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→Vidhi Vimarsha
=== ''Vidhi Vimarsha'' ===
=== ''Vidhi Vimarsha'' ===
Effect of Snehabasti: [verse 23-24]
==== Effect of Snehabasti: [verse 23-24] ====
Impediment by vata: [verse 26-30]
Charaka has given due importance to the nourishment properties of ''snehabasti''. Probable reason may be, drugs administered low in the rectum are delivered systemically by the inferior and middle rectal veins before passing through the liver. Thus the bioavailability increases as compared to oral route as degradation from metabolic enzymes is minimal. Hence energy providing capacity is more for ''snehabasti'' compared to oral fat consumption. Moreover, palatability is not an issue in ''basti'' hence larger doses for nourishment are possible to be used. Some fatty acids like omega-3-fatty acid, omega-9-fatty acid, alpha-linolenic acids, cervonic acid etc. are useful for normal intellectual capacity and brain functioning and also prevents ageing. ''Sneha'' itself and ''basti karma'' both remove ''vata'' hence age related degeneration due to increased ''vata'' can be hampered with the use of ''snehabasti'' which can be termed as ''oja'' enhancing effect. Higher intake of omega-3 fats is positively related to sperm morphology hence ''sneha basti'' can also be beneficial for semen’s qualitative improvement.
Vata has ruksha (dry) property on virtue of which it may hamper smooth movement of snehabasti while pratyagamana (removal of basti). Hydrogen sulphide produced by bacterial flora has inhibitory effect on intestinal motility which may be the possible reason for this occlusion. Hence the symptoms also resemble that of intestinal motility disorders and the treatment is targeted on improving the intestinal motility by use of certain drugs having tikshna properties and thus proves to be shodhana (helps evacuation) in nature. Salt has purgative action due to shifting of osmotic gradient, alcohol in low doses is responsible for enhanced gastric emptying, vinegar, cow urine are the acidic preparations that may help in stimulating colonic mucosa that helps in evacuation of occluded enema. Thus, these drugs are commonly employed in treatment of impediment by vata.
Impediment by pitta: [verse 31]
==== Impediment by ''vata'': [verse 26-30] ====
The normal site of pitta production in GI tract is pachyamanashaya which can be considered as a part of small intestine up to the level of caecum. However, impediment of snehabasti by pitta is probably a condition wherein vimarga-gamana (movement of pitta in improper direction) of pitta occurs which can be correlated with inflammation of colon due to any reason. If hot basti is given in already existing inflammation then it may lead to increase in symptoms. Thus, treatment is targeted to cure this acute inflammation. Hence sweet and bitter drugs are employed as they have pitta alleviating properties.
Impediment by kapha: [verse 32-33]
''Vata'' has ''ruksha'' (dry) property on virtue of which it may hamper smooth movement of ''snehabasti'' while ''pratyagamana'' (removal of ''basti''). Hydrogen sulphide produced by bacterial flora has inhibitory effect on intestinal motility which may be the possible reason for this occlusion. Hence the symptoms also resemble that of intestinal motility disorders and the treatment is targeted on improving the intestinal motility by use of certain drugs having ''tikshna'' properties and thus proves to be ''shodhana'' (helps evacuation) in nature. Salt has purgative action due to shifting of osmotic gradient, alcohol in low doses is responsible for enhanced gastric emptying, vinegar, cow urine are the acidic preparations that may help in stimulating colonic mucosa that helps in evacuation of occluded enema. Thus, these drugs are commonly employed in treatment of impediment by ''vata''.
==== Impediment by ''pitta'': [verse 31] ====
The normal site of ''pitta'' production in GI tract is ''pachyamanashaya'' which can be considered as a part of small intestine up to the level of caecum. However, impediment of ''snehabasti'' by ''pitta'' is probably a condition wherein vimarga-gamana (movement of pitta in improper direction) of pitta occurs which can be correlated with inflammation of colon due to any reason. If hot basti is given in already existing inflammation then it may lead to increase in symptoms. Thus, treatment is targeted to cure this acute inflammation. Hence sweet and bitter drugs are employed as they have pitta alleviating properties.
==== Impediment by kapha: [verse 32-33] ====
The normal site of kapha production in gastro-instestinal tract is amashaya which can be considered as stomach and an initial part of small intestine. Kapha has a role in moistening the gastric contents and facilitates its smooth passage in GI tract. Hence impediment by kapha can be well correlated with excess mucus activity which is secreted in stomach and carried to the intestine and colon by food or even secreted by colonic mucosa up to some extent. Sneha has snigdha (unctuous) properties which add to mucus activity hence leading to agnimandya that may produce the symptoms as described. Hence treatment is also planned to remove kleda (moisture) in order to reduce excess mucus activity.
