Vaitarana

Vaitaranabasti is a therapeutic enema. It is effective in diseases like amavata, katishoola (lumbago), gridhasi (sciatica), klaibya (sexual dysfunction), vishamajwara(fever) etc. The description is available in ayurveda texts likeChakradutta, Vrandhamadhava, Vangasenasamhita.In current scenario, it is used in amavatapatients as a safe, innocuous & custodian therapy for the patient. It is also useful in amadosha predominant conditions like anaha (abdominal distension),shotha (swelling),shula (pain). It has vata-kaphapacifying properties and helps in removing avarana of vata by kapha. The present chapter describes advantages and practical aspects of vaitaranabasti.

Contributors

Section/Chapter/topic	Concepts/Prakriti/Manas prakriti
Authors	Patil Rajkala P.1, Gupta Rishanki2
Reviewer	Basisht G.3,
Editor	Deole Y.S.4
Affiliations	1Department of Panchakarma, Faculty of Ayurveda, I.M.S., B.H.U., Varanasi, India 2Department of Rog Nidana, Faculty of Ayurveda, I.M.S., B.H.U., Varanasi, India 3Rheumatologist, Orlando, Florida, U.S.A. 4Department ofKayachikitsa, G.J.Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
Correspondence emails	rajkalapatil@bhu.ac.in, carakasamhita@gmail.com
Publisher	Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India
Date of publication:	November 18, 2022
DOI	In process

Etymology and derivation

According to Padma Purana, Vaitarana means ‘Vai’ (meaning truly) to ‘tarana’ (means saving). Vaitarana is called so because the enema is said to prevent many diseases. It means to donate, go across, to leave which helps to expel the dosha. Vaitarana is the name of river, which can bring back the dead to live.It is meant to cross a river, transporting (a departed spirit) over the river that flows between earth and the lower regions [Monier-Williams Sanskrit-English Dictionary, 1899]. Hence, this basti is so powerful that it can bring back life of a person, who is about to die. The first reference regarding vaitaranibasti is probably found in the Siddhayogaor Vrindamadhava ; narrated as separate section as this formulation does not satisfy inclusion in description ofniruhabasti.The critical edition of Vrindha Madhava by Dr.Premavati Tiwari and Dr. AshaKumari reports a variant reading where gudais replaced by Hingu.

The basic difference in niruha and vaitaranabasti as follow-

NIRUHA BASTI (purification enema)	VAITARANA BASTI (Vaitarana enema)
Contents- Makshika (honey), Lavana (salt), Sneha(oil), Kalka(paste), &Kwatha(decoction).	Contents- Saindhava (rock salt), Guda (jaggery), Chincha (tamrind), Taila (oil), &Drava Dravya (liquids).
Makshika(honey)	Instead of Makshika(honey) ;Guda(jaggery) is there.
here kalka(paste) mainly of satapushpa (dill seed) or madhanaphala (emetic nut).	chincha(tamrind) act as kalka (paste).
sneha(oil)	here rukshnasneha(oil processed with herbs of hot potency and dry property that will not increase kapha) used like bhrityasaindhavaditaila (special medicated oil).
Generally used kwatha (decoction) like dashmoola (group of ten herbs).	Here Gomutra(cow urine) used instead of any kwatha (decoction).

Ingredients described in different texts :

Contents	Chakradutta	Vrindhamadhava	Vangasena	Weight in grams/ml
Saindhava (rock salt)	1 karsha	1 karsha	1 karsha	10gms
Guda (jaggery)	1 shukti(1/2 pala)	1 shukti(1/2 pala)	1/2 pala	25gms
Amlika (tamrind)	1 pala	1 pala	1 pala	50gms
Gomutra (cow urine)	1 kudava(4pala)	1 kudava(4 pala)	Ishattaila	200ml
Godugdha (cow milk)	Not mentioned	Not mentioned	1 kudava	-
Taila(–ilataila- sesame oil)	Quantity not mentioned	Oil insmall quantity	Oil in small quantity	10-25ML

