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|title=Basti(therapeutic enema)

|title=Basti(therapeutic enema)

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|keywords=Basti, Basti meaning, Basti defination, Basti in ayurveda, uttar basti,basti Indication, Niruaha, Anuvasana, Charak samhita,carakasamhitaonline, Indian System of Medicine, enema

|keywords=Basti, Basti meaning, Basti definition, Basti in ayurveda, uttar basti, basti Indication, Niruaha, Anuvasana, Charak samhita, carakasamhitaonline, Indian System of Medicine, enema, therapeutic enema, benefits of basti, benefits of enema  

|description='basti' is applied to indicate therapeutic enema among panchakarma

|description='basti' is applied to indicate therapeutic enema among panchakarma

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|image=http://www.carakasamhitaonline.com/mediawiki-1.32.1/resources/assets/ogimgs.jpg

|label4 = Affiliations

|label4 = Affiliations

|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar  

|data4 = [[Charak Samhita Research, Training and Development Centre]], I.T.& R.A., Jamnagar  

|label5 = Correspondence email:

|label5 = Correspondence email:

|data7 =  Under process

|data7 =  Under process

}}

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The word ‘basti’ denotes therapeutic procedure of enema. It is one of the five purification procedures ([[panchakarma]]). Basti also spelled as vasti, literally means bladder or an injection-syringe made of bladder or injection itself.<ref>Monier-Williams, Monier-Williams Sanskrit- English Dictionary, 1st edition; Oxford University Press, Vasti, Page 933</ref> In anatomical perspective, the urinary bladder is called as basti. In ancient times, the bladder of animals (mainly goat or buffalo) was used to administer enema therapy, hence the therapy is knows as ‘basti’. [A.S.Sutra Sthana 28/2]<ref name= Sangraha> Vridha Vagbhata, Ashtanga Sangraha. Edited by Shivaprasad Sharma. 3rd ed. Varanasi: Chaukhamba sanskrit series office;2012.</ref> It is the best treatment for disorders of [[vata dosha]]. [Cha.Sa. [[Sutra Sthana]] 25/40]. Due to the primary importance of [[vata dosha]] in causing diseases, basti is considered as the chief treatment among [[panchakarma]]. [Su.Sa.Chikitsa Sthana 35/3]<ref name= Susruta> Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>

The word ‘basti’ denotes therapeutic procedure of enema. It is one of the five purification procedures ([[panchakarma]]). Basti also spelled as vasti, literally means bladder or an injection-syringe made of bladder or injection itself.<ref>Monier-Williams, Monier-Williams Sanskrit- English Dictionary, 1st edition; Oxford University Press, Vasti, Page 933</ref> In anatomical perspective, the urinary bladder is called as basti. In ancient times, the bladder of animals (mainly goat or buffalo) was used to administer enema therapy, hence the therapy is knows as ‘basti’. [A.S.Sutra Sthana 28/2]<ref name= Sangraha> Vridha Vagbhata, Ashtanga Sangraha. Edited by Shivaprasad Sharma. 3rd ed. Varanasi: Chaukhamba sanskrit series office;2012.</ref> It is the best treatment for disorders of [[vata dosha]]. [Cha.Sa. [[Sutra Sthana]] 25/40]. Due to the primary importance of [[vata dosha]] in causing diseases, basti is considered as the chief treatment among [[panchakarma]]. [Su.Sa.Chikitsa Sthana 35/3]<ref name= Susruta> Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>

In therapeutic management, it denotes medicated enema with decoction, oils or any other fluid either in rectum or urethra or vagina. The term ‘uttarabasti’ is used for enema given through anterior orifice like urethra or vagina. In unction therapy, local therapeutic procedures like keeping warm oils or medicated substance on affected body part are used. These procedures are termed after name of affected part as suffix to the word ‘basti’. E.g. ‘janubasti’ means keeping warm medicated substance on knee joint; ‘katibasti’ means keeping it on the lumbar region. Most commonly, the term ‘basti’ indicates per rectal enema. Hence this article focuses on therapeutic enema given per rectum.  

In therapeutic management, it denotes medicated enema with decoction, oils or any other fluid either in rectum or urethra or vagina. The term ‘uttarabasti’ is used for enema given through anterior orifice like urethra or vagina. In unction therapy, local therapeutic procedures like keeping warm oils or medicated substance on affected body part are used. These procedures are termed after name of affected part as suffix to the word ‘basti’. E.g. ‘janu basti’ means keeping warm medicated substance on knee joint; ‘kati basti’ means keeping it on the lumbar region. Most commonly, the term ‘basti’ indicates per rectal enema. Hence this article focuses on therapeutic enema given per rectum.  

==Etymology and derivation==

==Etymology and derivation==

===On the basis of procedure===  

===On the basis of procedure===  

#Enema with decoctions (Niruhabasti)

#Enema with decoctions (Niruha basti)

#Enema with unctuous substances (Anuvasanabasti)

#Enema with unctuous substances (Anuvasana basti)

#Enema through urethral or vaginal route (Uttarabasti)[Cha.Sa.[[Siddhi Sthana]] 10/8]

#Enema through urethral or vaginal route (Uttarabasti)[Cha.Sa.[[Siddhi Sthana]] 10/8]

The basti can be broadly classified into internal and external based on the site of administration

The basti can be broadly classified into internal and external based on the site of administration

====Internal====

==== Internal ====

====External====

#Administered over wounds for cleaning purpose (vrana basti) [Su.Sa.Chikitsa Sthana 35/11]<ref name=Susruta/>

Medicated oils are retained over particular body part for a specific duration. E.g. Medicated oil retained over knee (janubasti), medicated oil retained over lumbar region (katibasti) etc.

 

Medicated oils are retained over particular body part for a specific duration. E.g. Medicated oil retained over knee (janu basti), medicated oil retained over lumbar region (kati basti) etc.

===On the basis of pharmaco-therapeutic action===

===On the basis of pharmaco-therapeutic action===

The enema therapy is classified based onthe pharmaco-therapeutic activity of its ingredients.  

The enema therapy is classified based onthe pharmaco-therapeutic activity of its ingredients.  

#[[Dosha]] aggravating enema (Utkleshanabasti)

#[[Dosha]] aggravating enema (utkleshana basti)

#[[Dosha]] purificatory enema (Shodhanabasti)

#[[Dosha]] purificatory enema (shodhana basti)

#[[Dosha]] pacifying enema (Shamanabasti)[Sha.Uttarardha.6/17-19]<ref name= Shargadara> Sharangadhara. Sharangadhara Samhita. Translated from Sanskrit by K.R. Srikantha Murthy. Reprint ed. Varanasi: Chaukhambha orientalia;2016.</ref>

#[[Dosha]] pacifying enema (shamana basti)[Sha.Uttarardha.6/17-19]<ref name= Shargadara> Sharangadhara. Sharangadhara Samhita. Translated from Sanskrit by K.R. Srikantha Murthy. Reprint ed. Varanasi: Chaukhambha orientalia;2016.</ref>

===On the basis of number of basti===

===On the basis of number of basti===

The enema therapy is classified based on specific schedule and sequential sessions based on the severity of pathogens ([[dosha]] and [[dushya]]).  

