Changes

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 ''netra'' and ''basti'' is essential for physicians. Also, Inappropriate appliance of ''netra'' in the procedure leads to ''vyapat'' 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 ''netra'' and ''basti'' is essential for physicians. Also, Inappropriate appliance of ''netra'' in the procedure leads to ''vyapat'' 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 ''niruha''  (decoction type of enema)<ref>Gundeti MS, Raut AA, Kamat NM. Basti: Does the equipment and method of administration matter?. J Ayurveda Integr Med 2013;4:9-12</ref>. 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.<ref>Nampoothiri MR, Mahadevan L. Principles and Practice of Vasti. 1st ed. Derisanamcope: Y. Mahadeva Iyer’s Sri Sarada Ayurvedic Hospital; 2007. p. 49</ref>

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 ''niruha''  (decoction type of enema)<ref>Gundeti MS, Raut AA, Kamat NM. Basti: Does the equipment and method of administration matter?. J [[Ayurveda]] Integr Med 2013;4:9-12</ref>. 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.<ref>Nampoothiri MR, Mahadevan L. Principles and Practice of Vasti. 1st ed. Derisanamcope: Y. Mahadeva Iyer’s Sri Sarada Ayurvedic Hospital; 2007. p. 49</ref>

==== Defects of ''basti'' nozzle ====

==== Defects of ''basti'' nozzle ====

#after the administration such as transverse travel of medication in the colon ''vakram''. Majority of them fall in the second category.  

#after the administration such as transverse travel of medication in the colon ''vakram''. Majority of them fall in the second category.  

The ''dosha'' resulting from ''sthoolam'' is mentioned as ''karshana'' meaning emaciation which lacks clarity. The ''vyapat'' of ''atisthoola'' is considered along with those caused by ''karkasha, asrimat'' (''netra'' having edges/having hole) and ''avanata'' (downwards) by Sushruta and explained as causing ''gharshana'' (friction/rubbing), ''gudakshata'' (injury to ''guda'') and ''ruk'' (pain)<ref>Suśruta, Suśrutasamhita Cikitsāsthāna chapter 36. Varanasi: Krishnadas Academy; 1980. p. 513. (Krishnadas Ayurveda series 51) </ref>

The ''dosha'' resulting from ''sthoolam'' is mentioned as ''karshana'' meaning emaciation which lacks clarity. The ''vyapat'' of ''atisthoola'' is considered along with those caused by ''karkasha, asrimat'' (''netra'' having edges/having hole) and ''avanata'' (downwards) by Sushruta and explained as causing ''gharshana'' (friction/rubbing), ''gudakshata'' (injury to ''guda'') and ''ruk'' (pain)<ref>Suśruta, Suśrutasamhita Cikitsāsthāna chapter 36. Varanasi: Krishnadas Academy; 1980. p. 513. (Krishnadas [[Ayurveda]] series 51) </ref>

This explanation of Sushruta seems to be more apt to the context. Also, the number of ''netra dosha'' varies in Sushruta and eleven are considered there viz. ''atisthoola, avanata, karkasha, anubhinnam, sannikrushtakarnika'' (round protuberance designed close to the outlet aperture), ''viprakrushtakarnika'' (round protuberance designed far from outlet aperture), ''sookshmachidra'' (subtle aperture), ''atichhidra'' (wider aperture), ''atideergha, atihrasva'' and ''asrimat''<ref>Suśruta, Suśrutasamhita Cikitsāsthāna chapter 35. Varanasi: Krishnadas Academy; 1980. p. 515. (Krishnadas Ayurveda series 51)</ref> (Verse 4- 5)

This explanation of Sushruta seems to be more apt to the context. Also, the number of ''netra dosha'' varies in Sushruta and eleven are considered there viz. ''atisthoola, avanata, karkasha, anubhinnam, sannikrushtakarnika'' (round protuberance designed close to the outlet aperture), ''viprakrushtakarnika'' (round protuberance designed far from outlet aperture), ''sookshmachidra'' (subtle aperture), ''atichhidra'' (wider aperture), ''atideergha, atihrasva'' and ''asrimat''<ref>Suśruta, Suśrutasamhita Cikitsāsthāna chapter 35. Varanasi: Krishnadas Academy; 1980. p. 515. (Krishnadas [[Ayurveda]] series 51)</ref> (Verse 4- 5)

==== Defects of ''basti putaka'' (enema pot) ====

==== Defects of ''basti putaka'' (enema pot) ====

''Chakrapani'' has commented upon the terms ''vishama, sthoola, jalika, vatala, snigdha'' and ''klinna'' among defective ''basti''. He has also elaborated on ''visratva, daurgrahya, chyuti'' and ''adharyatva''. 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.  

''Chakrapani'' has commented upon the terms ''vishama, sthoola, jalika, vatala, snigdha'' and ''klinna'' among defective ''basti''. He has also elaborated on ''visratva, daurgrahya, chyuti'' and ''adharyatva''. 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.  

