Asthapana basti

Asthapana basti or niruha basti (therapeutic decoction enema) is a prime treatment for disorders due to vitiation of vata dosha. It can expel out the increased dosha. [Cha.Sa. Siddhi Sthana 1/27] Niruha basti (therapeutic decoction enema) can pacify vata at its root i.e. colon. Thus, it protects the whole body from diseases due to vata dosha. Both asthapana (therapeutic decoction enema) and virechana (therapeutic purgation) remove the doshas from the body through the colon. Asthapana basti (therapeutic decoction enema) has the advantage of eliminating dosha without causing difficulties like belching, pain in the heart region and koshtha (gut). [Cha.Sa. Siddhi Sthana 10/07] Niruha (therapeutic decoction enema) can be administered in weak persons, where virechana is contraindicated. (therapeutic purgation) [Cha.Sa. Chikitsa Sthana 28/86] Virechana (therapeutic purgation) is contraindicated in children and old people, whereas asthapana (therapeutic decoction enema) can be used for lifetime. [Cha.Sa. Siddhi Sthana 10/07] This chapter focuses on the concept and practices of asthapana basti (therapeutic decoction enema).

Contributors

Section/Chapter/topic	Concepts/Basti/Asthapana basti
Authors	Adarsh P. M. 1, Deole Y.S. 2
Reviewer & Editor	Basisht G.3
Affiliations	1 Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India 2 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India 3 Rheumatologist, Orlando, Florida, U.S.A.
Correspondence emails	dryogeshdeole@gmail.com, carakasamhita@gmail.com
Publisher	Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India
Date of publication:	August 25, 2023
DOI	10.47468/CSNE.2023.e01.s09.145

Etymology and derivation

Asthapana: The word asthapana is derived from aan, stha with lyut suffix in Sanskrit. This means to stay in one place (for longer time). Asthapana prevents the aging process by fixing the malfunctioning dosha.
Niruha: The word niruha is derived from nir (निर्) (privative)+ uha (ऊहा) (reasoning)+ karane (करणे घञ्). Thus, the word niruha stands for the treatment whose effect is beyond reasoning (or effective without any doubt).

