Changes

=== ''Vidhi Vimarsha'' ===

=== ''Vidhi Vimarsha'' ===

The knowledge on apt instruments to be used in respective procedure is vital in ensuring the procedure effect. In the case of basti (procedure), the knowledge on properly designed nētra and basti is essential for physicians. Also, Inappropriate appliance of nētra in the procedure leads to vyāpad and needs to be managed by the physician. Hence, this aspect is being dealt further in the chapter.

The knowledge on apt instruments to be used in respective procedure is vital in ensuring the procedure effect. In the case of basti (procedure), the knowledge on properly designed nētra and basti is essential for physicians. Also, Inappropriate appliance of nētra in the procedure leads to vyāpad and needs to be managed by the physician. Hence, this aspect is being dealt further in the chapter.

Research works have proved the importance of instruments and technique of administration which influences the total procedure and thereby its effect on the body. Usage of proper netra and basti in the procedure had influenced the time taken for administration by the maintenance of uniform pressure and gradual squeezing of the content during administration of nirooha  (decoction type of enema) 1. Also, it influenced the extent of reach of medication in the colon and its quantity. Usage of animal bladder for preparation of bastiputaka (bag or vessel) was possible and justified in earlier days, however, is not feasible and practical today. As an alternative, a plastic bag of 50 microns thickness and having 1.5 l capacity has been reported recently and is disposed of after single use.2

Research works have proved the importance of instruments and technique of administration which influences the total procedure and thereby its effect on the body. Usage of proper netra and basti in the procedure had influenced the time taken for administration by the maintenance of uniform pressure and gradual squeezing of the content during administration of nirooha  (decoction type of enema) 1. Also, it influenced the extent of reach of medication in the colon and its quantity. Usage of animal bladder for preparation of bastiputaka (bag or vessel) was possible and justified in earlier days, however, is not feasible and practical today. As an alternative, a plastic bag of 50 microns thickness and having 1.5 l capacity has been reported recently and is disposed of after single use.2

Verse 4- 5

 

==== Verse 4- 5 ====

 

Defect in nētra are eight in number and each of them affects the proper administration of basti procedure. Recommendable nētra according to Charaka, should have the following attributes:  apertures(at the tip, i.e outlet apperture and at the base (inlet aperture) of the netra) equal to little and thumb in circumference (यथावयोऽङ्गुष्ठकनिष्ठिकाभ्यां मूलाग्रयोः स्युः परिणाहवन्ति), straight  

Defect in nētra are eight in number and each of them affects the proper administration of basti procedure. Recommendable nētra according to Charaka, should have the following attributes:  apertures(at the tip, i.e outlet apperture and at the base (inlet aperture) of the netra) equal to little and thumb in circumference (यथावयोऽङ्गुष्ठकनिष्ठिकाभ्यां मूलाग्रयोः स्युः परिणाहवन्ति), straight  

(ऋजूनि), alike tail of a cow in shape (गोपुच्छसमाकृतीनि), smooth (श्लक्ष्णानि), curved in tip/round or circular (र्गुडिकामुखानि) and two round protuberances – one at the distal ¼ and other at the proximal end (कर्णिकैकाऽग्रचतुर्थभागे मूलाश्रिते बस्तिनिबन्धने द्वे). (Ca.Si-3/3)

(ऋजूनि), alike tail of a cow in shape (गोपुच्छसमाकृतीनि), smooth (श्लक्ष्णानि), curved in tip/round or circular (र्गुडिकामुखानि) and two round protuberances – one at the distal ¼ and other at the proximal end (कर्णिकैकाऽग्रचतुर्थभागे मूलाश्रिते बस्तिनिबन्धने द्वे). (Ca.Si-3/3)

Cakrapäni has made it clear that aprāpti and atigati of the dravya happens. He has interpreted tanu as kruśa (thin, emaciated) having equivalent meaning. He also adds that this limits the reach of medication to guda alone and causes discomfort locally. Jīrṇaṁ has been interpreted by him as karkaśa (meaning rough), thereby the term jīrṇaṁ implying two characters – disintegrated and/or rough.

