Changes

== Introduction ==

== Introduction ==

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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 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.

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''.

== Sanskrit text, Transliteration and English Translation ==

== Sanskrit text, Transliteration and English Translation ==

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Now we shall expound the chapter "Netrabastivyapat Siddhi" (Management of complications due to enema nozzle). Thus said Lord Atreya. henceforth listen to the description of defects in enema nozzles, their complications if used for ''basti'' and their management. [1-3]

Now we shall expound the chapter "Netrabastivyapat Siddhi" (Management of complications due to enema nozzle). Thus said Lord Atreya. henceforth listen to the description of defects in enema nozzles, their complications if used for ''[[basti]]'' and their management. [1-3]

=== Eight defects of nozzle and its harmful effect ===

=== Eight defects of nozzle and its harmful effect ===

#''shithilabandhanam'' (having loosely tied/inappropriate fastening of ''basti putaka'' with ''netra'' ),  

#''shithilabandhanam'' (having loosely tied/inappropriate fastening of ''basti putaka'' with ''netra'' ),  

#''parshvachhidram'' (having hole – laterally on one side of ''netra'') and  

#''parshvachhidram'' (having hole – laterally on one side of ''netra'') and  

#''vakram'' (having bents or curves) are to be avoided. If these sort of nozzles are used while ''basti'' procedure, it results in corresponding eight doshas.  These ''doshas'' (harmful effects) in the body as tabulated below:  

#''vakram'' (having bents or curves) are to be avoided. If these sort of nozzles are used while ''[[basti]]'' procedure, it results in corresponding eight doshas.  These ''doshas'' (harmful effects) in the body as tabulated below:  

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[4-5]

[4-5]

=== ''Basti putaka'' (defects of bladder/enema holding bag) ===

=== ''[[Basti]] putaka'' (defects of bladder/enema holding bag) ===

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[6-7]

[6-7]

=== Errors by ''basti'' administrator ===

=== Errors by ''[[basti]]'' administrator ===

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Defects related to ''pranetru'' (administrator or attendant who applies procedure) are ''savata'' (''basti'' filled with air), ''atidruta'' (very fast), ''utkshipta'' (raised/upwards), ''tiryak'' (oblique/sideways/transverse), ''ullupta'' (taken out), ''kampita'' (trembling/shaking), ''ati'' (excess/too far), ''bahyaga'' (outside/diverging from), ''mandavega'' (slow) and ''ativega'' (speedy) administration of ''basti'' and they cause harm to the body. [8]

Defects related to ''pranetru'' (administrator or attendant who applies procedure) are ''savata'' (''basti'' filled with air), ''atidruta'' (very fast), ''utkshipta'' (raised/upwards), ''tiryak'' (oblique/sideways/transverse), ''ullupta'' (taken out), ''kampita'' (trembling/shaking), ''ati'' (excess/too far), ''bahyaga'' (outside/diverging from), ''mandavega'' (slow) and ''ativega'' (speedy) administration of ''[[basti]]'' and they cause harm to the body. [8]

=== Effect of ''savata dosha'' (air entry during ''basti'' administration) ===

=== Effect of ''savata dosha'' (air entry during ''[[basti]]'' administration) ===

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Administration of medication from an improperly filled and/or tied ''basti'' and complete emptying of ''basti'' will cause entry of air into the rectum. ''Vata dosha'' gets vitiated inducing ''shoola'' (sharp, acute pain) and ''toda'' (pricking pain). ''Abhyanga'' (inunction), ''sveda'' (fomentation) to ''guda'' and consumption of diet comprising of ''vata dosha'' pacifying items are to be done as management.[9-10]

Administration of medication from an improperly filled and/or tied ''basti'' and complete emptying of ''basti'' will cause entry of air into the rectum. ''[[Vata dosha]]'' gets vitiated inducing ''shoola'' (sharp, acute pain) and ''toda'' (pricking pain). ''Abhyanga'' (inunction), ''sveda'' (fomentation) to ''guda'' and consumption of diet comprising of ''[[vata dosha]]'' pacifying items are to be done as management.[9-10]

=== ''Atidruta'' and ''utkshipta dosha'' (fast insertion and withdrawal) ===

=== ''Atidruta'' and ''utkshipta dosha'' (fast insertion and withdrawal) ===

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In case of very fast insertion and withdrawal of ''netra'' and introduction of ''netra'' in upward direction, ''arti'' (pain) occurs in waist, rectum and calf along with thighs. Consumption of diet comprising of ''vata dosha'' pacifying items, unction, fomentation and ''basti'' are to be advised as management.[10-11]

In case of very fast insertion and withdrawal of ''netra'' and introduction of ''netra'' in upward direction, ''arti'' (pain) occurs in waist, rectum and calf along with thighs. Consumption of diet comprising of ''[[vata dosha]]'' pacifying items, unction, fomentation and ''[[basti]]'' are to be advised as management.[10-11]

=== ''Tiryak dosha'' (improper direction of insertion) ===

=== ''Tiryak dosha'' (improper direction of insertion) ===

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If the squeezing of ''basti'' is interrupted in between (and re-done), that will cause obstruction to ''vata dosha'' and in turn vitiates it resulting in pain in chest and head along with weakness of thighs. Management should be done by administering ''basti'' comprising of ''dashamoola, shyama'' and ''gomutra''.