The enema therapy is classified based on specific schedule and sequential sessions based on the severity of pathogens ([[dosha]] and [[dushya]]).  

#Karma basti: Total 30 basti sessions with 12 decoction (niruha) and 18 unctuous (anuvasanabasti)

#Karma basti: Total 30 basti sessions with 12 decoction (niruha) and 18 unctuous (anuvasana basti)

#Kala basti: Total 16 basti sessions with 06 decoction (niruha) and 10 unctuous (anuvasanabasti)

#Kala basti: Total 16 basti sessions with 06 decoction (niruha) and 10 unctuous (anuvasana basti)

#Yoga basti: Total 8 basti sessions with 3 decoction (niruha) and 5 unctuous (anuvasanabasti)[Cha.Sa.[[Siddhi Sthana]] 1/47-49]

#Yoga basti: Total 8 basti sessions with 3 decoction (niruha) and 5 unctuous (anuvasana basti)[Cha.Sa.[[Siddhi Sthana]] 1/47-49]

===On the basis of total quantity===

===On the basis of total quantity===

A few examples are as follows:

A few examples are as follows:

*Twelve prasruta (1152 ml) termed as ‘Dwadasaprasrutikabasti’

*Twelve prasruta (1152 ml) termed as ‘Dwadasaprasrutika basti’

*Nine prasruta (864ml )termed as ‘Navaprasrutabasti/padahinabasti’

*Nine prasruta (864ml )termed as ‘Navaprasrutabasti/padahina basti’

*Five prasruta (480 ml) termed as ‘Pachaprasrutikabasti’

*Five prasruta (480 ml) termed as ‘Pachaprasrutika basti’

===Based on the chief ingredient===

===Based on the chief ingredient===

Some enemas are known by their chief ingredient. A few examples are as follows:  

Some enemas are known by their chief ingredient. A few examples are as follows:  

*Enema with equal quantity of honey and oil is termed as ‘Madhutailikabasti’

*Enema with equal quantity of honey and oil is termed as ‘Madhutailika basti’

*Presence of alkali in enema is termed as ‘Ksharabasti’

*Presence of alkali in enema is termed as ‘Kshara basti’

*Milk used as main ingredient in enema is termed as ‘Kshirabasti’

*Milk used as main ingredient in enema is termed as ‘Kshira basti’

==Niruhabasti (enema with decoction)==

==Niruhabasti (enema with decoction)==

The medicated enema with decoction of herbs as main ingredient is called ‘niruhabasti’. It is also known as ‘kashayabasti’. The word ‘niruha’ indicates its extensive therapeutic potency. As it stabilizes (sthapana) the [[dosha]], it is also known as ‘asthapanabasti’. [A.S.Sutra Sthana 28/6]<ref name=Sangraha/>

The medicated enema with decoction of herbs as main ingredient is called ‘niruhabasti’. It is also known as ‘kashaya basti’. The word ‘niruha’ indicates its extensive therapeutic potency. As it stabilizes (sthapana) the [[dosha]], it is also known as ‘asthapana basti’. [A.S.Sutra Sthana 28/6]<ref name=Sangraha/>

===Indications===

===Indications===

*Aggravated conditions of [[vata dosha]]

*Aggravated conditions of [[vata dosha]]

*Aggravation of [[vata]] associated with other [[dosha]][A.H.Sutra Sthana 19/1]<ref name= Hridaya > Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.</ref>

*Aggravation of [[vata]] associated with other [[dosha]][A.H.Sutra Sthana 19/1]<ref name= Hridaya > Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.</ref>

===Contraindications===

===Contraindications===

   

   

Niruha enema is contraindicated in following conditions:

Niruha basti is contraindicated in following conditions:

 

*Extremely weak and debilitated patients[Cha.Sa.[[Siddhi Sthana]] 1/37]

*Extremely weak and debilitated patients[Cha.Sa.[[Siddhi Sthana]] 1/37]

*Immediately after any other purificatory procedure like therapeutic emesis or purgation [Cha.Sa.[[Siddhi Sthana]] 1/37]

*Immediately after any other purificatory procedure like therapeutic emesis or purgation [Cha.Sa.[[Siddhi Sthana]] 1/37]

*Breathing difficulty, cough, skin diseases (kushtha), diabetes (madhumeha) etc.[Cha.Sa.[[Siddhi Sthana]] 2/14]

*Breathing difficulty, cough, skin diseases (kushtha), diabetes (madhumeha) etc.[Cha.Sa.[[Siddhi Sthana]] 2/14]

===Ingredients of niruha enema formulation===

===Ingredients of niruha basti formulation===

The predominant content of niruhabasti is a decoction of herbs. It also contains honey, rock salt, unctuous substance (usually oil or ghee) and medicinal paste (kalka). In some conditions, cow’s urine, fermented liquid preparation out of grains (danyamla), meat soup, milk etc. are used instead of decoction.

The predominant content of niruhabasti is a decoction of herbs. It also contains honey, rock salt, unctuous substance (usually oil or ghee) and medicinal paste (kalka). In some conditions, cow’s urine, fermented liquid preparation out of grains (dhanyamla), meat soup, milk etc. are used instead of decoction.

===Quantity of ingredients===

===Quantity of ingredients===

The general dosage of ingredients for 1152ml (dvadashaprasruta) basti are as follows. While preparation, the ingredients are mixed in the specific sequence and quantity as given below:  

The general dosage of ingredients for 1152 ml (dvadasha prasruta) basti are as follows. While preparation, the ingredients are mixed in the specific sequence and quantity as given below:  

#Honey:  192 ml (2 prasruta)

#Honey:  192 ml (2 prasruta)

#Rock salt (saindhava): 12gram (1 karsha)

#Rock salt (saindhava): 12 gram (1 karsha)

#Oil/ghee/unctuous substance (sneha): 288 ml (3 prasruta)

#Oil/ghee/unctuous substance (sneha): 288 ml (3 prasruta)

#Medicinal paste (kalka): 96 gram (1 prasruta)

#Medicinal paste (kalka): 96 gram (1 prasruta)

   

   

The proportion of unctuous substance and honey changes based on the predominance of [[dosha]] in diseases. It is as shown below in table 1.