Cakrapäni has made it clear that aprāpti and atigati of the dravya happens. He has interpreted tanu as kruśa (thin, emaciated) having equivalent meaning. He also adds that this limits the reach of medication to guda alone and causes discomfort locally. Jīrṇaṁ has been interpreted by him as karkaśa (meaning rough), thereby the term jīrṇaṁ implying two characters – disintegrated and/or rough.

On a critical view, one may note that two kinds of harmful effect of defective nētra are grouped here – 1) before administration such as leakage of medication in śithilabandhanam| and 2) after the administration such as transverse travel of medication in the colon vakram. Majority of them fall in the second category. The dōsha resulting from sthūlaṁ is mentioned as karṣaṇa meaning emaciation which lacks clarity. The vyāpad of atisthūla is considered along with those caused by karkaśa, asrimat (nētra having edges/having hole) and avanata (downwards) by Suśruta and explained as causing gharshana (friction/rubbing), gudakshata (injury to guda) and ruk (pain) 3. This explanation of Suśruta seems to be more apt to the context. Also, the number of nētra-dōṣā varies in Suśruta and eleven are considered there viz. atisthūla, avanata, karkaśa, anubhinnam, sannikrushtakarnika (round protuberance designed close to the outlet aperture), viprakrushtakarnika (round protuberance designed far from outlet aperture), sookshmachidra (subtle aperture), atichidra (wider aperture), atideergha, atihrasva and asrimat4.

On a critical view, one may note that two kinds of harmful effect of defective nētra are grouped here – 1) before administration such as leakage of medication in śithilabandhanam| and 2) after the administration such as transverse travel of medication in the colon vakram. Majority of them fall in the second category. The dōsha resulting from sthūlaṁ is mentioned as karṣaṇa meaning emaciation which lacks clarity. The vyāpad of atisthūla is considered along with those caused by karkaśa, asrimat (nētra having edges/having hole) and avanata (downwards) by Suśruta and explained as causing gharshana (friction/rubbing), gudakshata (injury to guda) and ruk (pain) 3. This explanation of Suśruta seems to be more apt to the context. Also, the number of nētra-dōṣā varies in Suśruta and eleven are considered there viz. atisthūla, avanata, karkaśa, anubhinnam, sannikrushtakarnika (round protuberance designed close to the outlet aperture), viprakrushtakarnika (round protuberance designed far from outlet aperture), sookshmachidra (subtle aperture), atichidra (wider aperture), atideergha, atihrasva and asrimat4.

Verse 6-7

 

==== Verse 6-7 ====

 

Defective basti putaka are eight in number and each of them affects the proper appliance in the procedure. When basti was used in olden times, a basti devoid of veins was selected from a dead animal (natural death/healthy and butchered) and it was processed prior by soaking in kashāya, (decoctions) gently rubbed and dried (दृढस्तनुर्नष्टसिरो विगन्धः कषायरक्तः सुमृदुः सुशुद्धः).5

Defective basti putaka are eight in number and each of them affects the proper appliance in the procedure. When basti was used in olden times, a basti devoid of veins was selected from a dead animal (natural death/healthy and butchered) and it was processed prior by soaking in kashāya, (decoctions) gently rubbed and dried (दृढस्तनुर्नष्टसिरो विगन्धः कषायरक्तः सुमृदुः सुशुद्धः).5

Cakrapäni has commented upon the terms viṣama, sthūla, jālika, vātala, snigdha and klinna among defective basti. He has also elaborated on visratva, daurgrāhya, cyuti and adhāryatva. As discussed earlier, practicality and feasibility issues and stringent laws in procuring animal parts have led to the replacement of basti (putaka) with plastic bags.  

Cakrapäni has commented upon the terms viṣama, sthūla, jālika, vātala, snigdha and klinna among defective basti. He has also elaborated on visratva, daurgrāhya, cyuti and adhāryatva. As discussed earlier, practicality and feasibility issues and stringent laws in procuring animal parts have led to the replacement of basti (putaka) with plastic bags.  

Suśruta has limited the number to five viz. prāstīrna [prāstIrNa; प्रास्तीर्ण (extended/flat/having network of veins)], bahala [bahala; बहल (thick/bushy/dense)], durbaddha [durbaddha; दुर्बद्ध (badly fastened)], sacchidra [sacchidra; सछिद्र (along with holes)] and alpa [alpa; अल्प (tiny)] 6. Prāstīrna causes leakage of medication and alpa in less effective due to less amount of medication getting administered7.