Pharmacological properties of ingredients

Sr.No	Contents	Botanical /English name	Rasa (Taste)	Virya (Potency)	Vipaka (metabolic properties- after digestion)	Guna	Properties	Chemical constituent
1.	Amlika	Tamarindus indica (fam. Fabaceae)/ Tamarind	Amla	Ushna	Amla	Guru, Ruksha, Sara.	Kaphavatanut, Dipana, Bastisuddhikara,	Tamarindica, saponin, sugar, inorganic acid.
2.	ErandTaila	Ricinus Communis/ Castor Oil	Madhura,Katu, Kashaya (Sweet, pungent, Astringent)	Ushna (Hot)	Madhura (Sweet)	Snigdha, Guru, Sukshma, Vyavayi, Vishada,Sara,Vikasi.	Shool, Shothain kati, Vrsya, Amavatahara, VataKaphahara and Adhobhagadoshahara (disorders of lower parts of the body)	-
3.	Saindhava	Rock salt	Madhura	Shita	-	Laghu	Srotosodhak	NACL
4.	Gomutra	Cow’s urine	Katu	Ushna	-	Laghu, Tikshna	Vatanulomana, Srotosodhak	Urea,Uric acid
5.	Guda	Saccharin offcinarum (fam.poaceae)/ Jaggery	Madhura	Ushna, Natishita	Madhura	Snigdha, Ishatksariya.	Vata-Pitta Nashaka. Saktasochana, Vrsya, Vataghna-Natipittajit- -Kaphavrddhikara, Krmivrddhikara, Balya, Medovrddhikara	sugar

Indications

• Shoola (pain),
• Anaha (gaseous distention),
• Amavata (diseases due to Ama and Vata)
• Shopha of kati, uru, prushta(inflammation of upper or lower back)
• Urusthambha (specific diseaseof lower limb)
• Gridhrasi (sciatica)
• Janusamkocham (stiffness in Knee)
• Vishamajwara(fever)
• Klaibya(impotency)

Method of preparation

A) Materials Required to Formulate Basti.

• Basti putak (enema can)
• Basti netra (nozzle)
• Gloves
• Cotton cloth
• Mortal &pastel

B)Ingredients of basti

• Guda (jaggery)
• Saindhavlavana(rock Salt)
• Gomutraarka(cow urine)
• Chincha (tamarind)
• Erandtaila (castor oil)

C)Procedure to formulate &give basti.

Pre-procedure:
a) Preparation of patient
b) Preparation of basti.

a) Preparation of patient: After the evacuation of bladder and bowels, local massage and fomentation on pelvic region shall be done.
b) Preparation of basti: Vaitaranabasti is prepared as per the classical method used for the preparation of niruhabasti. Jaggery (guda) is mixed uniformly with a small amount of lukewarm water. Saindhava is added to the above. Tilataila is added till the mixture become homogenous. Chinchakalka is prepared with warm water and added to the above mixture carefully. Gomutra is added slowly and mixing is continued so as to have uniform bastidravya. Finally, after filtering, bastidravyais made lukewarm by keeping it into hot water bath.

Main procedure (pradhana karma):

Patient is advised to lie down in the left lateral position on the basti table with straight body and left hand kept below head. His right leg is folded at knee joint and made to rest flat over the straight left leg. Then lukewarm (sukhoshna) unctuous material (sneha) is applied to the anal region and on the basti instrument (Netra). It is inserted slowly up to 1/4 part of the bastinetra. Lukewarm bastishould be administered slowly.

Post procedure (pashchat karma):

The basti instrument is removed from anus. Then gentle tapping on thigh & buttocks is done. Then the patient is asked to change posture to left lateral. If patient gets natural urge within 10 to 30 minutes, he will be advised to evacuate bowels.Clinical features of proper basti karma are observed.

Basti retention time (pratyagamana):Onemuhurta (48 minutes).

Clinical features after administration:
Proper dose

• Prashasta vidamutra (proper amount of defecation, urination & evacuation of flatus)
• Agni vriddhi(improves digestion)
• Ruchi (increased desire to take food),
• Ashayalaghvani (lightness in body)
• Rogaupshanti (resolution of disease state)
• Balavraddhi(increased physical strength).

Less dose

• Shiro hridaya, gudabasti, medhravedana(pain in head, heart, anal region, urinary bladder, penis)
• Shopha (swelling)
• Pratishyaya(rhinitis)
• Parikartika(fissure)
• Hrillasa (nausea)
• Maruta mutra sanga(retention of flatus & urine)
• Shwasa (dyspnea).