The proportion of unctuous substance and honey changes based on the predominance of [[dosha]] in diseases. It is as shown below in table 1.

{| class="wikitable"

{| class="wikitable"

|+ Table 1: [[Dosha]] specific proportion in basti formulation  

|+ Table 1: [[Dosha]] specific proportion in basti formulation  

!  !! [[Vata dosha]] !! [[Pitta]] [[dosha]] !![[Kapha]] [[dosha]]

!  !! [[Vata dosha]] !! [[Pitta]] [[dosha]] !![[Kapha]] [[dosha]]

|-

|-

| | Honey  || 144ml (3 pala) || 192ml (4 pala) ||288ml (6 pala)

| | Honey  || 144 ml (3 pala) || 192 ml (4 pala) ||288 ml (6 pala)

|-

|-

| | Unctuous Substance || 288ml (6 pala) || 192ml (4 pala)  || 144ml (3 pala)

| | Unctuous Substance || 288 ml (6 pala) || 192 ml (4 pala)  || 144 ml (3 pala)

|-

|-

|}

|}

[Cha.Sa.[[Siddhi Sthana]] 3/30]

[Cha.Sa.[[Siddhi Sthana]] 3/30]

===Dose of niruhabasti in different age groups===

===Dose of niruha basti in different age groups===

The dose of basti formulation changes as per the age. It is shown in table 2.  

The dose of basti formulation changes as per the age. It is shown in table 2.  

{| class="wikitable"

{| class="wikitable"

|+ Table 2: Age specific dosage of basti formulation   

|+ Table 2: Age specific dosage of basti formulation   

! Age  !! Dosage of basti  

! Age  !! Dosage of basti  

|-

|-

| | 1 year || 48ml (½ prasruta)

| | 1 year || 48 ml (½ prasruta)

|-

|-

| |Increase the dosage by 48ml (½ prasruta) each year till 12 years

| |Increase the dosage by 48 ml (½ prasruta) each year till 12 years

|-

|-

| | 12 year || 576ml (6 prasruta)

| | 12 year || 576 ml (6 prasruta)

|-

|-

| |Increase the dosage by 96ml (1 prasruta) each year till 18 years

| |Increase the dosage by 96 ml (1 prasruta) each year till 18 years

|-

|-

| | 18 year and above until age 70 || 1152ml (12 prasruta)

| | 18 year and above until age 70 || 1152 ml (12 prasruta)

|-

|-

| | Above 70 year ||960ml (10 prasruta)  

| | Above 70 year ||960 ml (10 prasruta)  

|-

|-

|}

|}

[Cha.Sa.[[Siddhi Sthana]] 3/31-32]

[Cha.Sa.[[Siddhi Sthana]] 3/31-32]

===Method of preparation of decoction enema===

=== Method of preparation of niruha basti (decoction enema) ===

The decoction enema is a combination of many ingredients as mentioned above. These ingredients should be mixed in a specific sequence to formulate homogenous mixture and achieve maximum therapeutic efficacy. The sequence of mixing of decoction enema is as follows.  

The decoction enema is a combination of many ingredients as mentioned above. These ingredients should be mixed in a specific sequence to formulate homogenous mixture and achieve maximum therapeutic efficacy. The sequence of mixing of decoction enema is as follows.  

    

    

The procedure of niruhabasti is done as a daily session of administration of enema. Procedure of a single session is described as below:  

The procedure of niruhabasti is done as a daily session of administration of enema. Procedure of a single session is described as below:  

====Pre therapeutic (purvakarma)====

 

====Pre therapeutic procedure (purva karma)====

On the day of administration, patient is advised to pass natural urges and should not be hungry. [Cha.Sa.[[Siddhi Sthana]] 3/17] Local massage with oil and sudation is done over abdomen, low back, gluteal region and thighs of the patient. The enema mixture is prepared and filled into the basti apparatus (basti yantra). In current clinical practices, two types of basti apparatus are used to administer decoction enema.  

On the day of administration, patient is advised to pass natural urges and should not be hungry. [Cha.Sa.[[Siddhi Sthana]] 3/17] Local massage with oil and sudation is done over abdomen, low back, gluteal region and thighs of the patient. The enema mixture is prepared and filled into the basti apparatus (basti yantra). In current clinical practices, two types of basti apparatus are used to administer decoction enema.  

The enema formulation is filled in the basti bag or enema pot. Then the medicine is passed through catheter to remove air bubbles.

The enema formulation is filled in the basti bag or enema pot. Then the medicine is passed through catheter to remove air bubbles.

====Therapeutic (pradhanakarma)====

====Therapeutic procedure (pradhana karma)====

   

   

Patient is advised to lie in left lateral position with left leg extended and flex the right leg at knee and hip. The anal orifice and the basti nozzle or catheter are lubricated with oil. Then the basti nozzle or catheter is inserted slowly and gently through the anal canal.  

Patient is advised to lie in left lateral position with left leg extended and flex the right leg at knee and hip. The anal orifice and the basti nozzle or catheter are lubricated with oil. Then the basti nozzle or catheter is inserted slowly and gently through the anal canal.  

After all enema medicine is in the rectum, the patient is advised to lie in supine position till he feels the urge for defecation. When the patient feels the urge, it shall pass. The time duration the administration of medicine and its evacuation is called as retention enema. The decoction enema is expected to come out within 48 minutes after administration. In a study, the retention time of enema with alkali (ksharabasti) in maximum number of participants (60%) is reported to be 5 minutes.<ref name=Thanki>Thanki K, Bhatt N, Shukla VD. Effect of kshara basti and nirgundi ghana vati on amavata (rheumatoid arthritis). Ayu. 2012 Jan;33(1):50-3. doi: 10.4103/0974-8520.100310. PMID: 23049184; PMCID: PMC3456864.</ref>  

After all enema medicine is in the rectum, the patient is advised to lie in supine position till he feels the urge for defecation. When the patient feels the urge, it shall pass. The time duration the administration of medicine and its evacuation is called as retention enema. The decoction enema is expected to come out within 48 minutes after administration. In a study, the retention time of enema with alkali (ksharabasti) in maximum number of participants (60%) is reported to be 5 minutes.<ref name=Thanki>Thanki K, Bhatt N, Shukla VD. Effect of kshara basti and nirgundi ghana vati on amavata (rheumatoid arthritis). Ayu. 2012 Jan;33(1):50-3. doi: 10.4103/0974-8520.100310. PMID: 23049184; PMCID: PMC3456864.</ref>  

====Post therapeutic (pashchatkarma)====

====Post therapeutic procedure (pashchat karma)====

After the evacuation of bowels patient is advised to take hot water bath and light to digest diet based on dominance of [[dosha]] as shown below. [Cha.Sa.[[Siddhi Sthana]] 3/27]

After the evacuation of bowels patient is advised to take hot water bath and light to digest diet based on dominance of [[dosha]] as shown below. [Cha.Sa.[[Siddhi Sthana]] 3/27]

The assessment of therapeutic effect is based on observation of clinical features.  