The normal site of kapha production in gastro-instestinal tract is amashaya which can be considered as stomach and an initial part of small intestine. Kapha has a role in moistening the gastric contents and facilitates its smooth passage in GI tract. Hence impediment by kapha can be well correlated with excess mucus activity which is secreted in stomach and carried to the intestine and colon by food or even secreted by colonic mucosa up to some extent. Sneha has snigdha (unctuous) properties which add to mucus activity hence leading to agnimandya that may produce the symptoms as described. Hence treatment is also planned to remove kleda (moisture) in order to reduce excess mucus activity.
Impediment by food in excess quantity: [verse 34-35]
==== Impediment by food in excess quantity: [verse 34-35] ====
Digestion of food starts from stomach and almost completed in small intestine. However, role of colon is very limited in digestion and confines to absorption of water, some minerals and produces vitamins by colonic bacterial flora. Thus, impediment by food suggests presence of undigested food that reaches colon. Ama is a product or is itself is undigested material of food. Thus, the symptoms of impediment by food resembles that of ama disorders. Undigested food material affects gastric motility hence pachana is the remedy that helps in digestion. Thus, in case of impediment by food pachana is preferred as it makes possible ama degradation into easily absorbable nutrients. If this pachana is not possible then mild purgation is also advised to remove out the undigested material.
Digestion of food starts from stomach and almost completed in small intestine. However, role of colon is very limited in digestion and confines to absorption of water, some minerals and produces vitamins by colonic bacterial flora. Thus, impediment by food suggests presence of undigested food that reaches colon. Ama is a product or is itself is undigested material of food. Thus, the symptoms of impediment by food resembles that of ama disorders. Undigested food material affects gastric motility hence pachana is the remedy that helps in digestion. Thus, in case of impediment by food pachana is preferred as it makes possible ama degradation into easily absorbable nutrients. If this pachana is not possible then mild purgation is also advised to remove out the undigested material.
Impediment by stools: [verse 36-37]
==== Impediment by stools: [verse 36-37] ====
Impediment by stools refers to the state of constipation or excess accumulation of stool in colon that obstructs the basti while evacuation. Constipation in general has following ill effects :
Impediment by stools refers to the state of constipation or excess accumulation of stool in colon that obstructs the basti while evacuation. Constipation in general has following ill effects :
• Abnormal colon contractions
• Abnormal colon contractions
• Dysfunctional innervations of colonic, anal sphincter, or pelvic floor muscles. These abnormalities can lead to lack of synchronization among the colon, anal sphincter, and pelvic floor.
• Dysfunctional innervations of colonic, anal sphincter, or pelvic floor muscles. These abnormalities can lead to lack of synchronization among the colon, anal sphincter, and pelvic floor.
All these effects reduce colonic motility and are similar to those symptoms of impediment by stool. Thus, treatment is targeted to resolve constipation and hence phalavarti and udavarta treatment principles are employed.
All these effects reduce colonic motility and are similar to those symptoms of impediment by stool. Thus, treatment is targeted to resolve constipation and hence phalavarti and udavarta treatment principles are employed.
Ailments caused by administration of basti on empty stomach: [verse 38-40]
When anuvasana is given on empty stomach or on emptied bowel or if the enema fluid is injected with great force then it goes up speedily and comes out from the throat or through the orifices in the upper part of the body which seems practically difficult phenomena but some evidences suggest that possibility cannot be ruled out. Materials introduced by enema, may in some instances pass through the valve into the ileum. Such incompetence may permit the enema fluid to reach the duodenum. Further, the possibility of material from even lower bowel reaching the mouth is strongly suggested by the fact that lycopodium spores, introduced into the colon by enema, have been recovered some hours later from washings of the stomach, alimentary canal movements. Thus when alimentary tract is empty and clear the sneha due to its easy penetration capacity may reach up to mouth. The treatment suggested i.e. pressure application over throat results in sudden sympathetic activation leading to adrenaline production. As a result of this, the smooth muscles of the digestive tract are inhibited, so peristalsis stops, sphincter of the bladder also contracts and the bladder wall relaxes. This may lead to involuntary defecation.
==== Ailments caused by administration of basti on empty stomach: [verse 38-40] ====
Importance of warm water in snehabasti course: [verse 43-45]
When anuvasana is given on empty stomach or on emptied bowel or if the enema fluid is injected with great force then it goes up speedily and comes out from the throat or through the orifices in the upper part of the body which seems practically difficult phenomena but some evidences suggest that possibility cannot be ruled out. Materials introduced by enema, may in some instances pass through the valve into the ileum. Such incompetence may permit the enema fluid to reach the duodenum. Further, the possibility of material from even lower bowel reaching the mouth is strongly suggested by the fact that lycopodium spores, introduced into the colon by enema, have been recovered some hours later from washings of the stomach, alimentary canal movements. Thus when alimentary tract is empty and clear the sneha due to its easy penetration capacity may reach up to mouth. The treatment suggested i.e. pressure application over throat results in sudden sympathetic activation leading to adrenaline production. As a result of this, the smooth muscles of the digestive tract are inhibited, so peristalsis stops, sphincter of the bladder also contracts and the bladder wall relaxes. This may lead to involuntary defecation.
