Changes

The preceding chapter ([[Snehavyapat Siddhi]]) dealt with the management strategies for ''snehabastivyapat'' and therefore this chapter elucidates the ''vyapat'' (complications) related to the instrumentation involved in either kind of ''basti''. ''Netra'' (nozzles designed for enema) and ''basti'' (bag designed for enema) that are to be avoided in procedures and ''vyapat'' (complications) arising due to inappropriate appliance of ''netra'' along with their management are explained in the chapter.

The preceding chapter ([[Snehavyapat Siddhi]]) dealt with the management strategies for ''snehabastivyapat'' and therefore this chapter elucidates the ''vyapat'' (complications) related to the instrumentation involved in either kind of ''basti''. ''Netra'' (nozzles designed for enema) and ''basti'' (bag designed for enema) that are to be avoided in procedures and ''vyapat'' (complications) arising due to inappropriate appliance of ''netra'' along with their management are explained in the chapter.

Even though the title of the chapter encompasses the term ''netra'' and ''basti''; ''vyapat'' caused by praṇēta are also dealt in here. It is supposed that a physician’s skill is usually tested when he enters the arena of ''basti'' practice. Lot of factors apart from clinical and theoretical knowledge are involved in a proper conduct of ''basti''. Instrumentation and technique are two such important factors cited here. Instrumentation whilst the days of Charaka were based on the most suitable and available material and hence such descriptions are expounded here. However, scientific advancement based on safety, feasibility and practicality in the present era has resulted in recent innovations such as use of metallic syringe in ''matrabasti'', use of plastic bags replacing animal urinary bladders, nozzles made of disposable materials etc. The fact remains that such innovations need to be put into practice protecting the essence as well as the fundamental principles behind ''basti'' procedure and not interfering or rather limiting its effect in relation to the technique. Much criticism has been made on the use of enema cans (as in Naturopathy) instead of conventional ''basti'', as it hinders the technique.

Even though the title of the chapter encompasses the term ''netra'' and ''basti''; ''vyapat'' caused by praṇēta are also dealt in here. It is supposed that a physician’s skill is usually tested when he enters the arena of ''basti'' practice. Lot of factors apart from clinical and theoretical knowledge are involved in a proper conduct of ''basti''. Instrumentation and technique are two such important factors cited here. Instrumentation whilst the days of Charak were based on the most suitable and available material and hence such descriptions are expounded here. However, scientific advancement based on safety, feasibility and practicality in the present era has resulted in recent innovations such as use of metallic syringe in ''matrabasti'', use of plastic bags replacing animal urinary bladders, nozzles made of disposable materials etc. The fact remains that such innovations need to be put into practice protecting the essence as well as the fundamental principles behind ''basti'' procedure and not interfering or rather limiting its effect in relation to the technique. Much criticism has been made on the use of enema cans (as in Naturopathy) instead of conventional ''basti'', as it hinders the technique.

Preventing complications while the procedure reflects two aspects of a physician; the extent of theoretical knowledge regarding ''basti'' and his expertise in the procedure. Identifying specific complications is made possible as a part of regular event evaluation irrespective of manifestation of any complications. Rectification of mistakes committed in technique are of immense value with respect to development of a standard operative procedure. Management of complications with respect to acute and chronic events is also an important aspect in ''siddhi''.

Preventing complications while the procedure reflects two aspects of a physician; the extent of theoretical knowledge regarding ''basti'' and his expertise in the procedure. Identifying specific complications is made possible as a part of regular event evaluation irrespective of manifestation of any complications. Rectification of mistakes committed in technique are of immense value with respect to development of a standard operative procedure. Management of complications with respect to acute and chronic events is also an important aspect in ''siddhi''.

==== 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 Charak, 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)

Chakrapani has made it clear that ''aprapti'' and ''atigati'' of the ''dravya'' happens. He has interpreted ''tanu'' as ''krisha'' (thin, emaciated) having equivalent meaning. He also adds that this limits the reach of medication to ''guda'' alone and causes discomfort locally. ''Jeernam'' has been interpreted by him as ''karkasha'' (meaning rough), thereby the term ''jeernam'' implying two characters – disintegrated and/or rough.

Chakrapani has made it clear that ''aprapti'' and ''atigati'' of the ''dravya'' happens. He has interpreted ''tanu'' as ''krisha'' (thin, emaciated) having equivalent meaning. He also adds that this limits the reach of medication to ''guda'' alone and causes discomfort locally. ''Jeernam'' has been interpreted by him as ''karkasha'' (meaning rough), thereby the term ''jeernam'' implying two characters – disintegrated and/or rough.

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

==== 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.  Charak in 3rd chapter of ''siddhi'' 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 ''netra'' 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 ''netra'' 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 ''netra'' 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 ''netra'' can be withdrawn (नेत्रं शनैरेव ततोऽपकर्षेत्). (Ca.Si.3/19, 20)

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 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 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)

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)

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)

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)

Sushruta has expressed views consistent to that of Charak 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)

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)