनयेत्, मुक्तनालमतिप्रवृत्त्या हन्यात्,अधोभागरक्तपित्तिनं तद्वत्, विलङ्घितदुर्बलेन्द्रियाल्पाग्निनिरूढा औषधवेगं न सहेरन्, कामादिव्यग्रमनसो न प्रवर्तते कृच्छ्रेणवा प्रवर्तमानमयोगदोषान् कुर्यात्, अजीर्णिन आमदोषः स्यात्, नवज्वरिणोऽविपक्वान् दोषान् न निर्हरेद् वातमेव च कोपयेत्,मदात्ययितस्य मद्यक्षीणे देहे वायुः प्राणोपरोधं कुर्यात्, आध्मातस्याधमतो वा पुरीषकोष्ठे निचितो वायुर्विसर्पन्सहसाऽऽनाहं तीव्रतरं मरणं वा जनयेत्, शल्यार्दिताभिहतयोः क्षते वायुराश्रितो जीवितं हिंस्यात्, अतिस्निग्धस्यातियोगभयंभवेत्, रूक्षस्य वायुरङ्गप्रग्रहं कुर्यात्, दारुणकोष्ठस्य विरेचनोद्धता दोषाहृच्छूलपर्वभेदानाहाङ्गमर्दच्छर्दिमूर्च्छाक्लमाञ्जनयित्वा प्राणान् हन्युः, क्षतादीनां गर्भिण्यन्तानां छर्दनोक्तो दोषः स्यात्;तस्मादेते न विरेच्याः||१२||

tatra subhagasya sukumārōktō dōṣaḥ syāt, kṣatagudasya kṣatē gudē prāṇōparōdhakarīṁ rujāṁ janayēt,muktanālamatipravr̥ttyā hanyāt, adhōbhāgaraktapittinaṁ tadvat, vilaṅghitadurbalēndriyālpāgninirūḍhāauṣadhavēgaṁ na sahēran, kāmādivyagramanasō na pravartatē kr̥cchrēṇa vā pravartamānamayōgadōṣānkuryāt, ajīrṇina āmadōṣaḥ syāt, navajvariṇō'vipakvān dōṣān na nirharēd vātamēva ca kōpayēt, madātyayitasyamadyakṣīṇē dēhē vāyuḥ prāṇōparōdhaṁ kuryāt, ādhmātasyādhamatō vā purīṣakōṣṭhē nicitō vāyurvisarpansahasānāhaṁ tīvrataraṁ maraṇaṁ vā janayēt, śalyārditābhihatayōḥ kṣatē vāyurāśritō jīvitaṁ hiṁsyāt,atisnigdhasyātiyōgabhayaṁ bhavēt, rūkṣasya vāyuraṅgapragrahaṁ kuryāt, dāruṇakōṣṭhasya virēcanōddhatādōṣā hr̥cchūlaparvabhēdānāhāṅgamardacchardimūrcchāklamāñjanayitvā prāṇān hanyuḥ, kṣatādīnāṁgarbhiṇyantānāṁ chardanōktō dōṣaḥ syāt; tasmādētē na virēcyāḥ||12||

tatra subhagasya sukumArokto doShaH syAt, kShatagudasya kShate gude prANoparodhakarIM rujAM janayet,muktanAlamatipravRuttyA hanyAt, adhobhAgaraktapittinaM tadvat, vila~gghitadurbalendriyAlpAgninirUDhAauShadhavegaM na saheran, kAmAdivyagramanaso na pravartate kRucchreNa vA pravartamAnamayogadoShAnkuryAt, ajIrNina AmadoShaH syAt, navajvariNo~avipakvAn doShAn na nirhared vAtameva ca kopayet, madAtyayitasyamadyakShINe dehe vĀyuH prANoparodhaM kuryAt, AdhmAtasyAdhamato vA purIShakoShThe nicito vĀyurvisarpansahasA~a~anAhaM tIvrataraM maraNaM vA janayet, shalyArditAbhihatayoH kShate vĀyurAshrito jIvitaM hiMsyAt,atisnigdhasyAtiyogabhayaM bhavet, rUkShasya vĀyura~ggapragrahaM kuryAt, dAruNakoShThasya virecanoddhatAdoShA hRucchUlaparvabhedAnAhA~ggamardacchardimUrcchAklamA~jjanayitvA prANAn hanyuH, kShatAdInAMgarbhiNyantAnAM chardanokto doShaH syAt; tasmAdete na virecyAH||12||

If virechana is given to a person who is subhaga (having tender health or soft perineum), then he or she will suffer from the same disorder as described for vamana administered to sukumara (having tender health).

Virechana given to the person suffering from anal injury will cause severe pain in the injured anus which may be even life threatening.

Virechana administered to the person suffering from prolapsed rectum may cause excessive diarrhea and prolapse which leads to the death of the patient. Similar adverse effects are observed if virechana is administered in the person suffering from adhobhaga-raktapitta (disease characterized by bleeding through the downward tract).

A person, who is specifically lightened due to fasting, has weak senses, low power of digestion or who has undergone niruha type of enema, cannot tolerate the effects of virechana medicines.

If virechana is given to the person whose mind is agitated by passion etc., then there will be either no purgation or purgation with difficulty. In such conditions, harmful effects are observed due to improper administration of virechana.

Virechana administered in the persons suffering from ajirna (indigestion) causes diseases due to ama (product of improper digestion and metabolism).

Virechana given to the patients suffering from acute fever does not eliminate the dosha which are unripened and causes aggravation of vata dosha.

Virechana administered to a person suffering from alcoholism and whose body is emaciated due to over use of wine leads to aggravation of vata dosha and causes danger to his life.

Virechana given in that suffering from tympanitis, vata accumulated in the chamber of feces may spread further which cause sudden more severe abdominal distension or death.

Virechana given in a person suffering from foreign body inside the body or injured by weapons, vata located in the wound may take away the life.

Virechana administered in the person who is excessively uncted or oleated, exerts the excessive effects and in a "dry" (un-oily) person, vata may produce stiffness in the body parts. Virechana given to the person having costive bowel, dosha excited by purgation may produce cardiac pain, tearing pain in joints, anaha (hardness of bowels, constipation), body-ache, vomiting, fainting and exhaustion. This may lead to the death of the patient.

Virechana given in those suffering from disease beginning with kshata (chest wound) and ending with pregnancy, the defects said under vamana may arise. Therefore, above mentioned persons should not be treated with virechana karma. [12]

Indications of virechana karma

शेषास्तु विरेच्याः; विशेषतस्तुकुष्ठज्वरमेहोर्ध्वरक्तपित्तभगन्दरोदरार्शोब्रध्नप्लीहगुल्मार्बुदगलगण्डग्रन्थिविसूचिकालसकमूत्राघातक्रिमिकोष्ठविसर्प-पाण्डुरोगशिरःपार्श्वशूलोदावर्तनेत्रास्यदाहहृद्रोगव्यङ्गनीलिकानेत्रनासिकास्यस्रवणहलीमकश्वासकासकामला-पच्यपस्मारोन्मादवातरक्तयोनिरेतोदोषतैमिर्यारोचकाविपाकच्छर्दिश्वयथूदरविस्फोटकादयः पित्तव्याधयो विशेषेणमहारोगाध्यायोक्ताश्च; एतेषु हि विरेचनं प्रधानतममित्युक्तमग्न्युपशमेऽग्निगृहवत्||१३||

śēṣāstu virēcyāḥ; viśēṣatastukuṣṭhajvaramēhōrdhvaraktapittabhagandarōdarārśōbradhnaplīhagulmārbudagalagaṇḍagranthivisūcikālasakamūtrāghātakrimikōṣṭhavisarpa-pāṇḍurōgaśiraḥpārśvaśūlōdāvartanētrāsyadāhahr̥drōgavyaṅganīlikānētranāsikāsyasravaṇahalīmakaśvāsakāsakāmalā-pacyapasmārōnmādavātaraktayōnirētōdōṣataimiryārōcakāvipākacchardiśvayathūdaravisphōṭakādayaḥ pittavyādhayō viśēṣēṇamahārōgādhyāyōktāśca; ētēṣu hi virēcanaṁ pradhānatamamityuktamagnyupaśamē'gnigr̥havat||13||

sheShAstu virecyAH; visheShatastukuShThajvaramehordhvaraktapittabhagandarodarArshobradhnaplIhagulmArbudagalagaNDagranthivisUcikAlasakamUtrAghAtakrimikoShThavisarpa-pANDurogashiraHpArshvashUlodAvartanetrAsyadAhahRudrogavya~gganIlikAnetranAsikAsyasravaNahalImakashvAsakAsakAmalA-pacyapasmAronmAdavAtaraktayoniretodoShataimiryArocakAvipAkacchardishvayathUdaravisphoTakAdayaH pittavyAdhayo visheSheNamahArogAdhyAyoktAshca; eteShu hi VirecanaM pradhAnatamamityuktamagnyupashame~agnigRuhavat||13||