==== Importance of warm water in snehabasti course: [verse 43-45] ====
Drinking warm water accelerates the gastric emptying, clears the bowel and hence prevents indigestion or constipation during basti course. It also has inhibitory effect on mucus production thus preventing from kapha vitiation. When hot water is consumed, the body temperature goes up and sweating starts, which can flush the toxic materials out of internal system and cleanse it properly.
Drinking warm water accelerates the gastric emptying, clears the bowel and hence prevents indigestion or constipation during basti course. It also has inhibitory effect on mucus production thus preventing from kapha vitiation. When hot water is consumed, the body temperature goes up and sweating starts, which can flush the toxic materials out of internal system and cleanse it properly.
Frequency of anuvasana basti: [verse 46-47]
==== Frequency of anuvasana basti: [verse 46-47] ====
In vata dominant individuals anuvasana is indicated daily. Pakvashaya i.e. colon is the site of production of vata. Hence to cure any vata disorder the production of vata has to be hampered which is achieved by giving snehabasti. In vata dominance in koshtha, snehabasti is readily absorbed because vata has ruksha (dry) property (AH. Su. 1/11) that in turn gives dryness to the colonic mucosa which attains proper oleation when comes in contact with basti.
In vata dominant individuals anuvasana is indicated daily. Pakvashaya i.e. colon is the site of production of vata. Hence to cure any vata disorder the production of vata has to be hampered which is achieved by giving snehabasti. In vata dominance in koshtha, snehabasti is readily absorbed because vata has ruksha (dry) property (AH. Su. 1/11) that in turn gives dryness to the colonic mucosa which attains proper oleation when comes in contact with basti.
Advice regarding basti administration: [verse 48-49]
==== Advice regarding basti administration: [verse 48-49] ====
• Unprocessed snehabasti is to be avoided in general as it causes abhishyanda. This may be explained by the fact that uncooked fats contain more free radicals and long chain fatty acids. Whereas due to cooking the free radicals are removed and long chain fatty acids may get converted into short chain fatty acids. Free radicals have a number of ill effects and they may increase preexisting inflammation. Short chain fatty acids are easily absorbed from colon whereas long chain fatty acids are rarely absorbed.
• Unprocessed snehabasti is to be avoided in general as it causes abhishyanda. This may be explained by the fact that uncooked fats contain more free radicals and long chain fatty acids. Whereas due to cooking the free radicals are removed and long chain fatty acids may get converted into short chain fatty acids. Free radicals have a number of ill effects and they may increase preexisting inflammation. Short chain fatty acids are easily absorbed from colon whereas long chain fatty acids are rarely absorbed.
• Fat digestion depends upon lipase enzyme, bile salts etc. Consuming fats from oral as well as from basti may dilute these enzymatic actions and also the process of emulsification is hampered thus most of the part of fats remain undigested which may in turn reduce digestive strength.
• Fat digestion depends upon lipase enzyme, bile salts etc. Consuming fats from oral as well as from basti may dilute these enzymatic actions and also the process of emulsification is hampered thus most of the part of fats remain undigested which may in turn reduce digestive strength.
• Utklesha, agnimandya and vataprakopa- Continuous use of snehabasti may cause utklesha as snehabasti is also an alternative way of oleation therapy (Ch. Su. 13/24). If continued still further, then ama formation occurs as indigested sneha and utklishtha (eager to be removed) dosha are not removed from the body by any shodhana procedure like virechana or niruha. Niruha on the contrary causes removal of vitiated dosha, next comes dhatu and when dhatus are removed from body then vata vitiation occurs. This can be correlated to the fact that if continuous niruha are given, it causes inflammation of mucosal lining or may further damage the colonic mucosa leading to leakage of nutrients from mucosa and negatively affecting nutritional activity of colonic bacterial flora.
• Utklesha, agnimandya and vataprakopa- Continuous use of snehabasti may cause utklesha as snehabasti is also an alternative way of oleation therapy (Ch. Su. 13/24). If continued still further, then ama formation occurs as indigested sneha and utklishtha (eager to be removed) dosha are not removed from the body by any shodhana procedure like virechana or niruha. Niruha on the contrary causes removal of vitiated dosha, next comes dhatu and when dhatus are removed from body then vata vitiation occurs. This can be correlated to the fact that if continuous niruha are given, it causes inflammation of mucosal lining or may further damage the colonic mucosa leading to leakage of nutrients from mucosa and negatively affecting nutritional activity of colonic bacterial flora.