Synonyms: Asthapana basti, niruha basti, kashaya basti

Types of asthapana basti

1. Based on veerya (potency):
1. Mridu asthapana basti (mild potency): The basti with mild potency is indicated in diseases of short duration, easy to cure, and having minimum strength.[Cha.Sa.Siddhi Sthana 10/15,16]. It is indicated in persons of inferior mental strength (avara sattva).[Su.Sa.Chikitsa Sthana 38/90]. It is indicated explicitly in old age and children.[Su.Sa.Chikitsa Sthana 35/10]The basti becomes mild (mridu), when milk (ksheera) etc. are added to it.[Cha.Sa.Siddhi Sthana 7/63]
   Prasrutika basti is an example of mridu basti (basti with mild potency), which is indicated for tender/delicate persons(sukumaras). There are chatur prasrutika, pancha prasrutika, shat prasrutika, sapta prasrutika and nava prasrutika bastis mentioned in prasruthayogika siddhi.
2. Teekshna asthapana basti (strong potency): The basti with strong potency is indicated in diseases of prolonged duration, challenging to cure, and having maximum strength. It can be administered in persons having superior mental strength (pravara sattva). The basti will get sharpness (teekshnatvam), when it gets added with cow’s urine (gomutra), pilu (Salvadora persica Linn), Chitraka (Plumbago zeylanica), salt (lavana) and alkali (kshara).
2. Based on effect (karma):
1. Utkleshana basti: This type of basti is intended to aggravate dosha in dormant state (leena avastha). After initial aggravation, the basti expelles the dosha to create equilibrium. Eranda beeja (seed of Ricinus communis), madhuka (Madhuka longifolia), pippali (Piper longum), saindhava (rock salt) and hapusha phala (Juniperus communis Linn.) as kalka are the ingredients of utkleshana basti. [Su.Sa. Chikitsa Sthana 35/93]
2. Doshahara basti : This pacifies dosha by removing them.The ingredients of doshahara basti are satahva (Anethum sowa), madhuka (Madhuca longifolia), kutaja beeja (Holarrhena antidysenterica), madanaphala (Randia dumetorum) along with kanjika (fermented rice gruel) and gomutra (cow’s urine). [Su.Sa. Chikitsa Sthana 35/94].
3. Dosha shamana basti: This pacifies dosha with mild potency.Priyangu (Callicarpa macrophylla), Madhuka (Madhuca longifolia), Musta (Cyperus rotundus), Rasanjana (semisolid extract obtained from decotion of Berberis aristata with milk) along with cow’s milk (goksheera) are the ingredients. [Su.Sa. Chikitsa Sthana 35/95]
3. Yapana basti (enema for sustaining life)
   Yapana bastis can be administered in all seasons. There are 12 types of yapana bastis mentioned and they are indicated in different stages of all diseases. They serve the action of niruha basti (therapeutic decoction enema) and sneha basti (therapeutic unctuous enema). Mustadi yapana basti. shaliparnyadi yapana basti, sthiradi yapana basti are examples of yapana basti. [Cha.Sa. Siddhi Sthana 12/16-17]
4. Piccha basti (enema for healing)
   Piccha basti is a kind of asthapana basti prepared using slimy (picchila) dravyas. It is indicated in conditions like diarrhea (atisara), where there is bleeding from rectum. [Cha.Sa. Chikitsa Sthana 19/93]
5. Ksheera basti (enema with medicated milk)
   The type of asthapana basti where medicated milk (shrita ksheera) is used instead of decoction is known as ksheera basti. It is also a kind of mridu basti (basti with mild potency). It is indicated mainly in diseases like vatarakta (rheumatism due to vitiated vata and rakta), sandhigata vata (degenerative joint disorder), visarpa (erysipelas), vatavyadhi (disorders due to vata) etc.
6. Rakta basti (enema with animal blood)
   Rakta basti contains the blood of freshly killed animals which is indicated mainly in atisara(diarrhea) where the patient is debilitated by losing blood through the rectum. It is indicated in raktatisara (ulcerative colitis with blood in stools) and jeevadana vyapat of virechana (therapeutic purgation) and basti (therapeutic enema). [Cha.Sa. Siddhi Sthana 6/82]
7. Doshaghna basti
1. Vataghna basti
   In diseases having the aggravation vata dosha, the basti processed with the decoction prepared out of drugs having the property to pacify vata (vataghna aushadha). Trividha sneha (combination of three snehas viz ghee, plant oil and muscle fat.), amla dravyas (drugs having sour taste) and saindhava (rock salt) is used. [Su.Sa. Chikitsa Sthana 38/77]
2. Pittaghna basti
   In diseases associated with pitta dosha, basti (therapeutic enema) processed with the decoction of nyagrodhadi gana combined with kakolyadi gana as kalka (paste) along with ghee and sugar is advised. [Su.Sa. Chikitsa Sthana 38/78]
3. Kaphaghna basti