The assessment of therapeutic effect is based on observation of clinical features.  

====Clinical features of optimal niruhabasti====

==== Clinical features of optimal niruha basti====

Sequential elimination of stool, [[pitta]], [[kapha]] and [[vata]], increased appetite, lightness in body, increase of strength and attainment of normalcy, passage of frothy and whitish mucous in stool are considered as features of optimal administration of niruhabasti. [Cha.Sa.[[Siddhi Sthana]] 1/41] [Ka.Sa.Khila Sthana 8/75-77]<ref name=Kashyapa>Vrddhajivaka, Kasyapa Samhita. Edited by Tewari P V, Reprint edition. Varanasi: Chaukhambha visvabharati; 2008</ref>

Sequential elimination of stool, [[pitta]], [[kapha]] and [[vata]], increased appetite, lightness in body, increase of strength and attainment of normalcy, passage of frothy and whitish mucous in stool are considered as features of optimal administration of niruhabasti. [Cha.Sa.[[Siddhi Sthana]] 1/41] [Ka.Sa.Khila Sthana 8/75-77]<ref name=Kashyapa>Vrddhajivaka, Kasyapa Samhita. Edited by Tewari P V, Reprint edition. Varanasi: Chaukhambha visvabharati; 2008</ref>

====Clinical features of inadequately administered niruhabasti====

==== Clinical features of inadequately administered niruha basti====

Headache, pain in cardiac region, anus, urinary bladder and genital organs; edema, coryza, griping pain and nausea; retention of flatus and urine and dyspnea are features of inadequate administration of niruhabasti. [Cha.Sa.[[Siddhi Sthana]] 1/42-43]

Headache, pain in cardiac region, anus, urinary bladder and genital organs; edema, coryza, griping pain and nausea; retention of flatus and urine and dyspnea are features of inadequate administration of niruhabasti. [Cha.Sa.[[Siddhi Sthana]] 1/42-43]

====Clinical features of excessively administered niruhabasti====

====Clinical features of excessively administered niruha basti====

Aggravation of [[vata dosha]] due to diminution of [[kapha]] and [[pitta]] [[dosha]], numbness, bodyache, mental fatigue, tremor, insomnia, debility, black outs, insanity and hiccups are features of excess administration of niruhabasti. [Cha.Sa.[[Siddhi Sthana]] 1/19-20]

Aggravation of [[vata dosha]] due to diminution of [[kapha]] and [[pitta]] [[dosha]], numbness, bodyache, mental fatigue, tremor, insomnia, debility, black outs, insanity and hiccups are features of excess administration of niruhabasti. [Cha.Sa.[[Siddhi Sthana]] 1/19-20]

The features of inadequate and excess administration of niruhabasti are treated with specific protocols.

The features of inadequate and excess administration of niruhabasti are treated with specific protocols.

==Anuvasanabasti (enema with unctuous substance)==

== Anuvasana basti (enema with unctuous substance) ==

   

   

Anuvasanabasti is a type of medicated enema with unctuous substances like oils, ghee etc. It is also called as ‘snehabasti’. The term ‘anuvasana’ means that can be followed daily. Hence the unctuous enema can be administered daily (anu divasa) without any complications. [Su.Sa.Chikitsa Sthana 35/18]<ref name=Susruta/> Unlike niruhabasti, this enema formulation contains unctuous substances only. Medicated oils are widely used in this therapy to produce unctuousness in the body. [A.S. Sutra Sthana 28/7]<ref name=Sangraha/>

Anuvasana basti is a type of medicated enema with unctuous substances like oils, ghee etc. It is also called as ‘sneha basti’. The term ‘anuvasana’ means that can be followed daily. Hence the unctuous enema can be administered daily (anu divasa) without any complications. [Su.Sa.Chikitsa Sthana 35/18]<ref name=Susruta/> Unlike niruhabasti, this enema formulation contains unctuous substances only. Medicated oils are widely used in this therapy to produce unctuousness in the body. [A.S. Sutra Sthana 28/7]<ref name=Sangraha/>

===Types (based on the dose)===

===Types (based on the dose)===

#Sneha basti: Dose of oil is ¼th of the total dose of niruhabasti i.e. maximum upto 288ml.[Su.Sa.Chikitsa Sthana 37/4]<ref name=Susruta/>

#Sneha basti: Dose of oil is ¼th of the total dose of niruhabasti i.e. maximum upto 288ml.[Su.Sa.Chikitsa Sthana 37/4]<ref name=Susruta/>

#Anuvasanabasti: Dose of oil is ½ of snehabasti i.e. 144ml. [Su.Sa.Chikitsa Sthana 35/18]<ref name=Susruta/>

#Anuvasanabasti: Dose of oil is ½ of snehabasti i.e. 144ml. [Su.Sa.Chikitsa Sthana 35/18]<ref name=Susruta/>

===Indications===

===Indications===

Anuvasanabasti is indicated in following conditions:  

Anuvasana basti is indicated in following conditions:  

*In cases of depletion of [[kapha]] and [[pitta]] [[dosha]] [Cha.Sa.[[Chikitsa Sthana]] 3/172]

*In cases of depletion of [[kapha]] and [[pitta]] [[dosha]] [Cha.Sa.[[Chikitsa Sthana]] 3/172]

*Conditions due to aggravation of [[vata dosha]] [Cha.Sa.[[Siddhi Sthana]] 2/19]

*Conditions due to aggravation of [[vata dosha]] [Cha.Sa.[[Siddhi Sthana]] 2/19]

===Contraindications===

===Contraindications===

Unctuous enema is contraindicated in diseases where purification is indicated like skin diseases (kushtha), obstinate urinary diseases including diabetes (prameha), obesity (sthaulya)[Cha.Sa.[[Siddhi Sthana]] 1/36]; the diseases with ama (undigested state) like acute fever, anemia, rhinitis etc. It shall not be given to patients on empty stomach and those who have low digestive capacity. [Cha.Sa.[[Siddhi Sthana]] 2/18]

Unctuous enema is contraindicated in diseases where purification is indicated like skin diseases ([[kushtha]]), obstinate urinary diseases including diabetes ([[prameha]]), obesity ([[sthaulya]])[Cha.Sa.[[Siddhi Sthana]] 1/36]; the diseases with [[ama]] (undigested state) like acute fever, anemia, rhinitis etc. It shall not be given to patients on empty stomach and those who have low digestive capacity. [Cha.Sa.[[Siddhi Sthana]] 2/18]