Matra basti: [verse 52-54]
==== Matra basti: [verse 52-54] ====
Matrabasti is a low dose form of snehabasti which is equal to lowest dose of oleation therapy. According to Vagbhata, the dose of matra basti is equal to the dose of hrasva snehapana. The Matra which gets digested in two Yama i.e. 6 hours, is called as hrasva matra but the dose required to get digested in two yama is not mentioned( A.S.Su 28/8). According to Acharya Sushruta, the dose of matra basti is ¼ of the dose of anuvasana basti and the dose of anuvasana basti is ¼ of niruha basti i.e. 24 pala. Hence, the dose of anuvasana basti is 6 Pala and dose of matra basti is 1½ Pala i.e. 6 tola(Su. Chi. 37/80). On the basis of above reference it can be said that the dose of matra basti is 1½ pala of sneha i.e. 6 tola equal to 60-70 ml. According to Acharya Kashyapa the dose of matrabasti is, (Ka. Khi. 8/104-5)
Matrabasti is a low dose form of snehabasti which is equal to lowest dose of oleation therapy. According to Vagbhata, the dose of matra basti is equal to the dose of hrasva snehapana. The Matra which gets digested in two Yama i.e. 6 hours, is called as hrasva matra but the dose required to get digested in two yama is not mentioned( A.S.Su 28/8). According to Acharya Sushruta, the dose of matra basti is ¼ of the dose of anuvasana basti and the dose of anuvasana basti is ¼ of niruha basti i.e. 24 pala. Hence, the dose of anuvasana basti is 6 Pala and dose of matra basti is 1½ Pala i.e. 6 tola(Su. Chi. 37/80). On the basis of above reference it can be said that the dose of matra basti is 1½ pala of sneha i.e. 6 tola equal to 60-70 ml. According to Acharya Kashyapa the dose of matrabasti is, (Ka. Khi. 8/104-5)
1prakuncha = 4 tola = (40ml) =kaniyasi matra
1prakuncha = 4 tola = (40ml) =kaniyasi matra
1½ pala = 6 tola = (60 ml) = madhyama matra
1½ pala = 6 tola = (60 ml) = madhyama matra
2 pala = 8 tola = (80ml) = uttama matra
2 pala = 8 tola = (80ml) = uttama matra
Practically employed methods regarding schedule of snehabasti:
The capacity to hold fecal matter, also termed as rectal compliance ranges between 60ml to 500ml. This may be the probable reason to use a dose in quantity lower than 60ml in order to retain the sneha for longer duration in rectum so that the volume of absorption increases. Hence though given in lower doses matrabasti can give similar results as that of other snehabasti in respect of oleation and nutritive activity.
Scope for further research:
==== Practically employed methods regarding schedule of snehabasti ====
Charaka has advocated to give continuously anuvasana maximum for 3 days, However matrabasti can be given continuously for longer durations. Generally, niruha and anuvasana are given alternately to avoid any complications. The maximum dose of snehabasti is 1/4th of maximum dose of niruha (Approx. 240 ml) and is to be given on the same day in evening after niruha. But practically such large doses are not used and up to 120 ml of snehabasti (classically anuvasana) is given on the next day of administration of niruha.
=== Scope for further research ===
• Matrabasti needs to be explored for its possible use as an alternative to snehapana and also standardisation of dosage needs to be done to get specific health benefit like shamana, brimhana etc.
• Matrabasti needs to be explored for its possible use as an alternative to snehapana and also standardisation of dosage needs to be done to get specific health benefit like shamana, brimhana etc.
• Yamaka (combination of different type of fats) sneha, needs to be tested clinically in large sample size as it is considered that combination of sneha gives rasayana effect.
• Yamaka (combination of different type of fats) sneha, needs to be tested clinically in large sample size as it is considered that combination of sneha gives rasayana effect.
=== Glossary ===
• Snēhabastī ( स्नेहबस्ति): Oiliness, unctousness, lubricity, moisture, oil medicated unctous enema having quantity four times less to that of decoction enema.
• Snēhabastī ( स्नेहबस्ति): Oiliness, unctousness, lubricity, moisture, oil medicated unctous enema having quantity four times less to that of decoction enema.
• Mātrābasti ( मात्राबस्ति): A form of unctous enema, The medicated enema given in such a dose which will show no complications even if the post-therapy regimen are not followed.
• Mātrābasti ( मात्राबस्ति): A form of unctous enema, The medicated enema given in such a dose which will show no complications even if the post-therapy regimen are not followed.