   In diseases having an association of kapha dosha, basti (therapeutic enema) processed with the decoction of aragvadhadi gana combined with pippalyadi gana as kalka (medicinal paste) along with honey, cow’s urine (gomutra) is to be used. [Su.Sa. Chikitsa Sthana 38/79]
4. Rakta shamana basti
   In diseases having loss of blood (shonita pravrutti), the enema processed with the decoction prepared out of ksheeri vrikshas (group of trees starting from nyagrodha) combined with sugar cane juice), milk, ghee, and sugar is used. [Su.Sa. Chikitsa Sthana 38/80]
8. Shodhana basti
   The enema, which is processed with the decoction and medicinal paste of shodhana dravyas (group of drugs with purifying action), with rock salt and unctuous substance (sneha) is known as the shodhana basti. [Su.Sa. Chikitsa Sthana 38/81]
9. Lekhana basti:
   The enema is processed with the decoction of triphala, cow’s urine, honey, alkali (kshara) and combined with ushakadi gana as a medicinal paste (kalka), known as lekhana basti. [Su.Sa. Chikitsa Sthana 38/82]
10. Brimhana basti:
    The basti processed with the decoction of drugs having the nourishing property(brimhana) combined with the drugs having a sweet taste (madhura rasa) as a medicinal paste (kalka) along with ghee and meat soup (mamsarasa) is known as brimhana basti. [Su.Sa. Chikitsa Sthana 38/83]
11. Grahi basti
    The enema is processed with the drugs of priyangvadi gana combined with ambashtadi gana as medicinal paste and honey and ghee known as grahi basti. [Su.Sa. Chikitsa Sthana 38/87]
12. Madhutailika basti
    When honey (madhu) and oil (taila) are given equal importance in enema, then it is known as madhutailika basti. Yapana basti, yuktharadha basti and siddha basti are synonyms of madhutailika basti. It helps remove the doshas and bring up the strength and complexion of a patient. The peculiarity of this kind of enema is that there will be no restrictions on diet, beverages, travel, and sexual intercourse. The enema shows many benefits to the patient with no complications at all. [Su.Sa. Chikitsa Sthana 38/114]
13. Yuktaratha basti
    The patient can travel in chariot (ratha) after taking this enema. Hence it is named as yuktaratha basti. This basti has ingredients like erandamuladi as decoction; vacha (Acorus calamus), madhuka (Madhuca longifolia) and pippali (Piper longum) as medicinal paste and taila (sesame oil) as unctuous substance (sneha). [Su.Sa. Chikitsa Sthana 35/8]
14. Siddha basti
    The attainment of strength, nourishment, and complexion and the cure of many diseases can be possible by this basti, and thus, it is named siddha basti. Yavakoladi siddha basti is one of its examples processed with the decoction of yava ( Hordeum vulgare),kola (Ziziphus mauritiana Lamk Z.jujuba Lamk), and kulattha (Dolichos biflorus ), along with the medicinal paste of magadhika (Piper longum) and yashtyahva (Glycyrrhiza glabra).[Su.Sa.Chikitsa Sthana 38/97-99]
15. Vaitarana basti
1. Gomutra vaitarana basti
   Fruit pulp of Tamarindus indicus as paste (amleeka kalka), jaggery, rock salt and cow’s urine along with little quantity of oil (taila) is used for the preparation of gomutra vaitarana basti. [Chakradatta Niroohadhikara 72/33]
2. Ksheera vaitarana basti
   All the ingredients are the same as gomutra vaitarana basti except cow’s milk in place of cow’s urine here. [Vang.Sa. Basti Adhikara 86-189]
16. Ardhamatrika basti
    It has a total quantity of 12 pala (1 pala equals 48g), which is half that of dvadasha prasrutha basti. Here decoction of dashamoola (group of roots of 10 drugs), honey, rock salt and shatapushpa (Anethum sowa) as medicinal paste is used. [Vang.Sa. Basti Adhikara 172-181]
17. Vrishya basti
    The decoction of egg of chataka (hen sparrow) and uchataka along with cow’s milk, ghee, sugar and athmagupta phala (fruit of Mucuna pruriens) as admixture (avapa) is aphrodisiac (vajikarana) in nature. [Su.Sa. Chikitsa Sthana 38/84]
18. Chakshushya basti
    Erandmauladi decoction, yashtyahva (Glycyrrhiza glabra) as the medicinal paste, and honey, rock salt, and oil are the ingredients of chakshushya basti. [A. Hri.Kalpa Sthana 4/27-29]
19. Churna basti
    Churnabasti has pain relieving (shulaghna) properties with hot water as a liquid component (dravadravya) instead of decoction. The medicinal paste of rasna (Pluchea lanceolata), vacha (Acorus calamus), bilva (Aegle marmelos), shatahva (Anethum sowa), ela (Eletteria cardamomum), putika (Holoptelia integrifolia), krishna (Piper longum), daru (Cedrus deodara) and kushdha (Saussuria lappa C. B Clarke) is used. [Cha.Sa. Siddhi Sthana 10/13-14]