===Dosage===

===Dosage===

*Maximum dose:288ml (6 pala)

*Maximum dose:288ml (6 pala)

*Medium dose :144ml (3 pala)

*Medium dose :144ml (3 pala)

===Procedure of administration===

===Procedure of administration===

====Pre therapeutic procedure (purvakarma)====

====Pre therapeutic procedure (purva karma)====

Unctuous enema is administered immediately after meals. [Su.Sa.Chikitsa Sthana 37/54]<ref name=Susruta/>  On the day of enema, the patient should take little quantity of food, ¼ part less than his regular diet quantity. The patient is advised to walk for few steps and to pass the natural urges if any. [Su.Sa.Chikitsa Sthana 37/57-58]<ref name=Susruta/> The lukewarm medicated oil or ghee is filled in the enema syringe attached with catheter. In some conditions, fine powders of Anethum sowa (shatapushpa) and rock salt are added to oil. [Su.Sa.Chikitsa Sthana 37/63]<ref name=Susruta/>  

Unctuous enema is administered immediately after meals. [Su.Sa.Chikitsa Sthana 37/54]<ref name=Susruta/>  On the day of enema, the patient should take little quantity of food, ¼ part less than his regular diet quantity. The patient is advised to walk for few steps and to pass the natural urges if any. [Su.Sa.Chikitsa Sthana 37/57-58]<ref name=Susruta/> The lukewarm medicated oil or ghee is filled in the enema syringe attached with catheter. In some conditions, fine powders of Anethum sowa (shatapushpa) and rock salt are added to oil. [Su.Sa.Chikitsa Sthana 37/63]<ref name=Susruta/>  

====Therapeutic procedure (pradhanakarma)====

====Therapeutic procedure (pradhana karma)====

   

   

The procedure of administration of enema in anuvasanabasti is same as mentioned above in context of of niruhabasti. Enema syringe is used instead of enema pot.

The procedure of administration of enema in anuvasana basti is same as mentioned above in context of of niruha basti. Enema syringe is used instead of enema pot.

   

   

====Post therapeutic procedure (pashchatkarma)====

====Post therapeutic procedure (pashchat karma)====

After administration of enema, patient is advised to lie down with well stretched body parts for 1-2 minutes(100 matra). Mild strokes over the gluteal region are given. Then both lower limbs are lifted slowly for three times to prevent the immediate evacuation of the medicine. [Cha.Sa.[[Siddhi Sthana]] 3/28] [Su.Sa.ChikitsaSthana 37/60-62]<ref name=Susruta/> Patting  is done over palms and soles followed by gentle massage over calf and painful body parts in upward direction for 1 – 2minutes (100 matra).[A.S.Sutra Sthana 28/31]<ref name=Sangraha/> The maximum retention time of medicine is about 9 hours. [Cha.Sa.[[Siddhi Sthana]] 1/46] In a study, the retention time for anuvasanabasti is reported as 3 to 6 hours in maximum (62.22%) participants.<ref name=Thanki/>

After administration of enema, patient is advised to lie down with well stretched body parts for 1-2 minutes(100 matra). Mild strokes over the gluteal region are given. Then both lower limbs are lifted slowly for three times to prevent the immediate evacuation of the medicine. [Cha.Sa.[[Siddhi Sthana]] 3/28] [Su.Sa.Chikitsa Sthana 37/60-62]<ref name=Susruta/> Patting  is done over palms and soles followed by gentle massage over calf and painful body parts in upward direction for 1 – 2minutes (100 matra).[A.S.Sutra Sthana 28/31]<ref name=Sangraha/> The maximum retention time of medicine is about 9 hours. [Cha.Sa.[[Siddhi Sthana]] 1/46] In a study, the retention time for anuvasana basti is reported as 3 to 6 hours in maximum (62.22%) participants.<ref name=Thanki/>

===Assessment of therapeutic efficacy===

===Assessment of therapeutic efficacy===

The assessment of therapeutic efficacy is done on the basis of clinical features observed in patient.

The assessment of therapeutic efficacy is done on the basis of clinical features observed in patient.

====Clinical features of optimal administration of anuvasanabasti (unctuous enema)====

====Clinical features of optimal administration of anuvasana basti (unctuous enema)====

Unobstructed expulsion of fecal matter mixed with oil, feeling of lightness in the abdomen, clarity in sense organs, improved quality of body tissues like blood etc., sleep and proper manifestation of natural urges are observed after optimal administration of basti. [Cha.Sa.[[Siddhi Sthana]] 1/44] The features are similar to that of oral intake of unctuous substances (snehapana). [A.H. Sutra Sthana 19/53]<ref name=Hridaya/> Proper movement/functioning of [[vata dosha]] and improved digestion are also observed in optimal anuvasanabasti.

Unobstructed expulsion of fecal matter mixed with oil, feeling of lightness in the abdomen, clarity in sense organs, improved quality of body tissues like blood etc., sleep and proper manifestation of natural urges are observed after optimal administration of basti. [Cha.Sa.[[Siddhi Sthana]] 1/44] The features are similar to that of oral intake of unctuous substances (snehapana). [A.H. Sutra Sthana 19/53]<ref name=Hridaya/> Proper movement/functioning of [[vata dosha]] and improved digestion are also observed in optimal anuvasana basti.

====Inadequate administration of anuvasanabasti====

====Inadequate administration of anuvasana basti====

Obstruction in the functioning of [[vata dosha]] like obstruction in passage of stool, urine and flatus; pain in lower parts of body, abdomen, arms, back and sides of chest; dryness and roughness of body are observed due to inadequate administration of anuvasanabasti. [Cha.Sa.[[Siddhi Sthana]] 1/45]

Obstruction in the functioning of [[vata dosha]] like obstruction in passage of stool, urine and flatus; pain in lower parts of body, abdomen, arms, back and sides of chest; dryness and roughness of body are observed due to inadequate administration of anuvasana basti. [Cha.Sa.[[Siddhi Sthana]] 1/45]

====Excessive administration of anuvasanabasti====

====Excessive administration of anuvasana basti====

Excessively administration of anuvasanabasti causes nausea, unconsciousness, mental fatigue, exhaustion, fainting and griping pain. [Cha.Sa.[[Siddhi Sthana]] 1/46] Anemia and discharge through nose, mouth and anus are also observed. [A.H. Sutra Sthana 19/53]<ref name=Hridaya/>

Excessively administration of anuvasana basti causes nausea, unconsciousness, mental fatigue, exhaustion, fainting and griping pain. [Cha.Sa.[[Siddhi Sthana]] 1/46] Anemia and discharge through nose, mouth and anus are also observed. [A.H. Sutra Sthana 19/53]<ref name=Hridaya/>

===Number of anuvasanabasti based on [[dosha]] vitiation===

===Number of anuvasana basti based on [[dosha]] vitiation===

   

   

General indications for administration of anuvasanabasti based on [[dosha]] vitiation is as below.   