Excess dose

• Kapha pitta kshaya (reduction of kapha& pitta)
• Anil prakopa (increment of vata)
• Angamarda (body pain)
• Klama (fatigue)
• Vepana (trembling)
• Nidra-balaabhava(absence of sleep & strength)
• Tamapravesha(blackouts)
• Hikka(hiccup)
• Unmada (insanity)
• Adhmana(bloating)
• Parikartika(fissure)
• Stambha(stiffness)
• Kamala(jaundice)

D)Time of administration

Vaitaranabastican be given after meal also.

Mode of action of basti

Basti introduced into the rectum (pakwashaya)acts upon the whole body and on every system of the body. It draws out impurities from head to toe by its potency just as the sun evaporates water from the earth by its heat. [Cha.Sa.Siddhi Sthana 7/64] As the cloth absorbs the dye from water mixed with kusumba(safflower) plant, in the same way Basti eliminates the mala from the body which have undergone liquefaction due to snehana and svedana. [A. Hru. Sutra Sthana 19]

The bastidravya churns and collects the accumulated dosha and stool (shakrut) from umbilical, hypogastric and pelvic region (nabhi, kati, parshwa and kukshi pradesha), causes oleation (snehana) to the body and expels out the dosha.[Cha. Sa. Siddhi Sthana1/40]

Mode of action ofvaitaranabasti:

Note: The pharmacological properties of ingredients after their rectal administration are not yet studied. The properties of ingredients after oral administration are studied and presented here for reference.

Saindhava lavana (rock salt): Saindhava lavanais the purest form of rock salt, considered the best among all varieties of salt and advisable for daily consumption. It possesses 85% NaCl and 15% trace materials, whereas anothersaltcontains 97% NaCl.It is salty and slightly sweet in taste; madhuravipaka (sweet post digestive effect), sheetaveerya (cold potency), light to digest and unctuous in nature. In bastitherapy, rock salt is added to prepare an emulsion. It helps to dissolve and expel dosha from the intestines.
The role of subtle (sukshma), unctuous (snigdha) and sharp (tikshna) properties are as below:

- By virtue of subtle (suskhmaguna),bastidravyareaches up to the molecular level. It helps to pass the drug molecule in systemic circulation through the mucosa.

- Sharp (tikshnaguna) breaks down the morbid mala & dosha bondings (sanghata), hence helpful for the elimination of waste due to its irritant property.

- Unctuous (snigdhaguna)is capable of liquefying the doshaand breaking it into minute particles.

Chincha / Tamarind (Tamarindus indica L.) :
Oral administration of chinchahasvata-kapha pacifying, dry (ruksha) and hot (ushna) properties. These are useful in management of amavata.Tamarind is rich in tartaric acid which is a potent antioxidant and is a good source of iron and thiamine. The ripe fruit of tamarind is madhura-amla (sweet-sour) in taste. It is heavy to digest (guru),dry (ruksha),and hot in potency (ushnaveerya) with sour (amla)post digestive effect (vipaka).

Ripe fruit pacifies vataand pitta. It has appetizing, digestive, thirst suppressing liver stimulant, anti-inflammatory, diuretic, anti-toxic, bladder purifing, anti-fatigue actions. It is useful for fever, constipation, loss of appetite, wound, sunstroke, rheumatism, inflammation, and diabetes. Its fruit is laxative. Leaves are useful to destroy parasitic intestinal worms. It is used as a food and has culinary uses. It is made into a refreshing and cooling beverage particularly used in fever. It possesses antioxidant, antiinflammatory, anti-microbial, anti-fungal, anti-viral,hepato-protective, anti-nematodal, molluscicidal, antidiabetic, anti-cytotoxic activities.

Tamarind fruit has anti spasmolytic activity by blocking calcium channel has a laxative effect due to the presence of malic acid, tartaric acid and potassium and it prevents cardiovascular diseases and obesity due to the content of polyphenol and flavanoids in it.

Jaggery: In vaitarana basti, jaggary is used instead of honey(madhu). Saindhavaalong with jaggary makes a homogenous mixture, to form a solution having properties to permeable the water easily. The retention of the irritative substances may be favored by making its solution as nearly isotonic as possible by using colloidal fluids as a combination of this bastidravya, it also helps in carrying the drug into the micro-cellular level.It also contains polyphenols, a phenolic compound withantioxidant and cytoprotective activities. Jaggery is a very useful substance for oedema patient, when it is consumed along with ardraka, abhaya, sunthi, or pippali. It is also good for the patients with dysuria, constipation, cardiac problems, asthma, allergies, chronic fever, piles, throat and lung infections, malabsorption syndrome (grahani) and kaphavataja roga.