Importance in the preservation of health and prevention

Therapeutic enema is advised in healthy individuals during the rainy season where there is vitiation of all three doshas [A. Hri. Sutra Sthana 3/42], after the administration of vamana (therapeutic emesis) and virechana (therapeutic purgation). [A. Hri. Sutra Sthana 3/45]

Importance in the management of diseases

• Basti (therapeutic enema) therapy (asthapana and anuvasana) is the most important among the therapies for treating vata dosha disorders. It enters the intestine (pakvashaya) after the administration cuts the root of aggravation of vata and thereby it pacifies vata all over the body. Its effect is like cutting the root of a tree (disease) will destroy the whole tree (disease). [Cha.Sa. Sutra Sthana 20/13]
• Basti (therapeutic enema), in general, is helpful in the prevention of aging, and it produces health, strength, proper digestion, intelligence, voice, and complexion.
• It is recommended for both children and old age as it effectively cures diseases without causing complications.
• It removes the vit (stool), shleshma, pitta and vata dosha from the body.
• It provides compactness to the body and strength to shukra dhatu (the 6^th basic structural element of the body).
• It removes doshas from the body’s channels and thus pacifies all diseases. [Cha.Sa. Siddhi Sthana 1/27]
• Administration of niruha basti (therapeutic decoction enema) before anuvasana basti (therapeutic unctuous enema) clears the channels.. It helps properly transport unctuous substance (sneha) like the pipe which carries water when the impurities causing obstruction are removed. [Su.Sa. Chikitsa Sthana 38/84]
• Basti (asthapana and anuvasana) is important as it is the prime treatment for vata. Vata is the reason for the diseases originating in peripheral tissues (shakha), visceral organs (koshtha), vital points of the body (marma), upper part of the body (urdhva), entire body (sarvavayava) and individual parts of the body (anga). The same vata is responsible for separating and combining stool, urine, pitta, etc. at their sites. As basti is supreme in managing vata, it is said to be half of the entire therapeutics. [Cha.Sa. Siddhi Sthana 1/38-40]

Indications of asthapana basti

• Sarvanga roga – The diseases are affecting the whole body.
• Ekanga roga – The diseases are affecting the organs.
• Kukshiroga – Diseases affecting the abdomen and pelvis
• Vata varcha mutra sanga – Obstruction to flatus, feces, urine
• Adhmana – abdominal distension
• Angasupti – Organ-level numbness
• Krimikoshtha – The gut infested with worms.
• Balavarnamamsaretaskshaya – depletion of strength, complexion, muscle, and sperms
• Atisara – Diarrhea without the involvement of metabolic dysfunction (ama)
• Udavarta - Upward movement of vata due to retention of stool and urine
• Parvabheda – Pain in joints
• Pleeha - Splenomegaly
• Abhitapa – Burning sensation
• Gulma – A type of lump
• Shula – Abdominal colic of different pathologies
• Shirakarnashula – Pain on head and ear
• Bhagandra – Fistula
• Unmada - Insanity
• Jwara - Fever
• Hrudaya parshva prushta katigraha – Pain over heart, sides of chest, lower back, and hip.
• Hrudroga – Diseases affecting heart
• Bhradhna - Inguinal hernia
• Vepana - Tremor
• Sphikjanujangha shula – Pain on flanks, knee, and calf
• Akshepaka - convulsions
• Gourava – Heaviness of body
• Ati laghava – Excessive lightness of body
• Uru gulpha parshnishula – Pain over thigh, ankle, and heel
• Rajakshaya – loss of menstrual blood with burning
• Vishamagni – Irregular state of agni
• Shosha - Emaciation
• Bahu, anguli, stanantashula – Pain over arms, fingers, and middle of chest
• Stambha - Stiffness
• Antrakujana – Gurgling sound in the intestine
• Parikartika – sharp cutting pain in anus
• Danta nakha parvasthi shula – Pain on teeth, nails bones and joints
• Anaha - Barborygmus with distention
• Pratishyaya – A type disease affecting nose including coryza
• Ashmari – Renal calculi
• Khuda – A disesase which is affecting the skin and muscle over the joints of legs and hands first and later spreads to deeper sites
• Vatavyadhi – Diseases originates from vitiated vata
• Alpalpodhana – Voidance of stool frequently in less quantity
• Sashabdodhana – Voidance of stool with sound
• Ugragandhodhana- Voidance of stool having foul smell. [Cha.Sa. Siddhi Sthana 2/16]