The persons other than above-mentioned are fit for virechana karma. It is specially advised for the persons mentioned in the table below:

Serial No.	Disease or State (in which virechana is indicated)	Translation in English
1	Kushtha	Obstinate skin diseases, including leprosy
2	Jwara	Fever
3	Meha	Obstinate urinary disorders, including diabetes mellitus
4	Urdhva-Raktapitta	Bleeding from upward tracts
5	Bhagandara	Fistula in ano
6	Udara roga	Obstinate abdominal diseases, including ascites
7	Arsha roga	Piles
8	Bradhna roga	Inguinal swelling
9	Pleeha roga	Splenomegaly
10	Gulma roga	Abdominal lump
11	Arbuda roga	Tumor
12	Galagandha	Goitre
13	Granthi roga	Lymphadenitis/cystic swellings
14	Visuchika roga	Cholera
15	Alasaka roga	Intestinal torpor
16	Mutraghata	Oliguria/Anuria
17	Krimikoshtha	Helminthiasis
18	Visarpa roga	Erysipelas
19	Pandu roga	Anemia
20	Sirah shula	Headache
21	Parshva shula	Pain in lateral sides of chest
22	Udavarta roga	Upward and oblique movement of wind in abdomen
23	Netra daaha	Burning sensation in the eyes
24	Aasya daaha	Burning sensation in the mouth
25	Hridroga	Heart disease
26	Vyanga roga	Dark brownish patches over the face
27	neelika roga	Bluish black moles
28	Netra sravana	Excessive discharge from the eyes
29	Naasika sravana	Excessive discharge from the nose
30	Aasya sravana	Excessive salivation
31	Haleemaka	A type of jaundice
32	Shvasa roga	Dyspnea
33	Kaasa roga	Cough
34	Kaamala	Jaundice
35	Apachi roga	Cervical adenitis
36	Apasmara roga	Epilepsy
37	Unmada roga	Psychotic disorders
38	Vatarakta	Gout
39	Yoni dosha	Defects of female genital tract
40	Retodosha	Defects of semen
41	Timira	Cataract
42	Arochaka	Anorexia
43	Avipaka	Indigestion
44	Chhardi	Vomiting
45	Shvayathu	Edema
46	Visphotaka	Pustular eruptions
47	Pitta vyadhyayo visheshena Maharogadhyayoktah	Paittika type disorders mentioned in Maharoga Adhyaya of Charaka Samhita Sutra Sthana

For the above-mentioned diseases, virechana karma is the foremost therapy. As the extinguisher of fire normalizes a house on fire, similarly virechana karma cures the diseases by eliminating aggravated pitta. [13]

Contra-indications of asthapana basti

अनास्थाप्यास्तुअजीर्ण्यतिस्निग्धपीतस्नेहोत्क्लिष्टदोषाल्पाग्नियानक्लान्तातिदुर्बलक्षुत्तृष्णाश्रमार्तातिकृशभुक्तभक्तपीतोदकवमितविरिक्तकृतनस्तः-

कर्मकुद्धभीतमत्तमूर्च्छितप्रसक्तच्छर्दिनिष्ठीविकाश्वासकासहिक्काबद्धच्छिद्रोदकोदराध्मानालसकविसूचिकामप्रजातामातिसार-मधुमेहकुष्ठार्ताः||१४||

anāsthāpyāstuajīrṇyatisnigdhapītasnēhōtkliṣṭadōṣālpāgniyānaklāntātidurbalakṣuttr̥ṣṇāśramārtātikr̥śabhuktabhaktapītōdakavamitaviriktakr̥tanastaḥ-

karmakuddhabhītamattamūrcchitaprasaktacchardiniṣṭhīvikāśvāsakāsahikkābaddhacchidrōdakōdarādhmānālasakavisūcikāmaprajātāmātisāra-madhumēhakuṣṭhārtāḥ||14||

anAsthApyAstuajIrNyatisnigdhapItasnehotkliShTadoShAlpAgniyAnaklAntAtidurbalakShuttRuShNAshramArtAtikRushabhuktabhaktapItodakavamitaviriktakRutanastaH-

karmakuddhabhItamattamUrcchitaprasaktacchardiniShThIvikAshvAsakAsahikkAbaddhacchidrodakodarAdhmAnAlasakavisUcikAmaprajAtAmAtisAra-madhumehakuShThArtAH||14||

Administration of asthapana or niruha basti is contra-indicated in the persons mentioned in the table given below:

Serial No.	Disease or State (in which asthapana basti is contraindicated)	Translation in English
1	Ajeerna	Indigestion
2	Atisnigdha	Over-unctuous
3	Peetasneha	(A person who has just ingested) smoothening/uncting substances
4	Utklishtha dosha	(A person who has) excited dosha
5	Alpaagni	Suppression of the power of digestion
6	Yaanaklaanta	(A person who is) exhausted due to riding
7	Atidurbala	(A person who is) excessively weak
8	Kshudhaarta	(A person who is) excessively hungry
9	Trishnaarta	(A person who is) excessively thirsty
10	Shramaarta	(A person who is) excessively tired (of doing laborious work)
11	Atikrisha	(A person who is) excessively emaciated
12	Bhuktabhakta	(A person who has) just ingested food
13	Peetodaka	(A person who has) just drunk water
14	Vamita	(A person who has) just undergone emesis
15	Virikta	(A person who has) just undergone purgation
16	Krita nastah karma	(A person who has) just used snuff (powder)
17	Kruddha	Anger
18	Bheeta	(A person who is) under the grip of fear
19	Matta	(A person who is) under the influence of narcosis
20	Murchhita	(A person who has) fainted
21	Prasaktachhardi	(A person who is) continuously vomiting
22	Nishtheevika	(A person who is) excessively spitting
23	Shvasa roga	Dyspnea
24	Kaasa roga	Cough
25	Hikka roga	Hiccup
26	Baddhodaraadhmaana	Tympanitis due to intestinal obstruction
27	Chidrodaraadhmaana	Tympanitis due to intestinal perforation
28	Udakodaraadhmaana	Tympanitis due to ascites
29	Alasaka roga	Intestinal torpor
30	Visuchika roga	Cholera
31	Amaprajaata	A woman who has delivered a premature baby
32	Amatisaara	Diarrhea associated with the symptoms of ama, i.e., the product of indigestion
33	Madhumeha	Diabetes mellitus
34	Kushtha roga	Obstinate skin diseases including leprosy

[14]

Adverse effects of asthapana basti administered in contra-indicated persons

तत्राजीर्ण्यतिस्निग्धपीतस्नेहानां दूष्योदरं मूर्च्छाश्वयथुर्वा स्यात्, उत्क्लिष्टदोषमन्दाग्न्योररोचकस्तीव्रः, यानक्लान्तस्य क्षोभव्यापन्नोबस्तिराशु देहं शोषयेत्, अतिदुर्बलक्षुत्तृष्णाश्रमार्तानां पूर्वोक्तोदोषः स्यात्, अतिकृशस्य कार्श्यं पुनर्जनयेत्,भुक्तभक्तपीतोदकयोरुत्क्लिश्योर्ध्वमधो वा वायुर्बस्तिमुत्क्षिप्य क्षिप्रं घोरान् विकाराञ्जनयेत्, वमितविरिक्तयोस्तु रूक्षं शरीरं निरूहःक्षतं क्षार इव दहेत्, कृतनस्तःकर्मणो विभ्रंशं भृशसंरुद्धस्रोतसः कुर्यात्, क्रुद्धभीतयोर्बस्तिरूर्ध्वमुपप्लवेत्, मत्तमूर्च्छितयो र्भृशंविचलितायां सञ्ज्ञायां चित्तोपघाताद् व्यापत् स्यात्, प्रसक्तच्छर्दिर्निष्ठीविकाश्वासकासहिक्कार्तानामूर्ध्वीभूतो वायुरूर्ध्वं बस्तिं नयेत्,बद्धच्छिद्रोदकोदराध्मानार्तानां भृशतरमाध्माप्य बस्तिः प्राणान् हिंस्यात्, अलसकविसूचिकामप्रजातामातिसारिणामामकृतो दोषःस्यात्, मधुमेहकुष्ठिनोर्व्याधेः पुनर्वृद्धिः; तस्मादेते नास्थाप्याः||१५||