Suśruta has limited the number to five viz. prāstīrna [prāstIrNa; प्रास्तीर्ण (extended/flat/having network of veins)], bahala [bahala; बहल (thick/bushy/dense)], durbaddha [durbaddha; दुर्बद्ध (badly fastened)], sacchidra [sacchidra; सछिद्र (along with holes)] and alpa [alpa; अल्प (tiny)] 6. Prāstīrna causes leakage of medication and alpa in less effective due to less amount of medication getting administered7.

Verse 8

 

==== Verse 8 ====

 

The probable errors committed by the person who administers basti are 10 in number.  Charaka in 3rd chapter of sidhi has laid down the standard operative procedure of administration as follows:

The probable errors committed by the person who administers basti are 10 in number.  Charaka in 3rd chapter of sidhi has laid down the standard operative procedure of administration as follows:

Guda and the distal ¼ of the netra) should be anointed first (स्निग्धे गुदे नेत्रचतुर्थभागं स्निग्धं) and slowly the nētra should be introduced in the direction of spine (शनैरृज्वनपृष्ठवंशम्), without any trembling, tremor etc., with skilled hands (अकम्पनावेपनलाघवादीन् पाण्योर्गुणांश्चापि विदर्शयंस्तम्) and the medication should be emptied in a single squeeze from basti (प्रपीड्य चैकग्रहणेन दत्तं) and slowly nētra can be withdrawn (नेत्रं शनैरेव ततोऽपकर्षेत्). (Ca.Si.3/19, 20)

Guda and the distal ¼ of the netra) should be anointed first (स्निग्धे गुदे नेत्रचतुर्थभागं स्निग्धं) and slowly the nētra should be introduced in the direction of spine (शनैरृज्वनपृष्ठवंशम्), without any trembling, tremor etc., with skilled hands (अकम्पनावेपनलाघवादीन् पाण्योर्गुणांश्चापि विदर्शयंस्तम्) and the medication should be emptied in a single squeeze from basti (प्रपीड्य चैकग्रहणेन दत्तं) and slowly nētra can be withdrawn (नेत्रं शनैरेव ततोऽपकर्षेत्). (Ca.Si.3/19, 20)

Suśruta has explained pranidhānadōṣā and pīḍānadōṣā separately and are six and four in number respectively8. Pīḍānakāla was not specified by Caraka and Vāgbhata have mentioned its significance in the procedure. Direct reference to pīḍānakāla by Suśruta lacks clarity, eventhough Dalhana gives commentary on pīḍānakāla as thirty mātrā for a person with mrudu (delicate/tender) koṣṭha कोष्ठ (bowels) 9.

Suśruta has explained pranidhānadōṣā and pīḍānadōṣā separately and are six and four in number respectively8. Pīḍānakāla was not specified by Caraka and Vāgbhata have mentioned its significance in the procedure. Direct reference to pīḍānakāla by Suśruta lacks clarity, eventhough Dalhana gives commentary on pīḍānakāla as thirty mātrā for a person with mrudu (delicate/tender) koṣṭha कोष्ठ (bowels) 9.

Practically, it is seen that conducting a per rectal examination prior to the introduction of nētra provides not only valuable information on the condition of rectum but also de-sensitizes10 the rectum thereby ensuring smooth conduct of the procedure. It is observed that chances of most defects in introduction are done away with the adoption of this maneuver in practice. Also, during squeezing of basti, if any resistance is felt, it is better to retract the nētra and re-introduce it as chances are likely that the aperture of nētra may be directed towards the wall of the anal canal.

Practically, it is seen that conducting a per rectal examination prior to the introduction of nētra provides not only valuable information on the condition of rectum but also de-sensitizes10 the rectum thereby ensuring smooth conduct of the procedure. It is observed that chances of most defects in introduction are done away with the adoption of this maneuver in practice. Also, during squeezing of basti, if any resistance is felt, it is better to retract the nētra and re-introduce it as chances are likely that the aperture of nētra may be directed towards the wall of the anal canal.