Niruha basti is also indicated in following diseases

• Adhimantha - glaucoma
• Ardita - facial paralysis
• Pakshaghata - hemiplegia
• Udara - obstinate disorders affecting the abdomen including Ascites.
• Upadamsha -syphilis
• Mutrakruchhra - dysuria
• Shukra artava stanya nasha: Depletion of semen, menstruation, and breast milk
• Hanugraha – lock jaw
• Manyagraha – neck stiffness
• Sharkara – multiple gravel like particle in urine
• Mudhagarbha – abnormal fetal presentation. [Su. Sa. Chikitsa Sthana 35/5]

Contraindications

• Persons suffering from severe weakness
• Injuries.
• Fainting
• Those who have undergone the process of purification any.
• Those whose life depends on the strength of morbid matter (agantu dosha) to survive [Cha.Sa. Siddhi Sthana.1/37]

Ingredients of niruha basti

As the name suggests, the important and predominant content of niruha basti (therapeutic decoction enema) is a decoction of herbs depending upon the disease condition of the patient. Its other ingredients are honey, rock salt, unctuous substances (usually oil or ghee) and medicinal paste. In some conditions, cow’s urine, fermented liquid preparation out of grains (dhanyamla), meat soup, milk etc. are used either as an alternative or as an admixture (Avapa) to the combination of basti.

Quantity of ingredients

The general dosage of ingredients for 1152 ml (dvadasha prasruta) basti are as follows. While preparing, there is a specific sequence of mixing the ingredients and their quantity is listed below.

1. Honey (madhu): 192 ml (2 prasruta)
2. Rock salt (saindhava): 12 gram (1 karsha)
3. Oil/ghee/unctuous substance (sneha): 288 ml (3 prasruta)
4. Medicinal paste (kalka): 96 gram (1 prasruta)
5. Decoction (kashaya): 384 ml (4 prasruta) to 480 ml (5 prasruta) *[Su.Sa. Chikitsa Sthana 38/37-39]
6. Additives (avapadravya): 192 ml (2 prasruta) [Cha.Sa.Siddhi Sthana 3/30]

The proportion of sneha (unctuous substance) and honey is based on dosha association.

Table 1. Ingredients’ proportion in basti formulation based on dosha association

	Vata predominance	Pitta dosha anubandha	Kapha dosha anubandha
Honey	3 pala (144 ml)	4 pala (192 ml)	6 pala (288 ml)
Unctuous substance	6 pala (288 ml)	4 pala (192 ml)	3 pala (144 ml)

[Cha.Sa. Siddhi Sthana 3/30]

Dose of asthapana basti in different age groups

The dose of basti formulation as per age. It is shown in table 2.

Table 2: Age specific dose of basti formulation

Age	Dosage
1 year	½ prasruta (48 ml)
Increase the dosage by ½ prasrutha each year till 12 years	48 ml to 576 ml
12 years	576 ml (6 prasruta)
Increase the dosage by 1 prasruta each year till 18 years	576 ml to 1152 ml
18 year and above until age 70	1152 ml (12 prasruta)
Above 70 years	960 ml (10 prasruta)

[Cha.Sa. Siddhi Sthana 3/31-32]

Table 3: Sushruta’s view on age specific dose of basti formulation

Age	Dosage
1 year	2 prasruta (192 ml)
8 years	4 prastuta (384 ml)
16 years	8 prasruta(768ml)
25 years and above up to 70 years	12 prsruta (1152 ml)
Above 70 years	8 prasruta (768 ml)

[Su.Sa. Chikitsa sthana 35/7]

Procedure of administration of asthapana basti

The procedure of administration of basti can be divided into three stages like the samshodhana (therapeutic emesis and purgation) procedures. They are.