tatrājīrṇyatisnigdhapītasnēhānāṁ dūṣyōdaraṁ mūrcchāśvayathurvā syāt, utkliṣṭadōṣamandāgnyōrarōcakastīvraḥ, yānaklāntasyakṣōbhavyāpannō bastirāśu dēhaṁ śōṣayēt, atidurbalakṣuttr̥ṣṇāśramārtānāṁ pūrvōktōdōṣaḥ syāt, atikr̥śasya kārśyaṁ punarjanayēt,bhuktabhaktapītōdakayōrutkliśyōrdhvamadhō vā vāyurbastimutkṣipya kṣipraṁ ghōrān vikārāñjanayēt, vamitaviriktayōstu rūkṣaṁ śarīraṁnirūhaḥ kṣataṁ kṣāra iva dahēt, kr̥tanastaḥkarmaṇō vibhraṁśaṁ bhr̥śasaṁruddhasrōtasaḥ kuryāt,kruddhabhītayōrbastirūrdhvamupaplavēt, mattamūrcchitayō rbhr̥śaṁ vicalitāyāṁ sañjñāyāṁ cittōpaghātād vyāpat syāt,prasaktacchardirniṣṭhīvikāśvāsakāsahikkārtānāmūrdhvībhūtō vāyurūrdhvaṁ bastiṁ nayēt, baddhacchidrōdakōdarādhmānārtānāṁ bhr̥śataramādhmāpya bastiḥ prāṇān hiṁsyāt, alasakavisūcikāmaprajātāmātisāriṇāmāmakr̥tō dōṣaḥ syāt, madhumēhakuṣṭhinōrvyādhēḥpunarvr̥ddhiḥ; tasmādētē nāsthāpyāḥ||15||

tatrAjIrNyatisnigdhapItasnehAnAM dUShyodaraM mUrcchAshvayathurvA syAt, utkliShTadoShamandAgnyorarocakastIvraH, yAnaklAntasyakShobhavyApanno bastirAshu dehaM shoShayet, atidurbalakShuttRuShNAshramArtAnAM pUrvoktodoShaH syAt, atikRushasya kArshyaMpunarjanayet, bhuktabhaktapItodakayorutklishyordhvamadho vA vĀyurbastimutkShipya kShipraM ghorAn vikArA~jjanayet, vamitaviriktayosturUkShaM sharIraM nirUhaH kShataM kShAra iva dahet, kRutanastaHkarmaNo vibhraMshaM bhRushasaMruddhasrotasaH kuryAt,kruddhabhItayorbastirUrdhvamupaplavet, mattamUrcchitayo rbhRushaM vicalitAyAM sa~jj~jAyAM cittopaghAtAd vyApat syAt,prasaktacchardirniShThIvikAshvAsakAsahikkArtAnAmUrdhvIbhUto vĀyurUrdhvaM bastiM nayet, baddhacchidrodakodarAdhmAnArtAnAMbhRushataramAdhyApya bastiH prANAn hiMsyAt, alasakavisUcikAmaprajAtAmAtisAriNAmAmakRuto doShaH syAt, madhumehakuShThinorvyAdheHpunarvRuddhiH; tasmAdete nAsthApyAH||15||

Application of Asthapana-basti (non-unctuous enema) in the persons suffering from indigestion, over-uncted and just taken unctuous substances causes dushyodara (udara-roga caused by aggravation of all the three dosha), fainting or edema. In the cases having excited dosha and suppression of digestion power, it causes severe type of anorexia. In a person exhausted due to riding, the asthapana-basti disturbed by agitation dry up the body quickly leading to emaciation. In the persons who are excessively weak and suffering from excessive hunger, thirst and tiredness, basti causes the same harms as discussed for exhausted due to riding. In excessively emaciated person if asthapana-basti is applied, it increases the emaciation. In those who have just taken food and water, asthapana basti causes provocation of vata which divert the enema upwards or downwards leading to manifestation of severe diseases soon. In that undergone emesis or purgation, the niruha or asthapana-basti burns the body as alkali does the wound. In a person who has undergone the snuffing, it causes the untoward effects related to sense organs and further obstruction of the channels of circulation. In the person having anger and fear, the basti may go upwards and produce agitation. In the condition of narcosis and fainting, the basti causes further agitation and there may be complications due to mental injury. If asthapana basti is applied in the conditions of constant vomiting, excessive spitting, dyspnea, cough and hiccup, vata moving upwards can cause upward movement of basti. In the persons suffering from intestinal obstruction, intestinal perforation and ascites associated with tympanitis, asthapana basti further increase the distension and may lead to the death of the patient. In the persons suffering from alasaka, visuchika, premature delivery and amatisara, it causes the disorders due to ama (product of improper digestion). In diabetes mellitus and kushtha (obstinate skin diseases including leprosy), application of asthapana basti further increases these diseases. Therefore, asthapana basti should not be given to the above mentioned persons.[15]

Indications of asthapana basti

शेषास्त्वास्थाप्याः; विशेषतस्तुसर्वाङ्गैकाङ्गकुक्षिरोगवातवर्चोमूत्रशुक्रसङ्गबलवर्णमांसरेतःक्षयदोषाध्मानाङ्गसुप्तिक्रिमिकोष्ठोदावर्तशुद्धातिसार-पर्वभेदाभितापप्लीहगुल्मशूलहृद्रोगभगन्दरोन्मादज्वरब्रध्नशिरःकर्णशूलहृदयपार्श्वपृष्ठकटीग्रहवेपनाक्षेपकगौरवातिलाघव-रजःक्षयार्तविषमाग्निस्फिग्जानुजङ्घोरुगुल्फपार्ष्णिप्रपदयोनिबाह्वङ्गुलिस्तनान्तदन्तनखपर्वास्थिशूल-शोषस्तम्भान्त्रकूजपरिकर्तिकाल्पाल्पसशब्दोग्रगन्धोत्थानादयो वातव्याधयो विशेषेण महारोगाध्यायोक्ताश्च;एतेष्वास्थापनं प्रधानतममित्युक्तं वनस्पतिमूलच्छेदवत्||१६||

śēṣāstvāsthāpyāḥ; viśēṣatastusarvāṅgaikāṅgakukṣirōgavātavarcōmūtraśukrasaṅgabalavarṇamāṁsarētaḥkṣayadōṣādhmānāṅgasuptikrimikōṣṭhōdāvartaśuddhātisāra-parvabhēdābhitāpaplīhagulmaśūlahr̥drōgabhagandarōnmādajvarabradhnaśiraḥkarṇaśūlahr̥dayapārśvapr̥ṣṭhakaṭīgrahavēpanākṣēpakagauravātilāghava-rajaḥkṣayārtaviṣamāgnisphigjānujaṅghōrugulphapārṣṇiprapadayōnibāhvaṅgulistanāntadantanakhaparvāsthiśūla-śōṣastambhāntrakūjaparikartikālpālpasaśabdōgragandhōtthānādayō vātavyādhayō viśēṣēṇa mahārōgādhyāyōktāśca; ētēṣvāsthāpanaṁpradhānatamamityuktaṁ vanaspatimūlacchēdavat||16||

sheShAstvAsthApyAH; visheShatastusarvA~ggaikA~ggakukShirogavatavarcomUtrashukrasa~ggabalavarNamAMsaretaHkShayadoShAdhmAnA~ggasuptikrimikoShThodAvartashuddhAtisAra-parvabhedAbhitApaplIhagulmashUlahRudrogabhagandaronmAdajvarabradhnashiraHkarNashUlahRudayapArshvapRuShThakaTIgrahavepanAkShepakagauravAtilAghava-rajaHkShayArtaviShamAgnisphigjAnuja~gghorugulphapArShNiprapadayonibAhva~ggulistanAntadantanakhaparvAsthishUla-shoShastambhAntrakUjaparikartikAlpAlpasashabdogragandhotthAnAdayo vAtavyAdhayo visheSheNa mahArogAdhyAyoktAshca; eteShvĀsthāpanaMpradhAnatamamityuktaM vanaspatimUlacchedavat||16||

The persons other than above-mentioned are fit for asthapana basti. It is especially useful for the persons mentioned in the table below:

Serial No.	Disease or State (in which asthapana basti is indicated)	Translation in English
1	Sarvaanga roga	Paralysis of the whole body
2	Ekaanga roga	Paralysis of one of the limb
3	Kukshi roga	Disorder of abdomen
4	Vata sanga	Retention of flatus
5	Varcho sanga	Retention of feces
6	Mootra sanga	Retention of urine
7	Shukra sanga	Retention of semen
8	Bala kshaya	Diminution of strength
9	Varna kshaya	Diminution of complexion
10	Mamsa kshaya	Diminution of muscle tissue
11	Retah kshaya	Diminution of semen
12	Doshaadhmaana	Tympanitis
13	Anga supti	Numbness of body parts
14	Krimikoshtha	Parasitic infestation of intestine
15	Udaavarta	Disorder due to reverse movement of the vata
16	Shuddhaatisaara	Diarrhea without association of ama
17	Parvabheda	Tearing pain in joints
18	Abhitaapa	Feeling of burning sensation
19	Pleeha roga	Splenic disorder
20	Gulma roga	Abdominal lump
21	Shula roga	Colic pain
22	Hridroga	Heart disease
23	Bhagandara	Fistula in ano
24	Unmada roga	Psychotic disorders
25	Jwara	Fever
26	Bradhna roga	Inguinal swelling
27	Shirahshula	Headache
28	Karnashula	Earache
29	Hridaya graha	Stiffness in heart
30	Paarshva graha	Stiffness in sides
31	Prishtha graha	Stiffness in back
32	Kati graha	Stiffness in waist
33	Vepana aarta	Suffering from tremor
34	Aakshepaka aarta	Suffering from convulsions
35	Gauravaarta	Suffering from heaviness
36	Atilaaghavaarta	Suffering from excessive lightness
37	Rajah-kshayaarta	Suffering from amenorrhea
38	Vishamaagni	Irregular power of digestion
39	Sphik-shula-shosha-stambha	Pain, atrophy and stiffness of hip
40	Jaanu-shula-shosha-stambha	Pain, atrophy and stiffness of knee-joints
41	Janghaa-shula-shosha-stambha	Pain, atrophy and stiffness of the calf region
42	Uru-shula-shosha-stambha	Pain, atrophy and stiffness of the thighs
43	Gulpha-shula-shosha-stambha	Pain, atrophy and stiffness of the ankles
44	Paarshni-shula-shosha-stambha	Pain, atrophy and stiffness of the heels
45	Prapada-shula-shosha-stambha	Pain, atrophy and stiffness of the feet
46	Yoni-shula-shosha-stambha	Pain, atrophy and stiffness of female genitals
47	Baahu-shula-shosha-stambha	Pain, atrophy and stiffness of arms
48	Anguli-shula-shosha-stambha	Pain, atrophy and stiffness of fingers
49	Stanaanta-shula-shosha-stambha	Pain, atrophy and stiffness of the periphery of the breasts
50	Danta-shula-shosha-stambha	Pain, atrophy and stiffness of teeth
51	Nakha-shula-shosha-stambha	Pain, atrophy and stiffness of nails
52	Parva-shula-shosha-stambha	Pain, atrophy and stiffness of joints
53	Asthi-shula-shosha-stambha	Pain, atrophy and stiffness of bones
54	Aantra koojana	Intestinal gurgling
55	Parikartika	Cutting pain in anal region
56	Alpaalpa-utthaana	Voiding stool in small quantity frequently
57	Sashabda-utthaana	Voiding stool with sound
58	Ugragandha-utthaana aadayo vyaadhyayah	(Diseases that cause) voiding stool with foul smell
59	Vata-vyaadhayo visheshena maharogadhyayoktah	Vatika disorders specially discussed in Maharoga Adhyaya of Charaka Samhita Sutra Sthana

In the above mentioned diseases, asthapana basti is the foremost therapy. As a tree gets destroyed by cutting its roots, similarly the above mentioned diseases are eradicated by administration of asthapana basti. [16]

Contra-indications of anuvasana basti

य एवानास्थाप्यास्त एवाननुवास्याः स्युः;विशेषतस्त्वभुक्तभक्तनवज्वरपाण्डुरोगकामलाप्रमेहार्शःप्रतिश्यायारोचकमन्दाग्निदुर्बलप्लीहकफोदरोरुस्तम्भवर्चोभेद-विषगरपीतपित्तकफाभिष्यन्दगुरुकोष्ठश्लीपदगलगण्डापचिक्रिमिकोष्ठिनः ||१७||

ya ēvānāsthāpyāsta ēvānanuvāsyāḥ syuḥ;viśēṣatastvabhuktabhaktanavajvarapāṇḍurōgakāmalāpramēhārśaḥpratiśyāyārōcakamandāgnidurbalaplīhakaphōdarōrustambhavarcōbhēda-viṣagarapītapittakaphābhiṣyandagurukōṣṭhaślīpadagalagaṇḍāpacikrimikōṣṭhinaḥ ||17||

ya evAnAsthApyAsta evAnanuvAsyAH syuH;visheShatastvabhuktabhaktanavajvarapANDurogakAmalApramehArshaHpratishyAyArocakamandAgnidurbalaplIhakaphodarorustambhavarcobheda-viShagarapItapittakaphAbhiShyandagurukoShThashlIpadagalagaNDApacikrimikoShThinaH ||17|

Those persons who are unfit for asthapana basti, are considered unfit for anuvasana basti. Conditions in which anuvasana basti is specifically contra-indicated, are listed in the table given below:

Serial No.	Disease or State (in which anuvasana basti is contraindicated)	Translation in English
1	Abhuktabhakta	A person who has not taken food
2	Navajwara	Acute fever
3	Pandu roga	Anemia
4	Kaamala	Jaundice
5	Prameha	Obstinate urinary disorders including diabetes
6	Arsha roga	Piles
7	Pratishyaya	Coryza
8	Arochaka	Anorexia
9	Mandaagni	Supression of the power of digestion
10	Durbala	Weak
11	Pleehodara	Splenic disorders
12	Kaphodara	Obstinate abdominal disease caused by aggravation of kapha
13	Urustambha	Stiffness of thigh and calf region
14	Varchobheda	Diarrhea
15	Vishapeeta	One who has ingested natural poison
16	Garapeeta	One who has ingested artificial/synthetic poison
17	Pittaabhishyanda	Conjuctivitis caused by aggravated pitta
18	Kaphaabhishyanda	Conjuctivitis caused by aggravated kapha
19	Gurukoshtha	Costive bowel
20	Shleepada roga	Filaria
21	Galagandha	Goitre
22	Apachi roga	Cervical adenitis
23	Krimikoshthi	(Those suffering from) intestinal parasites

[17]

Adverse effects of anuvasana basti in contra-indicated conditions

तत्राभुक्तभक्तस्यानावृतमार्गत्वादूर्ध्वमतिवर्तते स्नेहः, नवज्वरपाण्डुरोगकामलाप्रमेहिणां दोषानुत्क्लिश्योदरञ्जनयेत्,अर्शसस्यार्शांस्यभिष्यन्द्याध्मानं कुर्यात्, अरोचकार्तस्यान्नगृद्धिं पुनर्हन्यात्, मन्दाग्निदुर्बलयोर्मन्दतरमग्निं कुर्यात्,प्रतिश्यायप्लीहादिमतां भृशमुत्क्लिष्टदोषाणां भूय एव दोषं वर्धयेत्; तस्मादेते नानुवास्याः||१८||

tatrābhuktabhaktasyānāvr̥tamārgatvādūrdhvamativartatē snēhaḥ, navajvarapāṇḍurōgakāmalāpramēhiṇāṁ dōṣānutkliśyōdarañjanayēt,arśasasyārśāṁsyabhiṣyandyādhmānaṁ kuryāt, arōcakārtasyānnagr̥ddhiṁ punarhanyāt, mandāgnidurbalayōrmandataramagniṁ kuryāt,pratiśyāyaplīhādimatāṁ bhr̥śamutkliṣṭadōṣāṇāṁ bhūya ēva dōṣaṁ vardhayēt; tasmādētē nānuvāsyāḥ||18||

tatrAbhuktabhaktasyAnAvRutamArgatvAdUrdhvamativartate snehaH, navajvarapANDurogakAmalApramehiNAM doShAnutklishyodara~jjanayet,arshasasyArshAMsyabhiShyandyAdhmAnaM kuryAt, arocakArtasyAnnagRuddhiM punarhanyAt, mandAgnidurbalayormandataramagniM kuryAt,pratishyAyaplIhAdimatAM bhRushamutkliShTadoShANAM bhUya eva doShaM vardhayet; tasmAdete nAnuvAsyAH||18||