If the squeezing of ''basti'' is interrupted in between (and re-done), that will cause obstruction to ''[[vata dosha]]'' and in turn vitiates it resulting in pain in chest and head along with weakness of thighs. Management should be done by administering ''[[basti]]'' comprising of ''dashamoola, shyama'' and ''gomutra''.

In case of trembling of hands while introduction of ''netra'', burning sensation, ''davathuḥ'' (pain heat/inflammation) and swelling occur in ''guda''. ''Seka'' (pouring) and ''basti'' has to be dome with medicines having astringent and sweet taste and in cold state. [13-15]

In case of trembling of hands while introduction of ''netra'', burning sensation, ''davathuḥ'' (pain heat/inflammation) and swelling occur in ''guda''. ''Seka'' (pouring) and ''[[basti]]'' has to be dome with medicines having astringent and sweet taste and in cold state. [13-15]

=== ''Ati dosha'' (excessive deep insertion) ===

=== ''Ati dosha'' (excessive deep insertion) ===

In case of first one (slow administration), medicine doesn’t reach ''pakvashaya'' and is ineffective. Administration diverging from ''guda'' (second one), medicine is expelled out faster. In both cases, the ''snehabasti'' has to be done.  

In case of first one (slow administration), medicine doesn’t reach ''pakvashaya'' and is ineffective. Administration diverging from ''guda'' (second one), medicine is expelled out faster. In both cases, the ''snehabasti'' has to be done.  

In case of speedy administration, either medicine stays in ''koshtha'' or ascends up to ''gala'' (throat). There, ''basti'', ''vireka'' (purgation) and tight gripping of neck are to be done. [17-18]

In case of speedy administration, either medicine stays in ''koshtha'' or ascends up to ''gala'' (throat). There, ''[[basti]]'', ''vireka'' (purgation) and tight gripping of neck are to be done. [17-18]

=== Summary ===

=== Summary ===

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An intelligent physician who learns the ''dosha'' of ''netra, basti'' and ''praneta'' properly along with management shall practice ''basti''. [19]

An intelligent physician who learns the ''dosha'' of ''netra, basti'' and ''praneta'' properly along with management shall practice ''[[basti]]''. [19]

== Tattva Vimarsha (Fundamental Principles) ==

== Tattva Vimarsha (Fundamental Principles) ==

*The ''basti netra'' (nozzle), ''basti putaka'' (bladder/enema pot) should be non-defective to avoid complications of ''basti'' therapy.  

*The ''[[basti]] netra'' (nozzle), ''[[basti]] putaka'' (bladder/enema pot) should be non-defective to avoid complications of ''[[basti]]'' therapy.  

*''Basti'' therapy should be administered with utmost care by well trained, skilled and experienced ''praneta'' (administrator). If this is not followed, complications can occur in ''basti'' therapy.

*''[[Basti]]'' therapy should be administered with utmost care by well trained, skilled and experienced ''praneta'' (administrator). If this is not followed, complications can occur in ''[[basti]]'' therapy.

== Vidhi Vimarsha (Applied Inferences ) ==

== Vidhi Vimarsha (Applied Inferences ) ==

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 ===

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). [Cha. Sa.[[Siddhi sthana]] 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). [Cha. Sa.[[Siddhi sthana]] 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.

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>Sushruta. Chikitsa Sthana, Cha.35 Netrabastipramanapravibhaga Chikitsitam Adhyaya,Verse 4-5 In: Jadavaji Trikamji Aacharya, Editor. Sushruta Samhita. ?? ed. Varanasi: Krishnadas Ayurveda series 51, Krishnadas Academy; 1980. p. 515.</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>Sushruta. Chikitsa Sthana, Cha.35 Netrabastipramanapravibhaga Chikitsitam Adhyaya,Verse 4-5 In: Jadavaji Trikamji Aacharya, Editor. Sushruta Samhita. ?? ed. Varanasi: Krishnadas Ayurveda series 51, Krishnadas Academy; 1980. p. 515.</ref>

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

=== 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>Charak. Siddhi Sthana, Cha.3  Bastisutitam Siddhi Adhyaya. In: Jadavaji Trikamji Aacharya, Editors. Charak Samhita. 1st ed. Varanasi: Krishnadas Academy;2000. p.1-24.</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>Charak. Siddhi Sthana, Cha.3  Bastisutitam Siddhi Adhyaya. In: Jadavaji Trikamji Aacharya, Editors. Charak Samhita. 1st ed. Varanasi: Krishnadas Academy;2000. p.1-24.</ref>

=== 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.  Charak 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). [Cha.Sa. [[Siddhi Sthana]] 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). [Cha.Sa. [[Siddhi Sthana]] 3/19, 20]

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 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)

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)

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 ''teekshana [[nasya]]'' 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. (Verse 17-18)

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)

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)

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)