General indications for administration of anuvasana basti based on [[dosha]] vitiation is as below.   

{| class="wikitable"

{| class="wikitable"

|+ Table 4: Number of anuvasanabasti based on [[dosha]]  

|+ Table 4: Number of anuvasana basti based on [[dosha]]  

|-

|-

! [[Dosha]] involved  !! Number of anuvasanabasti sessions

! [[Dosha]] involved  !! Number of anuvasanabasti sessions

   

   

===Precautions at the time of selection of patient and drug/medication===

===Precautions at the time of selection of patient and drug/medication===

An improper selection of drug or patient may lead to complications. The highly potent drug to a delicate person or a less potent drug to a strong person will lead to complications. A proper knowledge about the patient’s nature of gut and digestive capacity is necessary. Educate the patient properly about the whole procedure, so that complete co-operation from patient’s side can be assured.

An improper selection of drug or patient may lead to complications. The highly potent drug to a delicate person or a less potent drug to a strong person will lead to complications. A proper knowledge about the patient’s nature of gut and digestive capacity is necessary. Educate the patient properly about the whole procedure, so that complete co-operation from patient’s side can be assured.

===Precautions at the time of administration===

===Precautions at the time of administration===

Practically most complications are observed by the improper administration of enema. Enema must be administered by a well trained physician. The patient should not be too much hungry at the time of administration of decoction enema. At the same time proper digestion is also required. Special care must be taken if the patient is having associated complaints like diabetes. After basti administration never allow the patient to withhold the urge. It is better to advice the patient not to close the toilet door from inside as fainting might happen during defecation. Advice the patient to take hot water bath followed by intake of moderate amount of food immedietly after passing the bowels.       

 

Practically most complications are observed by the improper administration of enema. Enema must be administered by a well trained physician. The patient should not be too much hungry at the time of administration of decoction enema. At the same time proper digestion is also required. Special care must be taken if the patient is having associated complaints like diabetes. After basti administration never allow the patient to withhold the urge. It is better to advice the patient not to close the toilet door from inside as fainting might happen during defecation. Advice the patient to take hot water bath followed by intake of moderate amount of food immediately after passing the bowels.       

==Importance in preservation of health and prevention==

==Importance in preservation of health and prevention==

==Importance in management of disease==

==Importance in management of disease==

Basti is the best treatment for aggravated [[vatadosha]]. [Cah.Sa.[[Siddhi Sthana]] 1/39] It can effectively manage the diseases due to associated [[dosha]]s like [[pitta]] and [[kapha]].[Su.Sa.Chikitsa Sthana 35/6]<ref name=Susruta/> It is considered as the major treatment in gouty arthritis (vatarakta), [Cha.Sa.[[Chikitsa Sthana 29/88]], abdominal lumps (gulma)[Cha.Sa.[[Chikitsa Sthana]] 5/100] etc. diseases. Basti shows its generalized action on all body parts.[Cha.Sa.[[Siddhi Sthana]] 7/64] The advantage of therapeutic enema over other purification procedures is that it can be administered in the most vulnerable age groups like old aged persons and young children.[Cha.Sa.[[Siddhi Sthana]]11/36] Basti is considered as half of the entire treatment or as the complete treatment itself in a given treatment protocol.[Cha.Sa.[[Siddhi Sthana]] 1/38-39]

Basti is the best treatment for aggravated [[vata dosha]]. [Cah.Sa.[[Siddhi Sthana]] 1/39] It can effectively manage the diseases due to associated [[dosha]]s like [[pitta]] and [[kapha]].[Su.Sa.Chikitsa Sthana 35/6]<ref name=Susruta/> It is considered as the major treatment in gouty arthritis (vatarakta), [Cha.Sa.[[Chikitsa Sthana 29/88]], abdominal lumps (gulma)[Cha.Sa.[[Chikitsa Sthana]] 5/100] etc. diseases. Basti shows its generalized action on all body parts.[Cha.Sa.[[Siddhi Sthana]] 7/64] The advantage of therapeutic enema over other purification procedures is that it can be administered in the most vulnerable age groups like old aged persons and young children.[Cha.Sa.[[Siddhi Sthana]]11/36] Basti is considered as half of the entire treatment or as the complete treatment itself in a given treatment protocol.[Cha.Sa.[[Siddhi Sthana]] 1/38-39]

==Mode of action==

==Mode of action==

The rectal route of drug administration is an alternate route of drug delivery. Certain studies suggest that rectal route is more efficient than the intravenous route as it partially bypasses the first pass metabolism of liver.<ref name=KadusPA>Kadus PA, Vedpathak SM. Anuvasan Basti in escalating dose is an alternative for Snehapana before Vamana and Virechana: Trends from a pilot study. J Ayurveda Integr Med 2014;5:246-50.</ref>

The rectal route of drug administration is an alternate route of drug delivery. Certain studies suggest that rectal route is more efficient than the intravenous route as it partially bypasses the first pass metabolism of liver.<ref name=KadusPA>Kadus PA, Vedpathak SM. Anuvasan Basti in escalating dose is an alternative for Snehapana before Vamana and Virechana: Trends from a pilot study. J Ayurveda Integr Med 2014;5:246-50.</ref>

A study showed that basti medicine reaches upto ileo-caecal junction<ref name=Juneja>Juneja Yashwant M, Thakar A. B. Standardization of procedure of administration of Basti w.s.r to Kshinashukra (oligozoospermia), MD Dissertation, IPGT& RA. Jamnagar: Gujarat Ayurved University; 2010</ref> however the active principles of formulation may extend their action to systemic levels. In an experimental study, the presence of active principle of a drug used in medicated enema is found in the systemic circulation. Gallic acid, a marker compound of Triphala (a compound containing Terminalia chebula, Terminalia belerica and Emblica officinalis), is observed in serum after administration of basti with triphala. Moreover, the concentration of gallic acid in serum is more, when the basti is added with catalytic adjuvant (prakshepakadravya). The concentration and rate of absorption depends on property of constituents in basti. The adjuvants might have irritant property, which cause mild inflammation in the colon. This inflammation alters the capillary permeability, which may enhance drug absorption.<ref name=SwapnilSApharma>Swapnil SA, BK Ashok, Anup B Thakar et al. An experimental study to evaluate the pharmacokinetic aspect of Lekhana Basti (Emaciating/ Desiccating Medicated Enema).  Anc Sci Life. 2011 Oct;31(2):38-43.</ref>