If anuvasana basti is administered to the person who is empty stomach, it goes upwards due to the absence of any obstruction in the passage. In the acute fever, anaemia, jaundice and prameha, anuvasana basti causes excitement of dosha which further leads to Udara roga (obstinate abdominal disease including ascites). In the person suffering from piles, use of anuvasana basti may create obstruction in the piles leading to adhmana (abdominal distension). In the person suffering from anorexia, application of anuvasana basti further diminishes the desire for food. In case of suppression of power of digestion and weakness, the application of anuvasana basti makes the digestive power poorer. If anuvasana basti is administered to the persons suffering from coryza, splenic disorders and such other diseases, it causes the further excitement of dosha which are already aggravated. Therefore, the above mentioned persons are unfit for the administration of anuvasana basti. [18]

Indications of anuvasana basti

य एवास्थाप्यास्त एवानुवास्याः; विशेषतस्तु रूक्षतीक्ष्णाग्नयः केवलवातरोगार्ताश्च; एतेषु ह्यनुवासनं प्रधानतममित्युक्तं मूलेद्रुमप्रसेकवत्||१९||

ya ēvāsthāpyāsta ēvānuvāsyāḥ; viśēṣatastu rūkṣatīkṣṇāgnayaḥ kēvalavātarōgārtāśca; ētēṣu hyanuvāsanaṁ pradhānatamamityuktaṁ mūlēdrumaprasēkavat||19||

ya evAsthApyAsta evAnuvAsyAH; visheShatastu rUkShatIkShNAgnayaH kevalavAtarogArtAshca; eteShu hyAnuvāsanaM pradhAnatamamityuktaMmUle drumaprasekavat||19||

The persons who are fit for asthapana basti are considered fit for anuvasana basti also. The conditions where specifically it is indicated, are listed in the table given below:

Serial No.	Disease or State (in which anuvasana basti is indicated)	Translation in English
1	Rukshah	A person having dryness in the body
2	Teekshnagnayah	A person having intense power of digestion
3	Kevalavata rogaartah	A person suffering from diseases caused due to vata alone, and not associated with ama.

In such patients, anuvasana basti is said to be the most effective and could be likened to watering a plant in its root.[19]

Contra-indications of shirovirechana

अशिरोविरेचनार्हास्तु अजीर्णिभुक्तभक्तपीतस्नेहमद्यतोयपातुकामाः स्नातशिराः स्नातुकामःक्षुत्तृष्णाश्रमार्तमत्तमूर्च्छितशस्त्रदण्डहतव्यवायव्यायामपानक्लान्तनवज्वरशोकाभितप्तविरिक्तानुवासितगर्भिणीनवप्रतिश्यायार्ताः,अनृतौ दुर्दिने चेति||२०||

aśirōvirēcanārhāstu ajīrṇibhuktabhaktapītasnēhamadyatōyapātukāmāḥ snātaśirāḥ snātukāmaḥkṣuttr̥ṣṇāśramārtamattamūrcchitaśastradaṇḍahatavyavāyavyāyāmapāna-

klāntanavajvaraśōkābhitaptaviriktānuvāsitagarbhiṇīnavapratiśyāyārtāḥ,anr̥tau durdinē cēti||20||

aShirovirechnarhAstu ajIrNibhuktabhaktapItasnehamadyatoyapAtukAmAH snAtashirAH snAtukAmaHkShuttRuShNAshramArtamattamUrcchitashastradaNDahatavyavAyavyAyAmapAna-

klAntanavajvarashokAbhitaptaviriktAnuvAsitagarbhiNInavapratishyAyArtAH,anRutau durdine ceti||20||

The persons unfit for shirovirechana (head- evacuation therapy) are listed in the table given below:

Serial No.	Disease or State (in which shirovirechana is contraindicated)	Translation in English
1	Ajeerni	A person suffering from indigestion
2	Bhuktabhakta	A person who has taken food
3	Peetasneha	A person who has ingested fatty substances.
4	Madyapaatukaama	A person who is desirous of drinking wine (and other alcoholic beverages)
5	Toyapaatukaama	A person who is desirous of drinking water
6	Snaatashira	A person who has taken head bath
7	Snaatukaama	A person who is desirous of taking bath
8	Kshudhaarta	A person who is afflicted with hunger, i.e., one who is starving
9	Trishnaarta	A person who is afflicted with thirst
10	Shramaarta	A person who is afflicted with exertion
11	Matta	A person who is afflicted with intoxication
12	Murchhita	A person who is afflicted with fainting
13	Shashtrahata	A person who has been injured with a weapon
14	Dandahata	A person who has been injured with a stick
15	Vyavaayaklaanta	A person who is exhausted by sexual intercourse
16	Vyayaamaklaanta	A person who is exhausted by physical exercise
17	Paanaklaanta	A person who is exhausted by intake of alcohol
18	Navajwara	Acute fever
19	Shokaabhitapta	A person who is afflicted with grief
20	Virikta	A person who has undergone purgation
21	Anuvasita	A person who has undergone Anuvasana Basti
22	Garbhini	A pregnant woman
23	Navapratishyaayaarta	A person suffering from acute coryza.
24	Anritu	Unsuitable season
25	Durdine	Cloudy/Overcast day

[20]

Adverse effects of shirovirechana in contra-indicated conditions

तत्राजीर्णिभुक्तभक्तयोर्दोष ऊर्ध्ववहानि स्रोतांस्यावृत्य कासश्वासच्छर्दिप्रतिश्यायाञ्जनयेत्, पीतस्नेहमद्यतोयपातुकामानां कृते चपिबतां मुखनासास्रावाक्ष्युपदेहतिमिरशिरोरोगाञ्जनयेत्, स्नातशिरसः कृते च स्नानाच्छिरसः प्रतिश्यायं, क्षुधार्तस्य वातप्रकोपं,तृष्णार्तस्य पुनस्तृष्णाभिवृद्धिं मुखशोषं च, श्रमार्तमत्तमूर्च्छितानामास्थापनोक्तं दोषं जनयेत्, शस्त्रदण्डहतयोस्तीव्रतरां रुजंजनयेत्, व्यवायव्यायामपानक्लान्तानां शिरःस्कन्धनेत्रोरःपीडनं, नवज्वरशोकाभितप्तयोरूष्मा नेत्रनाडीरनुसृत्य तिमिरं ज्वरवृद्धिंच कुर्यात्, विरिक्तस्य वायुरिन्द्रियोपघातं कुर्यात्, अनुवासितस्य कफः शिरोगुरुत्वकण्डूक्रिमिदोषाञ्जनयेत्, गर्भिण्या गर्भंस्तम्भयेत् स काणः कुणिः पक्षहतः पीठसर्पी वा जायते, नवप्रतिश्यायार्तस्य स्रोतांसि व्यापादयेत्, अनृतौ दुर्दिने च शीतदोषान्पूतिनस्यं शिरोरोगं च जनयेत्; तस्मादेते न शिरोविरेचनार्हाः||२१||

tatrājīrṇibhuktabhaktayōrdōṣa ūrdhvavahāni srōtāṁsyāvr̥tya kāsaśvāsacchardipratiśyāyāñjanayēt, pītasnēhamadyatōyapātukāmānāṁ kr̥tē capibatāṁ mukhanāsāsrāvākṣyupadēhatimiraśirōrōgāñjanayēt, snātaśirasaḥ kr̥tē ca snānācchirasaḥ pratiśyāyaṁ, kṣudhārtasya vātaprakōpaṁ,tr̥ṣṇārtasya punastr̥ṣṇābhivr̥ddhiṁ mukhaśōṣaṁ ca, śramārtamattamūrcchitānāmāsthāpanōktaṁ dōṣaṁ janayēt, śastradaṇḍahatayōstīvratarāṁrujaṁ janayēt, vyavāyavyāyāmapānaklāntānāṁ śiraḥskandhanētrōraḥpīḍanaṁ, navajvaraśōkābhitaptayōrūṣmā nētranāḍīranusr̥tya timiraṁjvaravr̥ddhiṁ ca kuryāt, viriktasya vāyurindriyōpaghātaṁ kuryāt, anuvāsitasya kaphaḥ śirōgurutvakaṇḍūkrimidōṣāñjanayēt, garbhiṇyā garbhaṁstambhayēt sa kāṇaḥ kuṇiḥ pakṣahataḥ pīṭhasarpī vā jāyatē, navapratiśyāyārtasya srōtāṁsi vyāpādayēt, anr̥tau durdinē ca śītadōṣān pūtinasyaṁśirōrōgaṁ ca janayēt; tasmādētē na śirōvirēcanārhāḥ||21||