Gomutra (cow urine): In vaitaranabasti, cow urine is main ingredient. Its pungent taste (katu rasa), pungent post digestive effect (katuvipaka), hot potency (ushnavirya), light to digest (laghu), dry (ruksha) and sharp (tikshna) properties pacify kapha and vata. It stimulates agni (agnideepana-pachana), purifies body channels (srotovishodhana),pacifies vata (vatanulomana) and relieves ama. It is the best and useful among all urines (mutra). It is useful in obesity, certain cardiac and renal diseases,indigestion, stomachache, diarrhea, oedema, jaundice,anemia, hemorrhoids and skin diseases including vitiligo. It acts as bio-enhancer and has antifungal, antimicrobial, germicidal, bactericidal, anthelmintic, antioxidant and antineoplastic action. It is useful in hypersensitivity reactions and in numerous other diseases including increasing the life span of a person. It has immune enhancer properties. It augments B and Tblastogenesis and IgA, IgG, and IgM titer in experimental animals. It exhibits antimicrobial and germicidal activity due to the presence of urea, creatinine, and Arum hydroxide (wwarnakshara) in it.Its anti-cancerous activity is due to the presence of uric acid and Allantoin in it. It shows wound healing activity due to the presence of allantoin, immunomodulation due to presence of Arum hydroxide. It prevents cardiovascular diseases due to the presence of kallikrein, urokinase, hippuric acid and ammonia in it. It attributes anti-obesity properties due to the content of copper. It exhibits anti-toxic activity by virtue of Arum hydroxide present in it.

Tilataila(Sesame oil): In vaitaranbasti, sesame oil is mixed with the solution of jaggary and saindhavato form uniform mixture.

Probable mode of action

It may act through vascular route(myo-enteric venous plexus),nervous route(specifically act on apana&samanavata,hence ENS involved).

There may be possible correlation -

• It modulates endocrine functions (myoentericplexus—ANS—Brain—Pituitary—Adrenal ovarian/testicular axis).
• It maycauses pressure variation of intestinal mucosa, which may induce difference in intestinal intra- cellular and extra -cellular fluid.
• It acts by a curious bio feedback mechanism yet to be identified.

Basti dravya reaches up to micro & macro levels due to its virya(potency). It helps first to disrupt the pathogenic process &carries the morbid matter towards the colon (pakwashaya) for elimination. Thus, it acts as a curative as well as purification measure.

practical application

The practical applied aspect of vaitaranibastiis described as follows:

A) Pre-requisites for formulation of basti: The following points should be in consideration to have good results;-

- Tamarind paste (Chinchakalka):The tamarind paste is prepared after removing fiber and seeds from it. Actual weight of this paste is measured. Tamarind (chicha) should be soaked in water(room temperature)overnight, then fibrous & seed part extracted & remaining portion should be filtered with the help of fine cotton cloth. In case of instant preparation, the tamarind can be used after soaking it in hot water for fifteen minutes. Tamarind (chincha) should be old (purana), blackish in texture; should not having whitish coated texture.

- Jaggery: It should be use in melted form(semiliquid preparation). Jaggery should be added with 3-4ml hot water, mixed gently & then should be filtered out.It should not be grinned or rigorously stirred in any possible way.

- Cow urine: It should not have any turbidity in appearance or strong pungent smell. Foaming is observed when it is mixed with other contents. It ensures the fresh and qualitative aspect of cow urine. In absence of fresh cow urine, its extract (gomutraarka) is used after diluting it in 1:2 or 1:3 ratio with lukewarm water.

B) Administration of basti to the patient:

- Vaitaranabasti should be administered at evening or in morning hours of day because during that time of a day pitta predominance is at its lower range or should say tikshnaguna effect is at its lowest peak

- Per rectal examination should be done before administration to check any anorectal disease like pile mass, sentinel tag, inflammation, fissure etc.Vaitaranabastiis contraindicated in such conditions.