1. Pre therapeutic procedure (purvakarma)
2. Chief therapeutic procedure (pradhana karma)
3. Post therapeutic procedure (paschat karma)

1. Pre therapeutic procedure (purvakarma)
1. Preparation of the medicine
1. Preparation of asthapana basti (therapeutic decoction enema) formulation by the collective missing of ingredients mentioned above using a churner (khaja).
2. The prepared formulation filled into the enema bag by tying it with the enema nozzle (bastinetra) without catching air inside and without producing wrinkles above the bag.
3. The tip of the enema nozzle should be inserted with a wick (varti) to prevent its leaking.
2. Preparation of the patient
1. The patient must have undergone oil application and sudation.
2. The patient must have an empty bowel and bladder.
3. The patient must not have a severe appetite.
2. Therapeutic procedure (pradhana karma)
• The patient should be lying in the left lateral position with the head side either raised or at the same height as that of the leg on a fair couch which is not lifted too much.
• The patient should be lying in an left lateral position with his own arm as the pillow below head.
• The right leg should be flexed at the knee whereas the left leg should be in extended position.
• The anal orifice (guda) should be lubricated and the 1/4th of the total length of the lubricated enema nozzle (which is equal to the distance from the tip of nozzle to the karnika at the tip) should be inserted in the same direction of the vertebral column.
• The hand of the person giving enema should not be shaking during the insertion of the nozzle.
• Repeated squeezing of the enema bag is not favorable, and the nozzle should be withdrawn slowly and carefully. [Cha.Sa. Siddhi Sthana 3/17-20]
3. Post therapeutic procedure (paschat karma)
• After the proper elimination of enema, the patient should have undergone bath with lukewarm water and take boiled rice with thin meat soup.
• The patient should be given anuvasana basti (therapeutic unctuous enema) with the oil (taila) having 1/4^th quantity of that of asthapana (therapeutic decoction enema) processed with drugs having the property to pacify vata and having sour taste, for the nourishment of the body after the digestion of the above-mentioned diet in the evening. [Cha.Sa. Siddhi Sthana 3/27-30]

Diet after the niruha basti (therapeutic decoction enema)

Table 4: Diet after niruha basti in different dosha involvement

Dosha Involvement	Diet
Vata	meat soup (mamsarasa)
Pittanubandha (association of Pitha)	milk (ksheera)
Kaphanubandha (association of kapha)	soup of pulses of various kinds (yusha)

[Cha.Sa. Siddhi Sthana 3/70]

Number, adjuvant, and properties of niruha basti in different dosha involvement

    Table 5: Number, adjuvant, and properties of niruha basti in different doshas

Dosha involvement	Adjuvant	properties	number
Vata	Meat soup (mamsa rasa)	Unctuous (snigdha), Hot in potency (ushna)	1
Pitta association	Milk (payas)	Sweet (svadu), cold in potency (sheeta)	2
Kapha association	Cows’ urine (mutra)	Pungent (katu), hot in potency (ushna), sharp in action (teekshna)	3

Complications of asthapana basti

There are mainly 12 complications of asthapana basti (therapeutic decoction enema) arise because of its improper administration. They are as below.

1. Ayoga – Untoward effects due to insufficient dose administration
2. Athiyoga – Untoward effects due to excess dose administration
3. Klama - exhaustion without exertion
4. Adhmana – abdominal distension
5. Hikka - hiccups
6. Hrudprapti – reaching cardiac region
7. Urdhvavata – upward dislocation of vata
8. Pravahika - dysentery
9. Shiro arti – headache
10. Angaarti – bodyache
11. Parikartha – sharp cutting pain in anus
12. Parisrava - excessive secretion

The following table shows details about these complications.

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