tatrAjIrNibhuktabhaktayordoSha UrdhvavahAni srotAMsyAvRutya kAsashvAsacchardipratishyAyA~jjanayet, pItasnehamadyatoyapAtukAmAnAM kRute capibatAM mukhanAsAsrAvAkShyupadehatimirashirorogA~jjanayet, snAtashirasaH kRute ca snAnAcchirasaH pratishyAyaM, kShudhArtasya vAtaprakopaM,tRuShNArtasya punastRuShNAbhivRuddhiM mukhashoShaM ca, shramArtamattamUrcchitAnAmĀsthāpanaoktaM doShaM janayet,shastradaNDahatayostIvratarAM rujaM janayet, vyavAyavyAyAmapAnaklAntAnAM shiraHskandhanetroraHpIDanaM, navajvarashokAbhitaptayorUShmAnetranADIranusRutya timiraM jvaravRuddhiM ca kuryAt, viriktasya vĀyurindriyopaghAtaM kuryAt, anuvAsitasya kaphaHshirogurutvakaNDUkrimidoShA~jjanayet, garbhiNyA garbhaM stambhayet sa kANaH kuNiH pakShahataH pIThasarpI vA jAyate, navapratishyAyArtasyasrotAMsi vyApAdayet, anRutau durdine ca shItadoShAn pUtinasyaM shirorogaM ca janayet; tasmAdete na ŚirovirecanarhAH||21||

Shirovirechana applied in the case of indigestion and full stomach causes the occlusion of the channels moving upwards by vitiated dosha which further leads to manifestation of cough, dyspnea, vomiting and coryza. In those who have taken fatty substances or desirous of taking wine or water or take after head-evacuation, shirovirechana gives rise to discharge from mouth and nose, dirt and stickiness in eyes, cataract and head diseases. If the person who has taken head- bath or takes head-bath after the therapy, then it causes the coryza. Application of shirovirechana in a person afflicted with hunger causes aggravation of vata dosha. If it is administered to the person afflicted with thirst then it further increases the thirst and causes the dryness of mouth. Shirovirechana applied in the cases of fatigue, intoxication and fainting produces the same adverse effects as mentioned under the asthapana basti. If this therapy is administered in the persons injured with weapons or stick, it increases the pain. In those exhausted by sexual intercourse, physical exercise and intake of alcohol, it causes pain in head, shoulder, eyes and chest. Shirovirechana applied to those suffering from acute fever and grief causes the heat to spread into the channels of eye, produces the cataract and increases the fever. If this therapy is given to the person who has undergone purgation therapy, then it aggravates vata dosha which may further leads to the damage of the sense organs. Shirovirechana given to the person who has undergone anuvasana basti, causes aggravation of kapha dosha which produces heaviness of head, itching and parasitic infestation. In the case of pregnant woman, this therapy inhibits the growth of the fetus and she gives birth to an offspring who may be blind by one eye, with deformity of upper limbs, hemiplegic and with deformity of lower limbs. Shirovirechana given to the person suffering from acute coryza causes the morbidity of the channels of circulation. If this therapy is given in unsuitable season and on a cloudy day then it causes the diseases due to cold, putrefied rhinitis and head-diseases. Therefore, these persons are not fit for head-evacuation therapy. [21]

Indications of shirovirechana

शेषास्त्वर्हाः, विशेषतस्तु शिरोदन्तमन्यास्तम्भगलहनुग्रहपीनसगलशुण्डिकाशालूकशुक्रतिमिरवर्त्मरोगव्यङ्गो पजिह्विकार्धावभेदकग्रीवास्कन्धांसास्यनासिकाकर्णाक्षिमूर्धकपालशिरोरोगार्दितापतन्त्रकापतानकगलगण्ड-दन्तशूलहर्षचालाक्षिराज्यर्बुदस्वरभेदवाग्ग्रहगद्गदक्रथनादय ऊर्ध्वजत्रुगताश्चवातादिविकाराः परिपक्वाश्च; एतेषु शिरोविरेचनंप्रधानतममित्युक्तं, तद्ध्युत्तमाङ्गमनुप्रविश्य मुञ्जादीषिकामिवासक्तां केवलं विकारकरं दोषमपकर्षति||२२||

śēṣāstvarhāḥ, viśēṣatastuśirōdantamanyāstambhagalahanugrahapīnasagalaśuṇḍikāśālūkaśukratimiravartmarōgavyaṅgō pajihvikārdhāvabhēdakagrīvāskandhāṁsāsyanāsikākarṇākṣimūrdhakapālaśirōrōgārditāpatantrakāpatānakagalagaṇḍa-dantaśūlaharṣacālākṣirājyarbudasvarabhēdavāggrahagadgadakrathanādaya ūrdhvajatrugatāścavātādivikārāḥparipakvāśca; ētēṣu śirōvirēcanaṁ pradhānatamamityuktaṁ, taddhyuttamāṅgamanupraviśya muñjādīṣikāmivāsaktāṁkēvalaṁ vikārakaraṁ dōṣamapakarṣati||22||

sheShAstvarhAH, visheShatastushirodantamanyAstambhagalahanugrahapInasagalashuNDikAshAlUkashukratimiravartmarogavya~ggo pajihvikArdhAvabhedakagrIvAskandhAMsAsyanAsikAkarNAkShimUrdhakapAlashirorogA-

rditApatantrakApatAnakagalagaNDadantashUlaharShacAlAkShirAjyarbudasvarabhedavAggrahagadgadakrathanAdaya UrdhvajatrugatAshcavAtAdivikArAHparipakvAshca; eteShu ŚirovirecanaM pradhAnatamamityuktaM, taddhyuttamA~ggamanupravishyamu~jjAdIShikAmivAsaktAM kevalaM vikArakaraM doShamapakarShati||22||

The persons other than above mentioned are fit for shirovirechana (head-evacuation therapy). It is especially useful in the conditions mentioned in the table given below:

Serial No.	Disease or State (in which shirovirechana is indicated)	Translation in English
1	Shirostambha	Stiffness of head
2	Dantastambha	Stiffness of teeth
3	Manyaastambha	torticollis
4	Galagraha	Spasm of the throat
5	Hanugraha	Lock-jaw
6	Peenasa	Chronic coryza
7	Galashundika	Tonsillitis
8	Galashaaluka	Tumor in the throat
9	Shukra-roga	Disorder of cornea
10	Timira	Cataract, Disorder of vision
11	Vartma-roga	Disorders of eye-lids
12	Vyanga-roga	Freckles
13	Upajihvika	Uvulitis
14	Ardhavabhedaka	Hemicrania, migraine
15	Greeva-roga	Diseases of the neck
16	Skandha-roga	Diseases of the shoulders
17	Amsa-roga	Diseases of the scapula
18	Asya-roga	Diseases of the mouth
19	Nasika-roga	Diseases of the nose
20	Karna-roga	Diseases of the ears
21	Akshi-roga	Diseases of the eyes
22	Murdha-roga	Diseases of the cranium
23	Kapala-roga	Diseases of the forehead
24	Shiroroga	Diseases of the head
25	Ardita	Facial paralysis
26	Apatantraka	Convulsions with unconsciousness
27	Apatanaka	Convulsions with consciousness
28	Galagandha	Goitre
29	Dantashula	Toothache
30	Dantaharsha	Tingling sensation of teeth
31	Dantachala	Looseness of teeth
32	Akshiraji	Streaks in eye
33	Arbuda	Tumor
34	Svarabheda	Hoarseness of voice
35	Vaggraha	Obstructed speech
36	Gadgad	Spasmodic speech
37	Krathana-adayah	Stammering etc.
38	Urdhvajatrugatashcha vatadi vikarah paripakvashcha	Diseases of the part above clavicle caused by aggravation of vatadi dosha and which are free from ama dosha

In these conditions, head-evacuation is the foremost therapy as it entering into the head eliminates the entire pathogenic impurities like fibrous coating of munja (a type of grass) from the pith (ishika). [22]