C) Clinical indications and contraindications of vaitaranabasti: The classical references of indications include shoola,anaha,amavata. Following table shows clinical conditions in which vaitaranabasti can be useful as well as contraindications.

Classical References	Current clinical correlations
Shoola (pain)	Vatashonita -Kaphaanubandha, amavastha of Sandhivata. Rhematoid Arthritis, Osteoarthritis, Gout Arthritis, Ankylosing Spondylitis, Systemic Lupus Erythematous, Avascular Necrosis.
Anaha (flatulence)	Vaitaranabastiis contraindicated in flatulence originated due to any space occupying lesion, Ileitis, Colitis, Pancreatitis, Hepatitis, Chronic Liver Disease, High Grade Fever, Crohn’s Disease, Ulcerative Colitis.
Amavata	Rheumatoid Arthritis,Osteoarthritis,Gout Arthritis,Ankylosing Spondylitis, Systemic Lupus Erythematous,Intervertebral Disc Prolapse,GreevagataVata,JanugataVata,Katigraha,Katishoola,Frozen Shoulder.

Other contraindications:

• Anal diseases
• Skin diseases
• Blood disorders
• Pitta prakriti

Current research works

• It is noticed that relief in sign and symptoms were found in patients when treated with vaitaranabasti and VatariGuggulu. Thus, it can be said that vaitaranabastiworks as a curative as well as purifying measure. Proper diet restrictions as per prakriti of a patient must be followed. This will provide a better and healthy life to Amavata patients.
• The study reveals that a patient has got significant result infunctional score and swelling. Patients had got very significant result in morning stiffness, pain, tenderness & grip. Since amavata is an autoimmune disease patients may require second course of the same pattern.
• It is noticed that relief in signs and symptoms of amavata was found in both groups. Comparatively, Valukasweda with Vaitarana Basti group showed better results.
• The clinical assessment of results proves the efficacy ofvaitaranabastiwith moderate improvement in symptoms.
• Vaitaranabasti can be used in the disease in which niruhabasti is indicated and which are caused due to Ama; vaitaranabastihave significant result in Sandhigatavata(Upastambhita).
• Vaitaranabasti is an effective treatment in the management of Amavata& it shows long lasting result. vaitaranabastican be administered without priorsnehapana, swedanaor virechana.
• Vaitaranabastiand virechanakarma is an effective treatment in the management of amavata. Proper line of treatment gives better result in Ayurveda.
• In this single center, randomized, open clinical study total 30 patients diagnosed with amavatawere selected. In one group AlambushadiGhana Vati(each500 mg) two tablets thrice a day was given and in second group Alambushadi Ghana vati with Vaitaranabastion alternate day (15 days) was administered. The result shows that excellent relief in 20% patients, significant relief in 60% patients, moderate relief in 13.33% patients, whereas mild relief in 6.66% patients. Research study concluded that comparing the effect of two therapies(Alambushadighanavatialong with vaitaranabasti) provided better relief than (Alambushadi Ghana Vvti alone) in most of the signs and symptoms of the disease at significant level.
• Vaitaranabastiis one of the most effective and economical bastiwhich can be administered in a wide range of diseases.
• The majority of the content drugs of vaitaranabastiare having laghu, ruksha, ushnaand tikshna properties which pacifies vatakapha dosha. Vaitaranabastishows significant effect in ama, shula and shotha avastha.
• Pharmacognostic studies shows that authentic drugs were used for preparation of the formulation and the physiochemical analysis indicates that the formulation meets all the qualitative standards. Current literature review indicates that characterization parameters of vaitaranabastiare not reported anywhere so the parameters discussed here may be used as identification tools for the quality assessment of vaitarana basti.

Vaitaranabasti is primarily depicted in the following texts:
B. Chakrapanidutta. Chakradutta with BhavarthaSandipaniHindiVyakhya. Varanasi; Chaukambha Sanskrit Sansthan; 1961.
C. Vangasena-Vangasena Samhita, Vol.2. Second edition. By Nirmal Saxena. Varanasi: Chaukambha Sanskrit Sansthan; 2001.
D. Vrndhamadhav-Sidhayogah, Part 2. First edition. By Dr. Premvati Tiwari & Dr. Asha Kumari. Varanasi: Chaukambha Sanskrit Sansthan; 2006.