Changes

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 ====

Defect in ''netra'' are eight in number and each of them affects the proper administration of ''basti'' procedure. Recommendable ''netra'' according to Charaka, should have the following attributes:  apertures(at the tip, i.e outlet aperture 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)

Defect in ''netra'' are eight in number and each of them affects the proper administration of ''basti'' procedure. Recommendable ''netra'' according to Charaka, should have the following attributes:  apertures(at the tip, i.e outlet aperture 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)

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)

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

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

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 ''kashaya'', (decoctions) gently rubbed and dried (दृढस्तनुर्नष्टसिरो विगन्धः कषायरक्तः सुमृदुः सुशुद्धः)<ref>Agnivēśa, Carakasamitha Sidhisthāna chapter 3</ref>

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 ''kashaya'', (decoctions) gently rubbed and dried (दृढस्तनुर्नष्टसिरो विगन्धः कषायरक्तः सुमृदुः सुशुद्धः)<ref>Agnivēśa, Carakasamitha Sidhisthāna chapter 3</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>

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>

''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)

==== Verse 8 ====

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

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

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 Charaka 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 Charaka 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.

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)

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

Chakrapani comments that even though wrong practices in administration were non-recommended earlier itself, details are being discussed further focusing their management. Sushruta 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 9-10)

Chakrapani comments that even though wrong practices in administration were non-recommended earlier itself, details are being discussed further focusing their management. Sushruta 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.

If any pain/discomfort is reported by the patient during the procedure, it is better to retract the ''netra'' and re-introduce it. (Verse 10-11)

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

Sushruta 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 ''varti'' (thread/pad) has to be placed in the aperture of ''netra'' 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 12)

Even though the ''karnika'' near to the distal end of ''netra'' prevents extensive introduction of the ''netra'' into ''guda'', sometimes the force with which ''netra'' is introduced into ''guda'' inflicts injury. ''Picchabasti'', explained elsewhere arrests the prolapse and controls the inflammation of the local structures. Sushruta has advised all measures explained in ''sadyakshata'' (acute injury) as management. (Verse 16)

 

 

 

 

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

 

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

Chakrapani clarifies that the term ''bhavyati'' used here means its non-entry to ''pakvashaya''. He adds that in ''manda'' and ''ativega'', ''avarana'' of ''vata'' occurs and in ''ativega'', it is due to the absence of ''avarana'' that results medicine ascending up to throat. He further says that in case of retention of medicine ''basti'' or ''vireka'' is advisable and in case of medicine reaching the throat, ''galapeeda'' has to be done.

Chakrapani clarifies that the term ''bhavyati'' used here means its non-entry to ''pakvashaya''. He adds that in ''manda'' and ''ativega'', ''avarana'' of ''vata'' occurs and in ''ativega'', it is due to the absence of ''avarana'' that results medicine ascending up to throat. He further says that in case of retention of medicine ''basti'' or ''vireka'' is advisable and in case of medicine reaching the throat, ''galapeeda'' has to be done.

Sushruta has explained that in ''ativega'', the medicine may come out through nose, mouth etc. He has advised ''teekshananasya'' in addition to ''vireka, galapeeda'' and pouring of medicines in cold state. Also, Dalhana has commented on a maneuver mentioned as ''avadhoonana'' as holding the head by hairs and shaking it.

Sushruta has explained that in ''ativega'', the medicine may come out through nose, mouth etc. He has advised ''teekshananasya'' in addition to ''vireka, galapeeda'' and pouring of medicines in cold state. Also, Dalhana has commented on a maneuver mentioned as ''avadhoonana'' 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 17-18)

 

==== 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''.(Verse 19)

=== Glossary ===

=== Glossary ===