Consideration of appropriate time for shirovirechana in emergency conditions

प्रावृट्शरद्वसन्तेतरेष्वात्ययिकेषु रोगेषु नावनं कुर्यात् कृत्रिमगुणोपधानात्; ग्रीष्मे पूर्वाह्णे, शीते मध्याह्ने, वर्षास्वदुर्दिने चेति||२३||

prāvr̥ṭśaradvasantētarēṣvātyayikēṣu rōgēṣu nāvanaṁ kuryāt kr̥trimaguṇōpadhānāt; grīṣmē pūrvāhṇē, śītēmadhyāhnē, varṣāsvadurdinē cēti||23||

prAvRuTsharadvasantetareShvAtyayikeShu rogeShu nAvanaM kuryAt kRutrimaguNopadhAnAt; grIShmepUrvAhNe, shIte madhyAhne, varShAsvadurdine ceti||23||

In the case of emergency, shirovirechana (head-evacuation therapy) should be given in the season other than pravriṭ (early rain), Sharad (autumn) and Vasanta (spring) by arranging environment artificially. In summer, it should be applied in the morning, in winter during noon time and in rainy season when sky is free from clouds. [23]

Summary

तत्र श्लोकाः-

इति पञ्चविधं कर्म विस्तरेण निदर्शितम्| येभ्यो यन्न हितं यस्मात् कर्म येभ्यश्च यद्धितम्||२४||

न चैकान्तेन निर्दिष्टेऽप्यर्थेऽभिनिविशेद्बुधः| स्वयमप्यत्र वैद्येन तर्क्यं बुद्धिमता भवेत्||२५||

उत्पद्येत हि साऽवस्था देशकालबलं प्रति| यस्यां कार्यमकार्यं स्यात् कर्म कार्यं च वर्जितम्||२६||

छर्दिर्हृद्रोगगुल्मानां वमनं स्वे चिकित्सिते| अवस्थां प्राप्य निर्दिष्टं कुष्ठिनां बस्तिकर्म च||२७||

तस्मात् सत्यपि निर्देशे कुर्यादूह्य स्वयं धिया| विना तर्केण या सिद्धिर्यदृच्छासिद्धिरेव सा||२८||

tatra ślōkāḥ-

iti pañcavidhaṁ karma vistarēṇa nidarśitam| yēbhyō yanna hitaṁ yasmāt karma yēbhyaśca yaddhitam||24||

na caikāntēna nirdiṣṭē'pyarthē'bhiniviśēdbudhaḥ| svayamapyatra vaidyēna tarkyaṁ buddhimatā bhavēt||25||

utpadyēta hi sā'vasthā dēśakālabalaṁ prati| yasyāṁ kāryamakāryaṁ syāt karma kāryaṁ ca varjitam||26||

chardirhr̥drōgagulmānāṁ Vamanṁ svē cikitsitē| avasthāṁ prāpya nirdiṣṭaṁ kuṣṭhināṁ bastikarma ca||27||

tasmāt satyapi nirdēśē kuryādūhya svayaṁ dhiyā| vinā tarkēṇa yā siddhiryadr̥cchāsiddhirēva sā||28||

tatra shlokAH- iti pa~jcavidhaM karma vistareNa nidarshitam| yebhyo yanna hitaM yasmAt karma yebhyashca yaddhitam||24||

na caikAntena nirdiShTe~apyarthe~abhinivishedbudhaH| svayamapyatra vaidyena tarkyaM buddhimatA bhavet||25||

utpadyeta hi sA~avasthA deshakAlabalaM prati| yasyAM kAryamakAryaM syAt karma kAryaM ca varjitam||26||

chardirhRudrogagulmAnAM VamanM sve cikitsite| avasthAM prApya nirdiShTaM kuShThinAM bastikarma ca||27||

tasmAt satyapi nirdeshe kuryAdUhya svayaM dhiyA| vinA tarkeNa yA siddhiryadRucchAsiddhireva sA||28||

Now the summing up verses:-

Thus, the Panchakarma has been described in detail in following sub-headings-

1. Contra-indications of each of the karma (therapy) along with reasoning;
2. Indications of each of the karma (therapy) of Panchakarma.

The wise physician should not blindly follow the general instructions laid down in this chapter in the form of conclusions but he should decide rationally using his own discretion because condition may arise due to the nature of place, time and strength of the patient in which the prescribed therapy may be ineffective and the prohibited therapy may be applicable such as emesis is prescribed in certain stage of vomiting, heart-disease and gulma (abdominal lump) though it is generally contra-indicated. Similarly basti is advised in the treatment of kushtha roga though it is generally contra-indicated depending upon the particular stage of the disease. Hence, in spite of general instructions available in the text, a physician should rationally think all the aspects using his intellect. The success achieved without proper reasoning is nothing but the success by chance. [24-28]

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृतेऽप्राप्ते दृढबलसंपूरिते सिद्धिस्थाने पञ्चकर्मीयसिद्धिर्नाम द्वितीयोऽध्यायः॥२॥

Ityagniveśakṛte tantre Carakapratisaṃskṛteˈprāpte Dṛḍhabalasampūrite Siddhisthāne Pañcakarmīyasiddhirnāma dvitīyoˈdhyāyaḥ .||2||

ityAgniveśaakRute tantre carakapratisaMskRute~prApte dRuDhabalasaMpUrite siddhisthAne pa~jcakarmIyasiddhirnAma dvitIyo~dhyAyaH. ||2||

Thus, ends the second chapter on successful management of Panchakarma in the treatise composed by Agnivesha, redacted by Charaka and because of its non-availability, supplemented by Dridhabala. [2]

Tattva Vimarsha (Fundamental Principles)

• All the Panchakarma procedures like vamana (therapeutic emesis), virechana( therapeutic purgation), asthapana (medicated enema with decoction), anuvasana ( medicated enema with oil), shirovirechana (purification of head and supraclavicular region) shall be performed after through examination of patients about indications and contra-indications.
• If these procedures are performed in the contra-indicated state, it leads to iatrogenic diseases.
• Vamana (therapeutic emesis) is mainly indicated in kapha dominant diseases.
• Virechana( therapeutic purgation) is mainly indicated in pitta dominant diseases.
• Asthapana (medicated enema with decoction) is mainly indicated in vata dominant diseases in which purification is the objective of treatment.
• Anuvasana (medicated enema with oil) is mainly indicated in vata dominant diseases in which nourishment and sustaining growth of tissues is the objective of treatment.
• Shirovirechana (purification of head and supraclavicular region) is mainly indicated in dosha dominant diseases of all organs present in supraclavicular region including brain.

Vidhi Vimarsha (Applied Inferences )

Chapter authority

It is the pattern of this classic that in the beginning of every chapter, Charaka proposes the topic which is to be discussed and secondly the common sentence for all the chapter (इति ह स्माह भगवानात्रेयः) is used which shows the authenticity of the text. There are number of discourses in medical science and it is not possible for all to discuss them completely and meticulously that’s why Agnivesha declares very honestly in the beginning of all the chapters that whatever has been discussed is as per the preaching of his teacher Lord Punarvasu Atreya. The title Bhagavana (lord) itself reveals that Punarvasu Atreya was an extraordinary personality who could completely discuss the medical science without any mistake and lacunae.

Success of treatment

Chikitsa is indicated in curable disease and another important concept of Ayurveda in this regard is that chatushpada upapatti (desired qualities of four limbs of treatment) are one of the important cause in the success of treatment. In the above mentioned verses the desired qualities of patients are lacking and patient is one of the important components among chatushpada. In such situations chances of complications are also high.

Contraindications of vamana

The above mentioned contra-indications are as per general rule but in specific conditions exceptions are also found such as generally vamana is contra-indicated in gulma roga but when kapha is increased and causing diminution of digestive fire, anorexia, nausea etc. in vatika gulma, vamana is indicated exceptionally.. Similarly vamana is advised in vomiting and heart disease according to condition which is the exception of the general instruction. In all the above mentioned states of contra-indications, vamana is not contra-indicated in the conditions of poisons, artificial poisons, incompatible food, intake of food during indigestion and ama (ailment caused by the product of improper digestion and metabolism) because these conditions are of emergent nature.

Vagbhata has added following contra-indications for vamana:

krimikoshtha, ashthila, arsha, bhrama, parshwaruk, Vatavyadhi

Indications of vamana

Vamana karma is mainly indicated in the diseases caused by kapha dosha reason being it is considered the best therapy among all causing elimination of kapha dosha. Vagbhatta says that vamana is indicated in the kapha dosha as well as in the combination of dosha where kapha is dominant. In the commentary of the view of Vagbhata, Arunadatta in his Sarvangasundara commentary says that here combination of dosha should be understood as kapha-pitta association.