A study showed that basti medicine reaches up to ileo-caecal junction<ref name=Juneja>Juneja Yashwant M, Thakar A. B. Standardization of procedure of administration of Basti w.s.r to Kshinashukra (oligozoospermia), MD Dissertation, IPGT& RA. Jamnagar: Gujarat Ayurved University; 2010</ref> however the active principles of formulation may extend their action to systemic levels. In an experimental study, the presence of active principle of a drug used in medicated enema is found in the systemic circulation. Gallic acid, a marker compound of Triphala (a compound containing Terminalia chebula, Terminalia belerica and Emblica officinalis), is observed in serum after administration of basti with triphala. Moreover, the concentration of gallic acid in serum is more, when the basti is added with catalytic adjuvant (prakshepakadravya). The concentration and rate of absorption depends on property of constituents in basti. The adjuvants might have irritant property, which cause mild inflammation in the colon. This inflammation alters the capillary permeability, which may enhance drug absorption.<ref name=SwapnilSApharma>Swapnil SA, BK Ashok, Anup B Thakar et al. An experimental study to evaluate the pharmacokinetic aspect of Lekhana Basti (Emaciating/ Desiccating Medicated Enema).  Anc Sci Life. 2011 Oct;31(2):38-43.</ref>

The efficacy of a treatment procedure highly depends upon the standard operative method. The method of administration of basti is very important. Basti administered through enema instrument (bastiyantra) by exerting uniform manual pressure shows that the contents reach upto ileo-caecal junction and more concentration of contents seen in the proximal colon. On the other hand, basti administered using enema-can which uses atmospheric pressure, also shows the same extent of reaching ileo-cecal junction, however the concentration of contents is less in proximal colon. Proximal colon has significant role in colonic motility and absorption. The interstitial cells of Cajal in sub-mucosal surface (ICC) of the circular muscle, are present only in the proximal colon. Loss of ICC correlates with loss of pace maker activity, defects in propagation, reduction in neurotransmission etc. Short chain fatty acids (SCFA) which play a major role in maintaining the colonic health are chiefly synthesized in proximal colon. Butyrate, one of the SCFA, promotes the absorption of water and electrolytes from the proximal colon. More concentration of basti medicine at proximal colon may stimulate the ICC thereby stimulating the propagation, neurotransmission etc. It may also facilitate greater absorption of water and electrolytes along with other active principles.<ref name=Manohar>Manohar SG, Ashwinikumar AR, Nitin MK. Basti: Does the equipment and method of administration matter? J Ayurveda Integr Med. 2013 Jan;4(1):9-12. doi: 10.4103/0975-9476.109543.</ref>

The efficacy of a treatment procedure highly depends upon the standard operative method. The method of administration of basti is very important. Basti administered through enema instrument (basti yantra) by exerting uniform manual pressure shows that the contents reach upto ileo-caecal junction and more concentration of contents seen in the proximal colon. On the other hand, basti administered using enema-can which uses atmospheric pressure, also shows the same extent of reaching ileo-cecal junction, however the concentration of contents is less in proximal colon. Proximal colon has significant role in colonic motility and absorption. The interstitial cells of Cajal in sub-mucosal surface (ICC) of the circular muscle, are present only in the proximal colon. Loss of ICC correlates with loss of pace maker activity, defects in propagation, reduction in neurotransmission etc. Short chain fatty acids (SCFA) which play a major role in maintaining the colonic health are chiefly synthesized in proximal colon. Butyrate, one of the SCFA, promotes the absorption of water and electrolytes from the proximal colon. More concentration of basti medicine at proximal colon may stimulate the ICC thereby stimulating the propagation, neurotransmission etc. It may also facilitate greater absorption of water and electrolytes along with other active principles.<ref name=Manohar>Manohar SG, Ashwinikumar AR, Nitin MK. Basti: Does the equipment and method of administration matter? J Ayurveda Integr Med. 2013 Jan;4(1):9-12. doi: 10.4103/0975-9476.109543.</ref>

===Therapeutic efficacy of basti===

===Therapeutic efficacy of basti===

Enema intended for removal of morbidity (lekhanabasti) is found effective in hyperlipidemia by reducing the serum cholesterol, serum LDL, serum apolipoprotein B. Significant reduction in weight, body mass index (BMI), body fat percentage and skin fold thickness were also reported.<ref name=Swapnilhyper>Swapnil SA, Anup B Thakar et al. Assessment of Lekhana Basti in the management of hyperlipidemia. Ayu. 2013 Oct;34(4):339-45. doi: 10.4103/0974-8520.127683.</ref> The hypersensitivity or hyper responsiveness of hypothalamo-pituitary adrenal (HPA) axis is the main reason for endocrine malfunction in human obesity. Serum cortisol levels are found to be decreased in obese patients after basti treatment. This suggests normalizing of HPA axis through basti. Medicated enema shows immuno-modulatory effect by regulating pro-inflammatory cytokines, immunoglobulins and functional properties of T-cells.<ref name=Urmila>Urmila T, Shubhada C et al. Immunological & metabolic responses to a therapeutic course of Basti in obesity. Indian J Med Res. 2015 Jul;142(1):53-62. doi: 10.4103/0971-5916.162099.</ref>

Enema intended for removal of morbidity (lekhana basti) is found effective in hyperlipidemia by reducing the serum cholesterol, serum LDL, serum apolipoprotein B. Significant reduction in weight, body mass index (BMI), body fat percentage and skin fold thickness were also reported.<ref name=Swapnilhyper>Swapnil SA, Anup B Thakar et al. Assessment of Lekhana Basti in the management of hyperlipidemia. Ayu. 2013 Oct;34(4):339-45. doi: 10.4103/0974-8520.127683.</ref> The hypersensitivity or hyper responsiveness of hypothalamo-pituitary adrenal (HPA) axis is the main reason for endocrine malfunction in human obesity. Serum cortisol levels are found to be decreased in obese patients after basti treatment. This suggests normalizing of HPA axis through basti. Medicated enema shows immuno-modulatory effect by regulating pro-inflammatory cytokines, immunoglobulins and functional properties of T-cells.<ref name=Urmila>Urmila T, Shubhada C et al. Immunological & metabolic responses to a therapeutic course of Basti in obesity. Indian J Med Res. 2015 Jul;142(1):53-62. doi: 10.4103/0971-5916.162099.</ref>