Sushruta has limited the number to five viz. ''praasteerna'' [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)]<ref>Suśruta, Suśrutasamhitha Cikitsāsthāna chapter 36. Varanasi: Krishnadas Academy; 1980. p. 513. (Krishnadas Ayurveda series 51)</ref>

Sushruta has limited the number to five viz. ''praasteerna'' [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)]<ref>Suśruta, Suśrutasamhitha Cikitsāsthāna chapter 36. Varanasi: Krishnadas Academy; 1980. p. 513. (Krishnadas [[Ayurveda]] series 51)</ref>

''Praasteerna'' causes leakage of medication and ''alpa'' in less effective due to less amount of medication getting administered<ref>Suśruta, Suśrutasamhitha Cikitsāsthāna chapter 35. Varanasi: Krishnadas Academy; 1980. p. 515. (Krishnadas Ayurveda series 51)</ref> (Verse 6-7)

''Praasteerna'' causes leakage of medication and ''alpa'' in less effective due to less amount of medication getting administered<ref>Suśruta, Suśrutasamhitha Cikitsāsthāna chapter 35. Varanasi: Krishnadas Academy; 1980. p. 515. (Krishnadas [[Ayurveda]] series 51)</ref> (Verse 6-7)

==== Errors during administration and management of complications ====

==== Errors during administration and management of complications ====

Chakrapani categorizes these as ''pranayana, badha'' and ''peedana''. ''Savata'' is a defect committed during ''badha'' (filling and tying of ''basti'') and ''peedana'' (squeezing of ''basti''). ''Atidruta, utkshipta, tiryak, kampita, ati,'' and ''bahyaga'' are considered as defects committed during ''pranayana'' (introduction of ''netra'' into the anus). ''Ullupta, mandavega'' and ''ativega'' are committed while ''peedana''.

Chakrapani categorizes these as ''pranayana, badha'' and ''peedana''. ''Savata'' is a defect committed during ''badha'' (filling and tying of ''basti'') and ''peedana'' (squeezing of ''basti''). ''Atidruta, utkshipta, tiryak, kampita, ati,'' and ''bahyaga'' are considered as defects committed during ''pranayana'' (introduction of ''netra'' into the anus). ''Ullupta, mandavega'' and ''ativega'' are committed while ''peedana''.

Sushruta has explained ''pranidhanadosha'' and ''peedana dosha'' separately and are six and four in number respectively<ref>Suśruta, Suśrutasamhitha Cikitsāsthāna chapter 35. Varanasi: Krishnadas Academy; 1980. p. 515. (Krishnadas Ayurveda series 51).</ref>. ''Peedanakala'' was not specified by Charak and Vagbhata have mentioned its significance in the procedure. Direct reference to peedanakala by Sushruta lacks clarity, even though Dalhana gives commentary on ''peedanakala'' as thirty ''matra'' for a person with ''mridu'' (delicate/tender) ''koshtha'' कोष्ठ (bowels)<ref>Suśruta, Suśrutasamhitha Cikitsāsthāna chapter 38. Varanasi: Krishnadas Academy; 1980. p. 534. (Krishnadas Ayurveda series 51)</ref>

Sushruta has explained ''pranidhanadosha'' and ''peedana dosha'' separately and are six and four in number respectively<ref>Suśruta, Suśrutasamhitha Cikitsāsthāna chapter 35. Varanasi: Krishnadas Academy; 1980. p. 515. (Krishnadas [[Ayurveda]] series 51).</ref>. ''Peedanakala'' was not specified by Charak and Vagbhata have mentioned its significance in the procedure. Direct reference to peedanakala by Sushruta lacks clarity, even though Dalhana gives commentary on ''peedanakala'' as thirty ''matra'' for a person with ''mridu'' (delicate/tender) ''koshtha'' कोष्ठ (bowels)<ref>Suśruta, Suśrutasamhitha Cikitsāsthāna chapter 38. Varanasi: Krishnadas Academy; 1980. p. 534. (Krishnadas [[Ayurveda]] series 51)</ref>

Practically, it is seen that conducting a per rectal examination prior to the introduction of ''netra'' provides not only valuable information on the condition of rectum but also de-sensitizes<ref>Manojkumar A K, Jigeesh P P, Binitha A, Subin V R. Kaśhāyavasti. In, Manojkumar A K (ed). Standard Operative Procedure of Pancakarma, 1st edition. Kottakkal, Regional Offset, 2013.</ref> 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 ''netra'' and re-introduce it as chances are likely that the aperture of ''netra'' may be directed towards the wall of the anal canal. (Verse 8)

Practically, it is seen that conducting a per rectal examination prior to the introduction of ''netra'' provides not only valuable information on the condition of rectum but also de-sensitizes<ref>Manojkumar A K, Jigeesh P P, Binitha A, Subin V R. Kaśhāyavasti. In, Manojkumar A K (ed). Standard Operative Procedure of Pancakarma, 1st edition. Kottakkal, Regional Offset, 2013.</ref> 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 ''netra'' and re-introduce it as chances are likely that the aperture of ''netra'' may be directed towards the wall of the anal canal. (Verse 8)