As per the view of Charaka, one predominant in kapha vomits easily. This should be accepted as an ideal condition for vamana karma. Therefore, either it is the diseased or healthy condition, predominance of kapha should be observed or produced (by the application of snehana and swedana), then one should administer vamana karma. In the context of Jwara Chikitsa, Charaka has given the specific view for the application of vamana which can be accepted in all the cases if kapha dosha is dominant with tendency to come out and situated in amashaya (stomach).

Vagbhata has added following indications as suitable for vamana:

Granthi, arbuda, medoroga, vidarika, hridroga, chittavibhrama, visarpa, vidradhi, putinasa, kanthapaka, adhijivhika, galashundika

Contraindications of virechana

Virechana is not advised in the conditions when kapha dosha is increased because manda (alpa) kapha is considered as an ideal condition for proper administration of virechana karma..Panchakarma is not administered in the state of indigestion. Chakrapani, the commentator of Charaka Samhita has interpreted the term subhaga kshata guda as subhaga guda (one who has delicate anus) and kshata guda (one who has anal injury). He has also mentioned subhagam means sukhasamvardhita (those who has never faced any hardship) according to the view of other scholars in his commentary. Virechana applied in the person having injury to anus or delicate anus causes harm to the patients. In the person who has taken the niruha type of enema, at least seven days gap is essential to perform virechana karma and vice-versa. Virechana in pregnant woman is contra-indicated up to seventh month except in emergency. In eighth month if disease is curable by vamana or virechana, then mridu vamana (mild emesis) or mridu virechana (mild purgative) can be given.

Vagbhata added following conditions in the list of contraindications:

Navaprasuta, navapratishyaya, Rajyakshma, Atisara, nityadukkhi, hridrogi, bhayabhita

Indications of virechana

Virechana is considered the best therapy to purify pitta dosha especially.

Virechana eliminates pitta or kapha pitta situated in pittashaya.

Virechana treatments are of many types such as mridu virechana, sukha virechana and tikshṇa virechana. All the persons are not treated by the same medicines. So the application depends upon the nature of koshtha, nature of the disease, strength of the person, age, season and many other considerable issues. Mridu virechana is not appropriate for the person having krurakoshtha and tikshna virechana is not suitable for mridu koshtha. Tikshna virechana is advised in mrittika bhakshanajanya pandu roga and baddhodara in Charaka Samhita but it cannot be given to the patient suffering from the heart disease. Mridu virechana is advised in kamala roga . Virechana given to the patients suffering from paittika disorders cannot be given to those suffering from pitta shlaishmika disorders. Again virechana medicines are of two types i.e. snigdha virechana and ruksha virechana. Snigdha virechana is used in the person having dryness in the body and ruksha virechana is used in the persons who have unctuousness in the body. For example snighdha virechana is advised in vatodara. Tikshna vamana and virechana, and other painful procedures are generally not advised in children and old, if required then mridu vamana and virechana should be administered . Virechana karma should be administered in Sharad ritu (autumn season) in healthy individuals because the aggravation of pitta-dosha takes place in this season naturally. Generally it should not be administered in peak of summer and peak of winter season as it may lead to atiyoga and ayoga respectively.

Vagbhata added following conditions in the list of indications:

Garavisha, pakwashayaruja, vibandha, Vidradhi, dushtavrana, akshipaka, abhishyanda, kacha, gudadaha, medhradaha, nasadaha, anaha, stanyadosha

Contraindications of asthapana basti

Asthapana basti is contra-indicated in the stage of ajeerna or ama. Asthapana and anuvasana basti are indicated in the treatment of baddhodara, so baddhodara mentioned in the contra-indications of asthapana should be read as baddhodaradhmana means it is contraindicated in adhmana due to baddhodara. Asthapana basti is contraindicated in kushtha roga but in a particular stage of the disease, Charaka has exceptionally indicated the asthapana and Anuvasana basti . [14]

Vagbhata added following conditions in the list of contraindications:

Pandu, bhrama, arochaka, unmada, shokagrasta, sthaulya, kanthashosha, kshatakshina, pregnant woman upto 7th month of gestation, gudashotha

Indications of asthapana basti

Asthapana basti is considered the best therapy in vatika disorders. It is given in disorders caused by other dosha. Basti can be administered in the vitiation of vata, pitta, kapha, samsarga (vitiation of two dosha), sannipata (vitiation of all the three dosha) and even in vitiation of rakta (blood) also. Application of first asthapana basti removes or purifies vata, second basti removes or purifies pitta and third to kapha dosha , purification of three dosha should be understood of either occlusion or association of vata with other dosha. Different applications of asthapana basti show that by processing and combination with different medicines, it exerts many effects such as samshodhana, samshamana, samgrahana, vajikarana, brimhana, karshana, vayahsthapana etc. Type of basti depends upon the nature of disease such as basti given in the condition of vata-mala sanga will be different in comparison to basti given in shuddhatisara, basti applied in the case of bala kshaya, mamsa kshaya and retas kshaya will be of different composition in comparison to basti administered in krimikoshhtha. In vatika disorders also, only asthapana basti is not given for longer duration that’s why karma basti, kala basti and yoga basti have been discussed by ancient sages for the rational use of the therapy. In all these types, asthapana and anuvasana basti are administered in a particular sequence for the better efficacy.

Vagbhata added following conditions in the list of indications:

Jwara, ashmari, upadamsha, vatarakta, arsha, stanyakshaya, mudhagarbha, mutakrichhra

Contraindications of anuvasana basti

Anuvasana basti is not advised in kaphaja disorders, medo vriddhi and ama dosha. Contraindications given in the text are as per general rule. Exceptional instructions are also found in the text considering the need of therapy in particular stage of disease such as in the patient suffering from piles if patient comes with associated symptoms like udavarta, excessive dryness of the body, abnormal movement of vata and pain, then anuvasana basti is advised. Anuvasana is contraindicated in the patients suffering from krimikoshtha also because initially he should not be treated with this type of basti as it will increase the disease. In the patient of krimikoshtha, initially asthapana basti followed by vamana and virechana should be applied and when koshtha is completely purified, anuvasana basti with vidanga oil can be administered.

Vagbhata added following conditions in the list of contraindications:

Prameha, Kushtha, Sthaulya, Pinasa, Krisha

Indications of anuvasana basti

Anuvasana basti and asthapana basti are considered the best therapy in vatika disorders. It has been stated that patients suitable for asthapana basti are suitable for anuvasana basti is general instruction, because krimikoshthi and patient suffering from heaviness in the body are suitable for asthapana basti but not for anuvasana basti. In krimikoshthi, first of all asthapana basti is administered, then vamana and virechana to purify the koshtha. When koshtha is purified, then anuvasana basti is advised as it is discussed in Vimana Sthana. So it should be accepted that instructions given in the text are applicable in most cases, but not in all cases. [19]

Indications of Shirovirechana

Shirovirechana type of nasya is mainly beneficial in kaphaja disorders.

Shirovirechana is mainly beneficial in kaphaja disorders where as Charaka says that it is beneficial in vatadi vikaras which are free from ama dosha. Here vatadi vikaras means vata shleshmika vikara of the head region are cured by proper administration of shirovirechana. Pinasa roga mentioned in the indications should be accepted as pakva pratishyaya (chronic coryza) as shirovirechana is contraindicated in the patients suffering from nava pratishyaya (acute coryza). [22]

Contra-indications of Shirovirechana

Vagbhata added the following conditions in list of contra-indications:

Apatarpita, Pitadrava, Gararta, Kruddha, vegavarodhita, Raktasravita, Sutika, Shwasapidita, Kasapidita

Current researches

Prameha and Kushtha are considered as contraindications of Asthapana Basti. Thus the conditions of diabetes and skin diseases comes under this umbrella of contraindication. However, more precisely, if these conditions are associated with aggravated vata, Asthapana Basti is used with good efficacy. The basti of gokshura and punarnava has shown good results in microalbuminuria in diabetic patients. Likewise basti has shown good results in skin condition like psoriatic arthritis.

Scope of further research

General indications and contraindications of all panchakarma are included in this chapter. Further it is needed to elaborate efficacy of these procedures in the specific stages of the disease. For e.g. Asthapana Basti is contraindicated in fatigue due to excess travelling (Yanaklanta). However in other reference Yuktaratha Basti is indicated in certain conditions with similarity of pathogenesis. Though basti is contraindicated in skin diseases (Kushtha), a formulation for basti is prescribed in management of Kushtha. This is specific to the conditions associated with specific dosha. A study is required to elaborate and explain the reasons.