A study reported that low dose medicated oil enema (matrabasti) is effective in reducing the signs and symptoms of osteoarthritis. There was significant reduction in pain and swelling in joints and reduction in pain during joint movements.<ref name=Mayuri>Mayuri RS, Charmi SM et al. A Clinical study of Matra Vasti and an ayurvedic indigenous compound drug in the management of Sandhigatavata (Osteoarthritis). Ayu. 2010 Apr;31(2):210-7. doi: 10.4103/0974-8520.72399.</ref>  Erandamuladiyapanabasti is found effective in reducing the pain, stiffness and tenderness related with lumbar spondylosis and improving the quality of life.<ref name=Damayanthie>Damayanthie Fernando, Anup B Thakar, VD Shukla. Clinical efficacy of Eranda Muladi Yapana Basti in the management of Kati Graha (Lumbar spondylosis). Ayu. 2013 Jan;34(1):36-41. doi: 10.4103/0974-8520.115444.</ref>   

A study reported that low dose medicated oil enema (matra basti) is effective in reducing the signs and symptoms of osteoarthritis. There was significant reduction in pain and swelling in joints and reduction in pain during joint movements.<ref name=Mayuri>Mayuri RS, Charmi SM et al. A Clinical study of Matra Vasti and an ayurvedic indigenous compound drug in the management of Sandhigatavata (Osteoarthritis). Ayu. 2010 Apr;31(2):210-7. doi: 10.4103/0974-8520.72399.</ref>  Erandamuladiyapanabasti is found effective in reducing the pain, stiffness and tenderness related with lumbar spondylosis and improving the quality of life.<ref name=Damayanthie>Damayanthie Fernando, Anup B Thakar, VD Shukla. Clinical efficacy of Eranda Muladi Yapana Basti in the management of Kati Graha (Lumbar spondylosis). Ayu. 2013 Jan;34(1):36-41. doi: 10.4103/0974-8520.115444.</ref>   

Panchamooladikaalabasti is reported to be effective in reducing the symptoms of rheumatoid arthritis (amavata) especially  pain, stiffness, swelling and tenderness in the joints. It is also found effective in reducing the generalized symptoms like heaviness of body, fatigue, feverishness and anorexia. Basti acts over the prime seat of [[vata dosha]] i.e. large intestine (pakvashaya) and controls it. The alkali present in the ksharabasti improves digestion and removes the accumulated toxins (ama).<ref name=BariaR>Baria R, Joshi N, Pandya D. Clinical efficacy of Panchamuladi Kaala Basti (enema) in the management of Amavata (Rheumatoid Arthritis). Ayu. 2011 Jan;32(1):90-4. doi: 10.4103/0974-8520.85737. PMID: 22131764; PMCID: PMC3215425.</ref>  

Panchamooladikaala basti is reported to be effective in reducing the symptoms of rheumatoid arthritis (amavata) especially  pain, stiffness, swelling and tenderness in the joints. It is also found effective in reducing the generalized symptoms like heaviness of body, fatigue, feverishness and anorexia. Basti acts over the prime seat of [[vata dosha]] i.e. large intestine (pakvashaya) and controls it. The alkali present in the kshara basti improves digestion and removes the accumulated toxins (ama).<ref name=BariaR>Baria R, Joshi N, Pandya D. Clinical efficacy of Panchamuladi Kaala Basti (enema) in the management of Amavata (Rheumatoid Arthritis). Ayu. 2011 Jan;32(1):90-4. doi: 10.4103/0974-8520.85737. PMID: 22131764; PMCID: PMC3215425.</ref>  

Unctuous enema in minimum dose (matrabasti) is found effective in 12 cases of anovulation. Ovulation occurred in the maximum number of participants (63.64%) and increased follicular size is also reported after matrabasti. Basti shows its action on Enteric Nervous System (ENS). The endogenous opioids especially beta endorphins may get stimulated. This may affect the GnRH secretion and there by regularize hypothalamo pituitary ovarian (HPO) axis. HPO axis regulates the ovarian cycle and ovulation. By the action over ENS, basti may also stimulate CNS and thereby stimulates pituitary. This results in the secretion of FSH and LH which plays an important role in ovulation.<ref>Donga KR, Donga SB, Dei LP. Role of Nasya and Matra Basti with Narayana Taila on anovulatory factor. Ayu. 2013 Jan;34(1):81-5. doi: 10.4103/0974-8520.115453. PMID: 24049410; PMCID: PMC3764886.</ref>  More studies are needed to study the effect of basti on specific pathways.

Unctuous enema in minimum dose (matra basti) is found effective in 12 cases of anovulation. Ovulation occurred in the maximum number of participants (63.64%) and increased follicular size is also reported after matra basti. Basti shows its action on Enteric Nervous System (ENS). The endogenous opioids especially beta endorphins may get stimulated. This may affect the GnRH secretion and there by regularize hypothalamo pituitary ovarian (HPO) axis. HPO axis regulates the ovarian cycle and ovulation. By the action over ENS, basti may also stimulate CNS and thereby stimulates pituitary. This results in the secretion of FSH and LH which plays an important role in ovulation.<ref>Donga KR, Donga SB, Dei LP. Role of Nasya and Matra Basti with Narayana Taila on anovulatory factor. Ayu. 2013 Jan;34(1):81-5. doi: 10.4103/0974-8520.115453. PMID: 24049410; PMCID: PMC3764886.</ref>  More studies are needed to study the effect of basti on specific pathways.

==List of theses done==

==List of theses done==

#Savjani Rekha T (2001): A clinical study on the management of sthaulya by panchatikta and lekhanabasti, Department of Kayachikitsa, IPGT&RA  Jamnagar

 

#Savjani Rekha T (2001): A clinical study on the management of sthaulya by panchatikta and lekhana basti, Department of Kayachikitsa, IPGT&RA  Jamnagar

#Bhatted Santosh (2002): A comparative study of the role of vajeekarana drugs administered orally and by basti in the management of klaibya with reference to erectile dysfunction. Department of Kayachikitsa, IPGT&RA  Jamnagar

#Bhatted Santosh (2002): A comparative study of the role of vajeekarana drugs administered orally and by basti in the management of klaibya with reference to erectile dysfunction. Department of Kayachikitsa, IPGT&RA  Jamnagar

#Mangalasseri Prakash (2002): A clinical study of shukragatavata w.s.r to premature ejaculation & its management with Akarakarbhati yoga yapanabasti, Department of Kayachikitsa, IPGT&RA  Jamnagar

#Mangalasseri Prakash (2002): A clinical study of shukragatavata w.s.r to premature ejaculation & its management with Akarakarbhati yoga yapanabasti, Department of Kayachikitsa, IPGT&RA  Jamnagar