Verse 9-10

 

==== Verse 9-10 ====

 

Cakrapäni comments that even though wrong practices in administration were non-recommended earlier itself, details are being discussed further focusing their management. Suśruta has explained the entry of air into rectum as a resultant of repeated squeezing of basti and is manifested with abdominal distension and severe stomach ache. Suitable basti is advised as management.

Cakrapäni comments that even though wrong practices in administration were non-recommended earlier itself, details are being discussed further focusing their management. Suśruta has explained the entry of air into rectum as a resultant of repeated squeezing of basti and is manifested with abdominal distension and severe stomach ache. Suitable basti is advised as management.

Verse 10-11

 

==== Verse 10-11 ====

 

If any pain/discomfort is reported by the patient during the procedure, it is better to retract the nētra and re-introduce it.

If any pain/discomfort is reported by the patient during the procedure, it is better to retract the nētra and re-introduce it.

Verse 12

 

==== Verse 12 ====

 

Suśruta has expressed views consistent to that of Charaka in this case. It is important to remember that as per the standard procedure of basti, a vartī (thread/pad) has to be placed in the aperture of nētra after tying it to basti, and then medication has to be poured to the basti. So, there are chances that a piece of the thread/pad may remain inside the aperture and care has to be taken to check it before introduction into guda.  

Suśruta has expressed views consistent to that of Charaka in this case. It is important to remember that as per the standard procedure of basti, a vartī (thread/pad) has to be placed in the aperture of nētra after tying it to basti, and then medication has to be poured to the basti. So, there are chances that a piece of the thread/pad may remain inside the aperture and care has to be taken to check it before introduction into guda.  

Verse 16

 

==== Verse 16 ====

 

Eventhough the karnika near to the distal end of nētra prevents extensive introduction of the netra into guda, sometimes the force with which nētra is introduced into guda inflicts injury. Picchābasti, explained elsewhere arrests the prolapse and controls the inflammation of the local structures. Suśruta has advised all measures explained in sadyakshata (acute injury) as management.

Eventhough the karnika near to the distal end of nētra prevents extensive introduction of the netra into guda, sometimes the force with which nētra is introduced into guda inflicts injury. Picchābasti, explained elsewhere arrests the prolapse and controls the inflammation of the local structures. Suśruta has advised all measures explained in sadyakshata (acute injury) as management.

Verse 17-18

 

==== Verse 17-18 ====

 

Cakrapäni clarifies that the term bhävyati used here means its non-entry to pakvāshaya. He adds that in manda and ativēga, ävarana of väta occurs and in ativēga, it is due to the absence of ävarana that results medicine ascending upto throat. He further says that in case of retention of medicine basti or vireka is advisable and in case of medicine reaching the throat, galapīda has to be done.

Cakrapäni clarifies that the term bhävyati used here means its non-entry to pakvāshaya. He adds that in manda and ativēga, ävarana of väta occurs and in ativēga, it is due to the absence of ävarana that results medicine ascending upto throat. He further says that in case of retention of medicine basti or vireka is advisable and in case of medicine reaching the throat, galapīda has to be done.

Suśruta has explained that in ativēga, the medicine may come out through nose, mouth etc. He has advised teekshananasya in addition to virēka, galapīda and pourng of medicines in cold state. Also, Dalhana has commented on a maneuver mentioned as avadhūnana as holding the head by hairs and shaking it.

Suśruta has explained that in ativēga, the medicine may come out through nose, mouth etc. He has advised teekshananasya in addition to virēka, galapīda and pourng of medicines in cold state. Also, Dalhana has commented on a maneuver mentioned as avadhūnana as holding the head by hairs and shaking it.

Retention of basti medicine inside the body is a serious complication and measures have to be adopted with an emergency management perspective. It is mandatory to monitor the retention time in basti and many a times it suggests the pharmacokinetics also.

Retention of basti medicine inside the body is a serious complication and measures have to be adopted with an emergency management perspective. It is mandatory to monitor the retention time in basti and many a times it suggests the pharmacokinetics also.

Verse 19

 

==== Verse 19 ====

 

As discussed earlier, with the knowledge of siddhi one acquires not only routine practice but expertise in prevention, identification, rectification and management of complications related to the respective karma.

As discussed earlier, with the knowledge of siddhi one acquires not only routine practice but expertise in prevention, identification, rectification and management of complications related to the respective karma.